NSAID adherence

[robynstuart]

Problem

Current adherence logic treats all treatments uniformly: non-adherent individuals immediately stop treatment and progress to the next option in the cascade. This doesn't reflect the reality of NSAIDs and TXA, which are use-at-will medications taken during menstruation, not continuous daily treatments like the Pill or hIUD.

Options considered for NSAIDs/TXA non-adherence

1. Skip adherence checks entirely - No adherence requirement; only non-responders progress to next treatment

2. Track adherence but don't stop treatment - Monitor adherence for analysis but allow continued use regardless

3. Stop treatment but allow re-trying - Non-adherent women stop but can be offered the same treatment again without progressing

4. Natural discontinuation over time - Probabilistic model where non-adherent women gradually stop using over time rather than abrupt cessation

Cascade progression logic

Two approaches for when women advance to the next treatment:

A. Only non-responders progress - Women only advance if treatment is biologically ineffective; non-adherent women don't progress

B. Both non-responders and non-adherent progress - Current behavior where both reasons advance women through cascade

Implemented solution

• NSAIDs/TXA: Natural discontinuation (option 4) with per-timestep probability of stopping when non-adherent
• Pill/hIUD: Immediate cessation (current behavior)
• Cascade progression: Both non-responders and non-adherent advance (option B)

Discussion

Open to feedback on whether this approach adequately captures treatment adherence patterns or if adjustments are needed based on evidence.

[nnoori-IDM]

Thanks Robyn. I think natural discontinuation for NSAID/TXA makes sense. It reflects the realistic drift-away behavior over time.

I also think allowing both non-responders and non-adherent users to progress through the cascade aligns with a patient-centered care approach. Based on the UW Start team's lit review, ease of dosing can play a role in treatment choice (TXA and NSAIDs require frequent and longer treatment durations which limit their usability). As a result, some individuals may be non-adherent—not because the option is ineffective, but because it does not fit well with their preferences or daily life.