Digital adherence technologies and differentiated care for tuberculosis treatment in the Philippines: Patient and Healthcare provider acceptability (Preprint)

Abstract

Digital adherence technologies (DATs), as an alternative tuberculosis (TB) treatment support strategy, are being studied whether they can support TB treatment and address the shortcomings of Directly Observed Therapy (DOT). Current research shows inconclusive results on whether DATs can enhance medication adherence among people with TB.

This study aims to understand the acceptability of DATs, namely medication labels and smart pillbox, among people with TB, healthcare workers (HCWs) and key informants (KIs) in the Phillippines. The objective is to gain valuable insights that can inform the design and implementation of DATs in the Southeast Asian region, with a focus on meeting the needs and preferences of end-users.

DAT users, HCWs and KIs were recruited from intervention facilities to participate in in-depth interviews conducted between March 2022 and January 2023. These interviews were transcribed and translated into English. A thematic analysis was carried out using NVivo software to identify and analyze themes. Themes were then structured within a modified social-ecological model, organized into six levels: individual, relationship, technology, program design, community and contextual level.

Twenty-five people with DS-TB and 20 HCWs or KIs were interviewed. At the individual level, both groups emphasized that users’ technology literacy level, financial conditions and motivation to be cured determined how they interacted with the DAT. For relationship, they acknowledged that DATs helped foster their relationship and enabled efficient treatment support. For technology, DAT users found DATs easy to use and able to reduce clinic visits. HCWs mentioned that DATs added to their workload but also allowed them to support users who missed doses. However, both groups experienced technical challenges with DATs. At the program implementation level, users appreciated the clear explanations and demonstrations provided by HCWs. Yet, some users reported inconsistencies between DAT settings and the information provided by HCWs. HCWs stressed the importance of comprehensive training and sufficient resources for effective program implementation in the future. At the community level, both groups noted that DATs and program design protected users’ privacy and reduced the risk of stigma. Finally, users and HCWs shared various contextual factors that influenced their experience with DAT, including infrastructure challenges and the impact of the COVID-19 pandemic.

In the Philippines, both people with TB and HCWs showed a high level of acceptance and satisfaction toward the impact of DAT and program design. They expressed a desire for the continuation of DATs. The challenges encountered underscore the need for ongoing technological development to minimize malfunctions, enhance the capacity of health facilities, and improve infrastructure. DATs have demonstrated their ability to strengthen user-HCW relationships and protect users from stigmatization. These compelling outcomes provide a strong rationale for the further implementation of such technologies in Southeast Asia.