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

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 neste...

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Autores principales: Kiwanuka, Noah, Kityamuwesi, Alex, Crowder, Rebecca, Guzman, Kevin, Berger, Christopher A., Lamunu, Maureen, Namale, Catherine, Kunihira Tinka, Lynn, Nakate, Agnes Sanyu, Ggita, Joseph, Turimumahoro, Patricia, Babirye, Diana, Oyuku, Denis, Patel, Devika, Sammann, Amanda, Turyahabwe, Stavia, Dowdy, David W., Katamba, Achilles, Cattamanchi, Adithya
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Public Library of Science 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10313004/
https://www.ncbi.nlm.nih.gov/pubmed/37390077
http://dx.doi.org/10.1371/journal.pdig.0000138
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author Kiwanuka, Noah
Kityamuwesi, Alex
Crowder, Rebecca
Guzman, Kevin
Berger, Christopher A.
Lamunu, Maureen
Namale, Catherine
Kunihira Tinka, Lynn
Nakate, Agnes Sanyu
Ggita, Joseph
Turimumahoro, Patricia
Babirye, Diana
Oyuku, Denis
Patel, Devika
Sammann, Amanda
Turyahabwe, Stavia
Dowdy, David W.
Katamba, Achilles
Cattamanchi, Adithya
author_facet Kiwanuka, Noah
Kityamuwesi, Alex
Crowder, Rebecca
Guzman, Kevin
Berger, Christopher A.
Lamunu, Maureen
Namale, Catherine
Kunihira Tinka, Lynn
Nakate, Agnes Sanyu
Ggita, Joseph
Turimumahoro, Patricia
Babirye, Diana
Oyuku, Denis
Patel, Devika
Sammann, Amanda
Turyahabwe, Stavia
Dowdy, David W.
Katamba, Achilles
Cattamanchi, Adithya
author_sort Kiwanuka, Noah
collection PubMed
description 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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spelling pubmed-103130042023-07-01 Implementation, feasibility, and acceptability of 99DOTS-based supervision of treatment for drug-susceptible TB in Uganda Kiwanuka, Noah Kityamuwesi, Alex Crowder, Rebecca Guzman, Kevin Berger, Christopher A. Lamunu, Maureen Namale, Catherine Kunihira Tinka, Lynn Nakate, Agnes Sanyu Ggita, Joseph Turimumahoro, Patricia Babirye, Diana Oyuku, Denis Patel, Devika Sammann, Amanda Turyahabwe, Stavia Dowdy, David W. Katamba, Achilles Cattamanchi, Adithya PLOS Digit Health Research Article 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. Public Library of Science 2023-06-30 /pmc/articles/PMC10313004/ /pubmed/37390077 http://dx.doi.org/10.1371/journal.pdig.0000138 Text en © 2023 Kiwanuka et al https://creativecommons.org/licenses/by/4.0/This is an open access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/) , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
spellingShingle Research Article
Kiwanuka, Noah
Kityamuwesi, Alex
Crowder, Rebecca
Guzman, Kevin
Berger, Christopher A.
Lamunu, Maureen
Namale, Catherine
Kunihira Tinka, Lynn
Nakate, Agnes Sanyu
Ggita, Joseph
Turimumahoro, Patricia
Babirye, Diana
Oyuku, Denis
Patel, Devika
Sammann, Amanda
Turyahabwe, Stavia
Dowdy, David W.
Katamba, Achilles
Cattamanchi, Adithya
Implementation, feasibility, and acceptability of 99DOTS-based supervision of treatment for drug-susceptible TB in Uganda
title Implementation, feasibility, and acceptability of 99DOTS-based supervision of treatment for drug-susceptible TB in Uganda
title_full Implementation, feasibility, and acceptability of 99DOTS-based supervision of treatment for drug-susceptible TB in Uganda
title_fullStr Implementation, feasibility, and acceptability of 99DOTS-based supervision of treatment for drug-susceptible TB in Uganda
title_full_unstemmed Implementation, feasibility, and acceptability of 99DOTS-based supervision of treatment for drug-susceptible TB in Uganda
title_short Implementation, feasibility, and acceptability of 99DOTS-based supervision of treatment for drug-susceptible TB in Uganda
title_sort implementation, feasibility, and acceptability of 99dots-based supervision of treatment for drug-susceptible tb in uganda
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10313004/
https://www.ncbi.nlm.nih.gov/pubmed/37390077
http://dx.doi.org/10.1371/journal.pdig.0000138
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