Temporal proximity to counseling is associated with longitudinal bedaquiline and antiretroviral therapy adherence in multidrug-resistant tuberculosis and HIV treatment

Medication adherence is a persistent challenge in the treatment of multidrug-resistant tuberculosis (MDR-TB) and HIV. Routine counseling notes are an underutilized source of information on patient adherence context.

We applied natural language processing (NLP) to routine counseling notes from a randomized controlled trial of MDR-TB/HIV treatment in South Africa. Topics were derived using topic modeling; notes were semantically matched to topics and clustered using K-means. We fitted linear mixed-effects (LME) regression models with participant-level random intercepts and five-fold cross-validation to model adherence to bedaquiline (BDQ) and antiretroviral therapy (ART), measured using cellular-enabled electronic dose monitor (EDM). Cosine similarity scores, cluster assignments, and temporal proximity to counseling sessions were included as covariates. Model fit was assessed using mean absolute error (MAE) and root mean square error (RMSE).