Use of a digital adherence technology for tuberculosis treatment supervision among adolescents

Abstract

ABSTRACT Background Adolescents (ages 10-19) affected by tuberculosis (TB) face unique challenges to completing TB treatment, resulting in increased loss to follow-up and mortality as compared to younger children and older adults. Digital adherence technologies (DATs) may be a useful tool for TB treatment monitoring. In this study we aimed to assess 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 between August 1, 2019 and June 30, 2021 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. Immediate (level) and trend (slope) changes in outcomes were assessed according to intention-to-treat (ITT) and per protocol (PP) principles. Findings 630 adolescents were included in the ITT analysis. In the post-intervention period, 78.4% of adolescents were enrolled on 99DOTS. The proportion successfully completing TB treatment was 92.4% (303/328) in the post-intervention period and 87.4% (264/302) in the pre-intervention period. In the adjusted ITT analysis, the proportion treated successfully increased (level change, PR 1.18 95% 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). Interpretation 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 treatment outcomes among adolescents with TB.