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BACKGROUND Patients with Drug sensitive tuberculosis (DSTB) often face challenges in adhering to medications. Tuberculosis Monitoring Encouragement Adherence Drive (TMEAD) is a digital pillbox that provides reminders for pill consumption and facilitates the remote monitoring of medication adherence. OBJECTIVE Present study assessed the acceptance of TMEAD among TB patients in Nasik city of Maharashtra. METHODS Qualitative In-depth interviews (IDI) were conducted with 40 DSTB patients and 16 treatment supporters. IDI were audio recorded. The observations were organized using the outline construct that assessed the technology acceptance into four major themes - performance expectancy (acceptability of the device), effort expectancy (perceived benefit of the device), social influence (saving time and money) and facilitating conditions (availability of medicines). RESULTS Better acceptance to TMEAD was related to perceptions that the reminder alarm improves medication adherence and remote monitoring too reduced the frequency of clinic visits, organization of medications made it easier to take them correctly. The device facilitated positive family involvement in the patient’s care, and that remote monitoring made patients feel more cared for by the health system. Lower patient acceptance to TMEAD was related to problems with the durability of the device, large size, issues with charging, and concerns regarding possible stigma. TB health visitors reported that TMEAD implementation resulted in reducing the frequent in-person interactions with patients and thus allowed them to dedicate more time to other important tasks. Patients who returned the devices reported that the primary reasons were stigma associated with TB, and issues of charging the device and taking device at workplace. CONCLUSIONS There are several features of the TMEAD that supports its acceptability among TB patients, while few barriers to patient use should be addressed by improving the design of the device. However, some barriers, such as disease-related stigma, are more difficult to modify and may limit use of the TMEAD. Overall, we conclude that TMEAD intervention has the potential to be integrated into the basket of digital adherence intervention under India’s National TB Elimination programme. |
