Accepted for/Published in: JMIR Formative Research
Date Submitted: Feb 1, 2023
Open Peer Review Period: Feb 1, 2023 - Mar 29, 2023
Date Accepted: Oct 14, 2023
(closed for review but you can still tweet)
Patients’ Experiences with an Enhanced Video Directly Observed Treatment System During Tuberculosis Treatment in Kampala, Uganda: A Qualitative Exit Study
ABSTRACT
Background:
Nonadherence to treatment remains a barrier to tuberculosis (TB) control. The standard Directly observed therapy (DOT) for monitoring medication to combat adherence has several structural and systemic challenges that limit its implementation. Digital adherence technologies such as Video DOT (VDOT) have recently emerged as alternative ways to monitor patients remotely. But few studies have evaluated the use of VDOT and the experiences of patients in Africa.
Objective:
The aim of this study was to assess the patients’ experiences that affected acceptability, usefulness and ease of use of VDOT during monitoring of TB treatment.
Methods:
We conducted a cross-sectional qualitative study using in-depth interviews with 30 participants at the exit of a randomized control trial of VDOT conducted in Kampala, Uganda, from July 2019 to December 2021. The study included adult patients who had completed treatment for drug-susceptible TB and used VDOT. Participants were purposively selected based on sex, level of adherence, and HIV status. Interviews were audio-recorded, transcribed, and analyzed using the Dedoose software. Themes for the analysis were adopted and modified based on the Technology Acceptance Model for Resource-Limited Settings (TAM-RLS) constructs to assess the experienced ease of use and usefulness, facilitators, and barriers to acceptability of VDOT use. Perceived usefulness refers to the benefits that users think they will obtain from using the new technology. Perceived ease of use refers to the simplicity in maneuvering through the different elements of the technology.
Results:
The mean age of participants was 35.3 ±12 years and 15 (50%) were female. Thirteen (43%) had a low level of education, 22 (73%) owned cellphones; of those, 10 (45%) had smartphones. Nine (28%) were TB/HIV coinfected and receiving antiretroviral therapy. Prominent subthemes that emerged as facilitators of experienced usefulness and ease of VDOT use were text message reminders, technology training support from health providers, timely patient-provider communication, family social support and financial incentives. TB/HIV coinfected patients specifically reported gaining an extra benefit of adherence support for their antiretroviral medication. External barriers to the usefulness and ease of VDOT use were unstable electricity, cellular network coverage for patients who traveled to rural areas and the app technology malfunctioning. Concerns about stigma, disease disclosure, perceived breach in privacy and confidentiality also affected ease of VDOT use.
Conclusions:
Overall, the participants reported positive experiences with using VDOT. The acceptability and experienced ease of VDOT use were facilitated by the automatic text reminders, incentives, the technology support from the health providers and social support from family members. We identified some external barriers that highlight the need for upfront investment in the local technological infrastructure for future implementation of VDOT. Privacy, confidentiality and stigma concerns must be carefully addressed when scaling up VDOT.
Citation
Request queued. Please wait while the file is being generated. It may take some time.
Copyright
© The authors. All rights reserved. This is a privileged document currently under peer-review/community review (or an accepted/rejected manuscript). Authors have provided JMIR Publications with an exclusive license to publish this preprint on it's website for review and ahead-of-print citation purposes only. While the final peer-reviewed paper may be licensed under a cc-by license on publication, at this stage authors and publisher expressively prohibit redistribution of this draft paper other than for review purposes.