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Improving Tuberculosis Treatment Adherence Support: The Case for Targeted Behavioral Interventions

Author

Listed:
  • Justin J. Boutilier

    (Department of Industrial and Systems Engineering, University of Wisconsin-Madison, Madison, Wisconsin 583706)

  • Jónas Oddur Jónasson

    (Operations Management, Sloan School of Management, Massachusetts Institute of Technology, Cambridge, Massachusetts 02142)

  • Erez Yoeli

    (Sloan School of Management, Massachusetts Institute of Technology, Cambridge, Massachusetts 02142)

Abstract

Problem definition : Lack of patient adherence to treatment protocols is a main barrier to reducing the global disease burden of tuberculosis (TB). We study the operational design of a treatment adherence support (TAS) platform that requires patients to verify their treatment adherence on a daily basis. Academic/practical relevance : Experimental results on the effectiveness of TAS programs have been mixed; and rigorous research is needed on how to structure these motivational programs, particularly in resource-limited settings. Our analysis establishes that patient engagement can be increased by personal sponsor outreach and that patient behavior data can be used to identify at-risk patients for targeted outreach. Methodology : We partner with a TB TAS provider and use data from a completed randomized controlled trial. We use administrative variation in the timing of peer sponsor outreach to evaluate the impact of personal messages on subsequent patient verification behavior. We then develop a rolling-horizon machine learning (ML) framework to generate dynamic risk predictions for patients enrolled on the platform. Results : We find that, on average, sponsor outreach to patients increases the odds ratio of next-day treatment adherence verification by 35%. Furthermore, patients’ prior verification behavior can be used to accurately predict short-term (treatment adherence verification) and long-term (successful treatment completion) outcomes. These results allow the provider to target and implement behavioral interventions to at-risk patients. Managerial implications : Our results indicate that, compared with a benchmark policy, the TAS platform could reach the same number of at-risk patients with 6%–40% less capacity, or reach 2%–20% more at-risk patients with the same capacity, by using various ML-based prioritization policies that leverage patient engagement data. Personal sponsor outreach to all patients is likely to be very costly, so targeted TAS may substantially improve the cost-effectiveness of TAS programs.

Suggested Citation

  • Justin J. Boutilier & Jónas Oddur Jónasson & Erez Yoeli, 2022. "Improving Tuberculosis Treatment Adherence Support: The Case for Targeted Behavioral Interventions," Manufacturing & Service Operations Management, INFORMS, vol. 24(6), pages 2925-2943, November.
    • Handle: RePEc:inm:ormsom:v:24:y:2022:i:6:p:2925-2943
    DOI: 10.1287/msom.2021.1046
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    1. Francesco Bartolucci & Valentina Nigro, 2010. "A Dynamic Model for Binary Panel Data With Unobserved Heterogeneity Admitting a √n-Consistent Conditional Estimator," Econometrica, Econometric Society, vol. 78(2), pages 719-733, March.
    2. Ngai-Hang Z Leung & Ana Chen & Prashant Yadav & Jérémie Gallien, 2016. "The Impact of Inventory Management on Stock-Outs of Essential Drugs in Sub-Saharan Africa: Secondary Analysis of a Field Experiment in Zambia," PLOS ONE, Public Library of Science, vol. 11(5), pages 1-18, May.
    3. Can Zhang & Atalay Atasu & Turgay Ayer & L. Beril Toktay, 2020. "Truthful Mechanisms for Medical Surplus Product Allocation," Manufacturing & Service Operations Management, INFORMS, vol. 22(4), pages 735-753, July.
    4. Aswani, Anil & Kaminsky, Philip & Mintz, Yonatan & Flowers, Elena & Fukuoka, Yoshimi, 2019. "Behavioral modeling in weight loss interventions," European Journal of Operational Research, Elsevier, vol. 272(3), pages 1058-1072.
    5. Jónas Oddur Jónasson & Sarang Deo & Jérémie Gallien, 2017. "Improving HIV Early Infant Diagnosis Supply Chains in Sub-Saharan Africa: Models and Application to Mozambique," Operations Research, INFORMS, vol. 65(6), pages 1479-1493, December.
    6. Salla A Munro & Simon A Lewin & Helen J Smith & Mark E Engel & Atle Fretheim & Jimmy Volmink, 2007. "Patient Adherence to Tuberculosis Treatment: A Systematic Review of Qualitative Research," PLOS Medicine, Public Library of Science, vol. 4(7), pages 1-16, July.
    7. Retsef Levi & Georgia Perakis & Gonzalo Romero, 2017. "On the Effectiveness of Uniform Subsidies in Increasing Market Consumption," Management Science, INFORMS, vol. 63(1), pages 40-57, January.
    8. Hessam Bavafa & Lorin M. Hitt & Christian Terwiesch, 2018. "The Impact of E-Visits on Visit Frequencies and Patient Health: Evidence from Primary Care," Management Science, INFORMS, vol. 64(12), pages 5461-5480, December.
    9. Salla A Munro, 2007. "Patient Adherence to Tuberculosis Treatment: A Systematic Review of Qualitative Research," Working Papers id:1107, eSocialSciences.
    10. Hoda Parvin & Shervin Beygi & Jonathan E. Helm & Peter S. Larson & Mark P. Van Oyen, 2018. "Distribution of Medication Considering Information, Transshipment, and Clustering: Malaria in Malawi," Production and Operations Management, Production and Operations Management Society, vol. 27(4), pages 774-797, April.
    11. Karthik V. Natarajan & Jayashankar M. Swaminathan, 2014. "Inventory Management in Humanitarian Operations: Impact of Amount, Schedule, and Uncertainty in Funding," Manufacturing & Service Operations Management, INFORMS, vol. 16(4), pages 595-603, October.
    12. Gemma Berenguer & Pinar Keskinocak & J. George Shanthikumar & Jayashankar M. Swaminathan & Luk Van Wassenhove & Jérémie Gallien & Iva Rashkova & Rifat Atun & Prashant Yadav, 2017. "National Drug Stockout Risks and the Global Fund Disbursement Process for Procurement," Production and Operations Management, Production and Operations Management Society, vol. 26(6), pages 997-1014, June.
    13. Sarang Deo & Milind Sohoni, 2015. "Optimal Decentralization of Early Infant Diagnosis of HIV in Resource-Limited Settings," Manufacturing & Service Operations Management, INFORMS, vol. 17(2), pages 191-207, May.
    14. Terry A. Taylor & Wenqiang Xiao, 2014. "Subsidizing the Distribution Channel: Donor Funding to Improve the Availability of Malaria Drugs," Management Science, INFORMS, vol. 60(10), pages 2461-2477, October.
    15. Hovell, M.F. & Sipan, C.L. & Blumberg, E.J. & Hofstetter, C.R. & Slymen, D. & Friedman, L. & Moser, K. & Kelley, N.J. & Vera, A.Y., 2003. "Increasing Latino Adolescents' Adherence to Treatment for Latent Tuberculosis Infection: A Controlled Trial," American Journal of Public Health, American Public Health Association, vol. 93(11), pages 1871-1877.
    16. Gary Chamberlain, 1980. "Analysis of Covariance with Qualitative Data," The Review of Economic Studies, Review of Economic Studies Ltd, vol. 47(1), pages 225-238.
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    Cited by:

    1. Suparerk Lekwijit & Christian Terwiesch & David A. Asch & Kevin G. Volpp, 2024. "Evaluating the Efficacy of Connected Healthcare: An Empirical Examination of Patient Engagement Approaches and Their Impact on Readmission," Management Science, INFORMS, vol. 70(6), pages 3417-3446, June.
    2. Emma Gibson & Sarang Deo & Jónas Oddur Jónasson & Mphatso Kachule & Kara Palamountain, 2023. "Redesigning Sample Transportation in Malawi Through Improved Data Sharing and Daily Route Optimization," Manufacturing & Service Operations Management, INFORMS, vol. 25(4), pages 1209-1226, July.
    3. Jackie Baek & Justin J. Boutilier & Vivek F. Farias & Jónas Oddur Jónasson & Erez Yoeli, 2025. "Policy Optimization for Personalized Interventions in Behavioral Health," Manufacturing & Service Operations Management, INFORMS, vol. 27(3), pages 770-788, May.
    4. Hamsa Bastani & Osbert Bastani & Bryce McLaughlin, 2025. "Beating the Winner's Curse via Inference-Aware Policy Optimization," Papers 2510.18161, arXiv.org, revised Feb 2026.

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