Use of a digital adherence technology to support TB treatment among adolescents

BACKGROUND Adolescents (ages 10-19) affected by TB face unique challenges to completing TB treatment. Digital adherence technologies (DATs) may be a useful tool for TB treatment monitoring. In this study, we assessed whether 99DOTS, a low-cost DAT, could improve treatment outcomes among adolescents with pulmonary TB (PTB). METHODS We conducted an interrupted time series (ITS) analysis of adolescents initiating treatment for drug-susceptible PTB at 30 health facilities in Uganda. ITS analysis was used to model the change in TB treatment outcomes and loss to follow-up in adolescents prior to and after the implementation of a 99DOTS-based intervention. RESULTS Of 630 adolescents, 78.4% of adolescents were enrolled on 99DOTS in the post-intervention period. In the adjusted analysis, the proportion treated successfully increased (level change, proportion ratio [PR] 1.18, 95% confidence interval [CI] 1.08-1.28) and the proportion lost to follow-up decreased (level change, PR 0.93, 95% CI 0.88-0.98) in the immediate post-intervention period. Both proportions remained similar throughout the post-intervention period ( P value for slope change >0.05). CONCLUSION There was a high uptake of 99DOTS among adolescents with TB, and use of 99DOTS was associated with improved treatment outcomes. DATs should be further explored as a promising adolescent-specific tool for improving TB treatment outcomes. .