Implementation, feasibility, and acceptability of 99DOTS-based supervision of treatment for drug-susceptible TB in Uganda

Abstract

99DOTS is a low-cost digital adherence technology that allows people with tuberculosis (TB) to self-report treatment adherence. There are limited data on its implementation, feasibility, and acceptability from sub-Saharan Africa. We conducted a longitudinal analysis and cross-sectional surveys nested within a stepped-wedge randomized trial at 18 health facilities in Uganda between December 2018 and January 2020. The longitudinal analysis assessed implementation of key components of a 99DOTS-based intervention, including self-reporting of TB medication adherence via toll-free phone calls, automated text message reminders and support actions by health workers monitoring adherence data. Cross-sectional surveys administered to a subset of people with TB and health workers assessed 99DOTS feasibility and acceptability. Composite scores for capability, opportunity, and motivation to use 99DOTS were estimated as mean Likert scale responses. Among 462 people with pulmonary TB enrolled on 99DOTS, median adherence was 58.4% (inter-quartile range [IQR] 38.7-75.6) as confirmed by self-reporting dosing via phone calls and 99.4% (IQR 96.4-100) when also including doses confirmed by health workers. Phone call-confirmed adherence declined over the treatment period and was lower among people with HIV (median 50.6% vs. 63.7%, p<0.001). People with TB received SMS dosing reminders on 90.5% of treatment days. Health worker support actions were documented for 261/409 (63.8%) people with TB who missed >3 consecutive doses. Surveys were completed by 83 people with TB and 22 health workers. Composite scores for capability, opportunity, and motivation were high; among people with TB, composite scores did not differ by gender or HIV status. Barriers to using 99DOTS included technical issues (phone access, charging, and network connection) and concerns regarding disclosure. 99DOTS was feasible to implement and highly acceptable to people with TB and their health workers. National TB Programs should offer 99DOTS as an option for TB treatment supervision.

Implementation outcomes of tuberculosis digital adherence technologies: a scoping review using the RE-AIM framework

“…Problems with automated SMS delivery or receipt were also described. Two articles reported on technology measures with the 99DOTS intervention [14,70].…”

“…[INSERT FIGURE 3] The plot summarises the percentage of DAT engagement over total dose days for 54 observations from 41 studies included in this analysis. Studies included for SMS interventions [16,24,26,27]; Phone [28,29]; 99DOTS [15,[30][31][32]; Pillboxes [10,15,16,20,[33][34][35][36][37][38][39][40]; VST [15,[41][42][43][44][45][46][47][48][49][50][51][52][53][54][55][56][57][58][59][60]; and Ingestion Sensors [61]. For Wei (2024) and Liu (2015) pillbox openings were supplemented with pill counts so not all adherence was measured based on engagement with the digital adherence technology [10,…”

Efektifitas Telemedicine Pada Pengobatan Tuberculosis Pada Negara Berpenghasilan Menengah ke Bawah: Systematic Review

“…Beberapa keuntungan menggunakan intervensi mobile seperti kenyamanan, kemudahan, efisiensi biaya, skala luas, personalisasi, dan kemampuan untuk mengirim pesan sensitif waktu dengan perangkat. [24] M-Health dapat mempengaruhi pasien yang cenderung kurang terlibat dengan layanan kesehatan konvensional. [25] Pemerintah dapat mendapat manfaat dari peningkatan dukungan untuk manajemen pasien dan peningkatan komunikasi langsung di daerah pedesaan.…”