Digital monitoring technologies could enhance tuberculosis medication adherence in Uganda: Mixed methods study

Article Author(s): Dr. Angella Musiimenta1, Wilson Tumuhimbise1, Aaron T. Mugaba1, Dr. Conrad Muzoora1, Mari Armstrong-Hough2&3, Prof. David Bangsberg4, Assoc. Prof. J. Lucian Davis5, Dr. Jessica E. Haberer6


Background: Effective administration of tuberculosis therapy remains challenging. The recommended strategy of direct observed therapy is challenging and its implementation has been limited in many settings. Digital adherence technologies could be promising patient-centered strategies for monitoring adherence. However, few quality studies have assessed patients’ experiences with these technologies.

Objective: To explore TB patients’ perceptions of a digital adherence intervention composed of a digital adherence monitor and SMS texts.

Methods: We purposively sampled TB patients who owned phones, had been taking TB medication for at least a month, and were receiving their treatment from Mbarara Regional Referral Hospital. We interviewed 35 TB patients to elicit information on perceptions of the proposed intervention which electronically monitors how they take their medication, and sends SMS reminders to patients to help them take their medications, as well as send SMS notifications to patients’ social supporters to provide the patient with assistance if possible. We inductively analyzed data using content analysis to derive categories describing how participants perceived the intervention.

Results: Participants anticipated that the intervention would enhance medication adherence by reminding them to take medication, and helping in the management of complicated regimen. Participants felt that monitoring adherence could enable them to demonstrate their commitment to adherence. Participants expressed concerns about not seeing the SMS on time and unintended TB status disclosure.

Conclusion: Digital adherence technologies may provide acceptable alternative approaches to monitoring TB medication, especially in settings where DOT is difficult to implement.

Keywords: Digital adherence technologies; Forgetfulness; Habit formation; Medication adherence; Real-time monitoring; SMS reminders; Tuberculosis.

Bibliographical metadata

Journal Journal of clinical tuberculosis and other mycobacterial diseases
Publisher Elsevier Ltd.
Related Faculties/Schools

1Mbarara University of Science and Technology, Mbarara, Uganda

2Uganda Tuberculosis Implementation Research Consortium, Makerere University, Kampala, Uganda

3Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT, USA

4Oregon Health & Science University-Portland State University School of Public Health, USA

5Harvard Medical School, Boston, MA, USA

6Massachusetts General Hospital Center for Global Health, Boston, MA, USA