Directly-Observed Therapy (DOT) to Digital Adherence Technology (DAT)

From Directly-Observed Therapy (DOT) to Digital Adherence Technology (DAT) for TB Treatment is a pragmatic, stepped-wedge implementation evaluation to determine whether a 99DOTS-based strategy improves TB treatment outcomes compared to routine care. 99DOTS is a digital adherence technology involving placing the blister pack of TB medicines in a custom-designed envelope such that a new toll-free phone number is revealed when each day’s pills are opened. After taking the pills, patients are asked to call the toll-free number. When a call is made, the 99DOTS system records that pills have been taken and transmits this information to health workers. The system also sends an SMS each day to remind patients to take their TB medicines. Overall, the goal is to make TB treatment more convenient for patients by enabling them to take medicines when and where they choose, instead of having to be observed taking medicines by a health worker.

The main objective of the DOT to DAT implementation study is to evaluate the effectiveness, implementation and costs of a 99DOTS-based strategy to improving TB treatment adherence.

So far, we have enrolled 18 trial sites that meet eligibility criteria and randomized these sites into the study months when they will switch to the intervention. We have also begun the process of introducing 99DOTS at sites and training health facility staff to use the technology.