JMIR Publications

ABSTRACT

Background:

Digital adherence technologies (DATs) are promising tools for supporting tuberculosis treatment. DATs can be used to remind person with TB to take treatment and serve as a proxy for medication adherence. Good engagement with the DAT from the person with TB and healthcare provider (HCP) perspectives are important for intervention fidelity. The Adherence Support Coalition to End TB (ASCENT) project evaluated two DAT types, pillboxes and medication labels (99DOTS), in cluster-randomised trials across five countries.

Objective:

Our objective was to investigate participant and healthcare provider engagement with DATs for TB treatment, by type of DAT and country.

Methods:

This study is a sub-analysis of data generated through the ASCENT trials enrolling adults with drug-susceptible TB. A pillbox opening (pillbox users) or dosing confirmation SMS sent by the participant (label users) were recorded on the adherence platform and represented a digital dose. Descriptive analysis was employed to provide an overview of dose-day outcomes. DAT engagement was assessed from a participant and HCP perspective. For the former, we summarised the frequency of digital engagement overall and by treatment phases, and the frequency of consecutive non-engagement days. For the latter, we summarised the frequency of doses added manually by the HCP, days from the actual dose-day to when a manual dose was added, and events of consecutive manual dosing of >3 and >7 days, added more than one week after the dose-day.

Results:

Of 9,511 participants included, 6,719 (71%) were using the pillbox, 37% were female and the median age was 40 years. Across DATs there were 1,384,879 dose-days (70% from pillbox users); 84% were recorded as digital, 11% as manual, 4% had no information, and less than 1% were confirmed as missed. Digital dosing reduced marginally from intensive compared to the continuation phase. The percentage of digital dose-days was higher among pillbox (87%) versus labels users (76%). Manual dosing was most common in the Philippines (22%) and least common in Tanzania (15%) among label users, while it was most common in the Philippines and Ukraine (12%) among pillbox users. Overall, 18% of label users and 9% of pillbox users had a run of more than 7 consecutive non-digital dose-days that were resolved more than one week after the dose-day, with the highest occurrence in the Philippines (32% for labels and 17% for pillboxes).

Conclusions:

There was considerable variation in DAT engagement across countries and DAT types, indicating differences in how the intervention was implemented. Further refinement of the intervention and improvements in the delivery may be necessary for improving outcomes.