PMID- 37390077 OWN - NLM STAT- PubMed-not-MEDLINE LR - 20230703 IS - 2767-3170 (Electronic) IS - 2767-3170 (Linking) VI - 2 IP - 6 DP - 2023 Jun TI - Implementation, feasibility, and acceptability of 99DOTS-based supervision of treatment for drug-susceptible TB in Uganda. PG - e0000138 LID - 10.1371/journal.pdig.0000138 [doi] LID - e0000138 AB - 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. CI - Copyright: (c) 2023 Kiwanuka et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. FAU - Kiwanuka, Noah AU - Kiwanuka N AD - Department of Epidemiology & Biostatistics, School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda. FAU - Kityamuwesi, Alex AU - Kityamuwesi A AD - Walimu, Uganda Tuberculosis Implementation Research Consortium, Kampala, Uganda. FAU - Crowder, Rebecca AU - Crowder R AD - Center for Tuberculosis and Division of Pulmonary and Critical Care Medicine, San Francisco General Hospital, University of California San Francisco, San Francisco, California, United States of America. FAU - Guzman, Kevin AU - Guzman K AD - Department of Medicine, University of California San Francisco, San Francisco, California, United States. FAU - Berger, Christopher A AU - Berger CA AUID- ORCID: 0000-0002-0034-7544 AD - Center for Tuberculosis and Division of Pulmonary and Critical Care Medicine, San Francisco General Hospital, University of California San Francisco, San Francisco, California, United States of America. FAU - Lamunu, Maureen AU - Lamunu M AD - Walimu, Uganda Tuberculosis Implementation Research Consortium, Kampala, Uganda. FAU - Namale, Catherine AU - Namale C AD - Walimu, Uganda Tuberculosis Implementation Research Consortium, Kampala, Uganda. FAU - Kunihira Tinka, Lynn AU - Kunihira Tinka L AD - Walimu, Uganda Tuberculosis Implementation Research Consortium, Kampala, Uganda. FAU - Nakate, Agnes Sanyu AU - Nakate AS AD - Walimu, Uganda Tuberculosis Implementation Research Consortium, Kampala, Uganda. FAU - Ggita, Joseph AU - Ggita J AD - Walimu, Uganda Tuberculosis Implementation Research Consortium, Kampala, Uganda. FAU - Turimumahoro, Patricia AU - Turimumahoro P AD - Walimu, Uganda Tuberculosis Implementation Research Consortium, Kampala, Uganda. FAU - Babirye, Diana AU - Babirye D AD - Walimu, Uganda Tuberculosis Implementation Research Consortium, Kampala, Uganda. FAU - Oyuku, Denis AU - Oyuku D AD - Walimu, Uganda Tuberculosis Implementation Research Consortium, Kampala, Uganda. FAU - Patel, Devika AU - Patel D AD - Department of Surgery, San Francisco General Hospital, University of California San Francisco, San Francisco, California, United States of America. FAU - Sammann, Amanda AU - Sammann A AD - Department of Surgery, San Francisco General Hospital, University of California San Francisco, San Francisco, California, United States of America. FAU - Turyahabwe, Stavia AU - Turyahabwe S AD - Uganda National Tuberculosis and Leprosy Programme, Ministry of Health, Kampala, Uganda. FAU - Dowdy, David W AU - Dowdy DW AD - Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America. FAU - Katamba, Achilles AU - Katamba A AUID- ORCID: 0000-0002-2347-4183 AD - Walimu, Uganda Tuberculosis Implementation Research Consortium, Kampala, Uganda. AD - Department of Medicine, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda. FAU - Cattamanchi, Adithya AU - Cattamanchi A AUID- ORCID: 0000-0002-6553-2601 AD - Walimu, Uganda Tuberculosis Implementation Research Consortium, Kampala, Uganda. AD - Center for Tuberculosis and Division of Pulmonary and Critical Care Medicine, San Francisco General Hospital, University of California San Francisco, San Francisco, California, United States of America. AD - Division of Pulmonary Diseases and Critical Care Medicine, University of California Irvine, Irvine, California, United States of America. LA - eng PT - Journal Article DEP - 20230630 PL - United States TA - PLOS Digit Health JT - PLOS digital health JID - 9918335064206676 PMC - PMC10313004 COIS- The authors have declared that no competing interests exist. EDAT- 2023/06/30 19:14 MHDA- 2023/06/30 19:15 PMCR- 2023/06/30 CRDT- 2023/06/30 13:34 PHST- 2022/10/04 00:00 [received] PHST- 2023/05/30 00:00 [accepted] PHST- 2023/06/30 19:15 [medline] PHST- 2023/06/30 19:14 [pubmed] PHST- 2023/06/30 13:34 [entrez] PHST- 2023/06/30 00:00 [pmc-release] AID - PDIG-D-22-00294 [pii] AID - 10.1371/journal.pdig.0000138 [doi] PST - epublish SO - PLOS Digit Health. 2023 Jun 30;2(6):e0000138. doi: 10.1371/journal.pdig.0000138. eCollection 2023 Jun.