Acceptability of a Digital Adherence Tool Among Patients With Tuberculosis and Tuberculosis Care Providers in Kilimanjaro Region, Tanzania: Mixed Methods Study

Abstract

Background:The WHO has recommended digital adherence tools (DAT) as a promising intervention to improve anti-TB drug adherence. However, the acceptability of DAT in resource-limited settings is not adequately studied Objective: In this study, we investigated the acceptability of DAT among tuberculosis patients and TB care providers in Kilimanjaro, Tanzania Methods: We conducted a convergent parallel mixed method study among TB patients and TB care providers participating in our two-armed cluster randomised trial (Remind TB). The trial aimed to investigate whether the evriMED pillbox with reminder cues and adherence feedback effectively improves adherence to anti-TB treatment among TB patients in Kilimanjaro Region in Tanzania. We conducted exit and in-depth interviews among participants, as well as in-depth interviews among TB care providers from the intervention arm. We conducted a descriptive analysis of quantitative data from exit interviews using Stata version 15. Translated transcript and memos were organised using NVivo software version 12. We employed inductive and deductive thematic framework analysis, guided by Sekhon's theoretical framework of acceptability (TFA)Results: Out of 280 enrolled, 100(41%) were interviewed during exit interviews, and eighteen participants and fifteen TB care providers were in-depth interviewed. The findings showed that the digital adherence tool (DAT) was highly accepted, with 83% expressing satisfaction and 98% reporting positive experiences with its use. Seventy-eight (78%) understood how the intervention works, and 92% successfully used the pill box. Good perceived effectiveness was reported by 84% who noticed improved adherence, and many preferred continuing receiving reminder SMS, indicating high levels of self-efficacy. Ethical concerns were minimal, as 85% did not worry about remote monitoring. However, some participants felt burdened by the use of DAT of which 9% faced difficulties keeping the device at home, 12% were not pleased with receiving daily reminder SMS and 30% reported challenges related to internet connectivity. TB care providers accepted the intervention due to its perceived impact on treatment outcomes and behavior change in adherence counseling and they demonstrated high level of intervention coherence.Conclusions: Digital adherence tools (DAT) are highly acceptable in Tanzania. However, some barriers, such as TB-related stigma and internet connectivity, may limit acceptance.