Developing an integrated medication event monitoring system and smartphone-based ecological momentary assessment delivery platform to identify real-time factors influencing TB treatment adherence in South Africa

Background: Identifying real-time factors influencing adherence to Tuberculosis (TB) treatment is critical for informing treatment support interventions. Studies often use methods prone to recall bias, failing to capture objective real-time adherence-related factors.

Objective: To develop and test the functionality of an integrated medication event monitoring system and modified ecological momentary assessment (MEMS-mEMA) technology platform to collect real-time data on factors influencing daily dosing of drug-susceptible TB treatment.

Methods: We developed backend technology integrating a medication event monitoring (MEM) device with REDCap to deliver electronic surveys. System functionality was tested among individuals initiating TB treatment who received a Wisepill MEM device to store medication and capture dosing data, using device openings as a proxy for medication intake. Modified EMA (mEMA) surveys were administered randomly once every rolling seven days, and when the MEM device was not opened. In-depth interviews, followed by rapid qualitative analysis, were conducted to capture user experiences. Device openings and the total number of EMA surveys delivered and completed, including response rates, were presented.

Results: We successfully developed and tested the MEMS-mEMA system for collecting data on factors influencing TB treatment adherence. Ten adults newly initiating TB treatment participated in a pilot study for two months (male = 7; female = 3); mean age = 37 years (SD ±13.1), 50% living with TB/HIV coinfection. The median number of days the MEM device was opened during the two-month intensive treatment phase was 61 days. Participants demonstrated good comprehension of study requirements and did not report major challenges responding to surveys.

Conclusions: Findings suggest that this novel platform can collect real-time data on factors influencing TB treatment adherence for a larger feasibility study to inform intervention development in South Africa.