What is it about?
Adherence counselors routinely document the concerns and experiences that participants discuss during treatment, but these notes are rarely analyzed systematically. We used natural language processing, a form of AI that organizes text by meaning, to analyze 327 adherence-counseling notes from 76 adults receiving treatment for multidrug-resistant tuberculosis (MDR-TB) and HIV in South Africa. We also used regression to model adherence to bedaquiline (BDQ) and antiretroviral therapy (ART), measured using cellular-enabled electronic dose monitoring (EDM). The analysis grouped the notes into six themes: substance use, logistical barriers, limited social support, side-effect management, financial stability, and financial insecurity with low social support. These themes were not independently associated with adherence to BDQ or ART as measured using EDM. Compared with the first seven days after counseling, BDQ and ART adherence were lower during the period between sessions; ART adherence was also lower during the week preceding the next session. These exploratory findings suggest that the timing and continuity of adherence support may improve adherence among patients with MDR-TB and HIV. Our approach also provides a framework for using routinely collected counseling notes to study treatment experiences and adherence at scale.
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This page is a summary of: Temporal proximity to counseling is associated with longitudinal bedaquiline and antiretroviral therapy adherence in multidrug-resistant tuberculosis and HIV treatment, PLOS One, October 2026, PLOS,
DOI: 10.1371/journal.pone.0355696.
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