A Case Study on the Implementation and Efficacy of a Digital Directly Observed Therapy Platform for Multidrug-Resistant Tuberculosis in Khayelitsha, South Africa

Multidrug-resistant tuberculosis (MDR-TB) remains a major public health challenge in South Africa, necessitating prolonged treatment with high adherence. Conventional directly observed therapy, while a standard of care, imposes significant burdens on patients and health systems. Digital directly observed therapy has emerged as a potential alternative, but its practical application in high-burden, resource-constrained settings is not well documented. This case study evaluated the implementation process, feasibility, and preliminary efficacy of a digital directly observed therapy platform for MDR-TB patients in Khayelitsha, a peri-urban settlement in South Africa. A mixed-methods case study design was used. Quantitative data on patient enrolment, adherence metrics, and treatment outcomes were extracted from programme records. Qualitative data were obtained through focus group discussions with patients and semi-structured interviews with involved healthcare workers. The platform was integrated into existing clinic workflows. Preliminary analysis showed high acceptance, with over 85% of offered patients enrolling. Qualitative data highlighted a perceived reduction in patient stigma and travel burden. Key challenges included inconsistent access to smartphones and reliable mobile data connectivity. The digital directly observed therapy platform was a feasible and acceptable adjunct to MDR-TB management in this setting, offering a more patient-centred approach. It complemented, rather than replaced, essential clinic-based support. Future implementations should incorporate strategies to address technology access, such as providing loaned devices or data subsidies. Further research is required to compare long-term treatment outcomes with conventional directly observed therapy and to conduct formal cost-effectiveness analyses. tuberculosis, multidrug-resistant, digital health, directly observed therapy, telemedicine, South Africa, implementation science This case study provides practical insights for public health programmes considering digital adherence technologies for MDR-TB care in similar resource-constrained environments.