Impact of the 99DOTS digital adherence technology on tuberculosis treatment outcomes in North India: a pre-post study

Chen, Amy Z.; Kumar, Rajneesh; Baria, R. K.; Shridhar, Pramod Kumar; Subbaraman, Ramnath; Thies, William

doi:10.21203/rs.3.rs-1900171/v1

Cited by 7 publications

(9 citation statements)

References 16 publications

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“…The 57.7% of overall doses confirmed by phone calls in our study is similar to that reported in two studies from India and a meta-analysis which included this study and 10 other DAT implementation projects. (7, 8) In addition, the decreased engagement over the course of treatment is similar to that reported in India by Cross et al(2) However, through a combination of self-report and calls to people with TB, health workers confirmed that >98% of expected doses were taken. Thomas et al also confirmed high levels of adherence (88%) among people with TB using 99DOTS in India using random urine isoniazid screening.…”

Section: Discussionsupporting

confidence: 78%

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

Kiwanuka

Kityamuwesi

Crowder

et al. 2022

Preprint

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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.

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Section: Discussionsupporting

confidence: 78%

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

Kiwanuka

Kityamuwesi

Crowder

et al. 2022

Preprint

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“…In the only randomized trial of 99DOTS to date, we showed that only 52% of people with TB were enrolled on 99DOTS, and 99DOTS-based treatment supervision did not improve treatment outcomes (2). Other implementation studies have found similarly low enrollment of people with TB on 99DOTS and have reported similar treatment outcomes between routine- and 99DOTS-based treatment supervision (1-3).…”

Section: Introductionmentioning

confidence: 82%

“…Digital adherence technologies (DATs) have been proposed as one potential intervention to support people with TB to successfully complete treatment. 99DOTS is a low-cost DAT, whereby people with TB self-report medication dosing by calling toll-free phone numbers hidden underneath pills in blister packs (1,2). 99DOTS has been deployed in some Asian and African countries, including India (1,3), Uganda (2) and Kenya (4).…”

Section: Introductionmentioning

confidence: 99%

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Implementation of enhanced 99DOTS for TB treatment supervision in Uganda: An interrupted time series analysis

Crowder,

Nakasendwa,

Kityamuwesi

et al. 2024

Preprint

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Rationale: Digital adherence technologies are being scaled-up for tuberculosis treatment despite limited evidence of their effectiveness and concerns about accessibility. Objectives: To determine whether an enhanced 99DOTS-based treatment supervision improves uptake of 99DOTS and tuberculosis treatment outcomes. Methods: We included all adults initiated on treatment for drug-suceptible pulmonary tuberculosis between August 2019 and June 2021 at 18 99DOTS-experienced health (n=6,382) facilities and 12 99DOTS-naive health facilities (n=4,253) in Uganda. Using an interrupted time series design, we compared the proportions with treatment success (primary outcome) and enrolled on 99DOTS in the 9 months before and the 12 months after implementing an 'enhanced 99DOTS' intervention that included components to increase uptake (providing low-cost phones to people with TB when needed) and enhance treatment monitoring and support (task shifting to community health workers and automated task lists). Data on treatment initiation and outcomes were derived from routine TB treatment registers. Measurements and Main Results: At 99DOTS-experienced facilities, the proportion enrolled on 99DOTS increased from 49.2% to 86.4%. The proportion completing treatment remained similar across periods (78.3% vs. 78.6%). There was no immediate level change in treatment success following the intervention but there was a significant change in monthly slope (proportion ratio 1.01, 95% CI 1.00-1.02), reflecting an improved treatment success trend following the intervention. Results were similar at 99DOTS-naive facilities, except there was no significant change in treatment success slope. Conclusions: Enhanced 99DOTS had high uptake and did not negatively affect treatment outcomes. Equity in access should be prioritized during implementation.

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“…Hasil lain yang berbeda ditunjukan oleh Chen et al (2022) di India, hasil penelitian ini menunjukkan bahwa tidak ada perbedaan yang signifikan dari hasil kepatuhan pengobatan sebelum dan sesudah implementasi 99DOTS. Didukung dengan penlitian Thomas et al (2019) di India, dimana penilaian 99DOTS memberi hasil yang kurang optimal dalam mengukur kepatuhan, sebagian dikarenakan kurangnya keterlibatan pasien pada 99DOTS.…”

Section: Intervensi Menggunakan Aplikasi Digital 99dotsunclassified

Literature Review: Effectiveness of Digital Self-Reporting on Tuberculosis Treatment Completion Adherence

Dewanti,

Masfuri

2023

JNC

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Tuberculosis (TB) is a directly infectious disease caused by Mycobacterium tuberculosis. Medication adherence important to recovery TB patients. Failure of TB medication can caused spreading infection, MDR-TB (Multi Drug Resistant) to mortality. Digital based for self-reporting can help to improve medication adherence. Purpose: To determine the effectiveness of digital based self reporting that can encourage medication adherence in TB medication. Methods: Scooping review of international article with the keywords “digital health”, “tuberculosis”, “medical adherence” through the online database Scopus and Clinical Key with inclusion criteria : digital health for TB patient, SMS, VDOT, and 99DOTS use in TB medication, and article published between 2017-2022. Study did in October – December 2022 to analyze assosiated based self reporting that can encourage medication adherence in TB medication The result, a Analysis related to intervention using 99DOTS and SMS showing increased significant and unsignificant. VDOT shows increasing in TB adherence medication so that it can be recommended for apply.: Digital based self reporting that can encourage medication adherence in TB medication.

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Impact of the 99DOTS digital adherence technology on tuberculosis treatment outcomes in North India: a pre-post study

Cited by 7 publications

References 16 publications

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

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

Implementation of enhanced 99DOTS for TB treatment supervision in Uganda: An interrupted time series analysis

Literature Review: Effectiveness of Digital Self-Reporting on Tuberculosis Treatment Completion Adherence

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