Medication Event Reminder Monitor [MERM] Boxes

The Medication Event Reminder Monitor (MERM) is a digital pillbox that has been designed to monitor Multidrug-resistant TB (MDR-TB) treatment in resource-constrained settings, using relatively affordable technology and drugs provided by the National TB Elimination Programme (NTEP).

Figure: MERM Container for Shorter/ Longer Oral MDR-TB Regimen; Source: Guidelines for PMDT in India, 2021, p143.

• This system is specifically designed to be used with multiple blister-packaged TB medications in Drug-resistant TB (DR-TB) regimens.
• The MERM provides programmable visual and audible reminders of daily dosing and monthly refill by capturing data on pillbox opening as a proxy for dose ingestion.
• It transmits these data to a server so that Healthcare Providers (HCPs)/ treatment supporters can remotely visualize patients’ dosing histories to support enhanced adherence counselling.
• In addition, by providing near real-time adherence data, the MERM can facilitate the identification of high-risk patients and prompt early intervention by HCPs to reduce non-adherence.
• When compared to facility-based Directly Observed Therapy (DOT) in which patients travel to clinics to be observed taking their medications, monitoring using the MERM may also reduce the required frequency of patient visits to TB clinics.

Resources

• Guidelines for Programmatic Management of Drug-resistant Tuberculosis in India, March 2021.
• Standard Operating Procedure Manual - Procurement & Supply Chain Management, MOHFW, GOI.

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