Acceptability of using the medication monitor and experience of a differentiated care approach for TB treatment adherence among people living with TB in South Africa

Rachel Mukora; Barack Ahumah; Noriah Maraba; Catherine Orrell; Lauren Jennings; Pren Naidoo; Katherine L Fielding; Kavindhran Velen; Salome Charalambous; Candice M Chetty-Makkan

doi:10.1371/journal.pgph.0001885

Acceptability of using the medication monitor and experience of a differentiated care approach for TB treatment adherence among people living with TB in South Africa

PLOS Glob Public Health. 2023 Oct 27;3(10):e0001885. doi: 10.1371/journal.pgph.0001885. eCollection 2023.

Authors

Rachel Mukora^{1

2}, Barack Ahumah², Noriah Maraba¹, Catherine Orrell^{3

4}, Lauren Jennings⁴, Pren Naidoo⁵, Katherine L Fielding^{2

6}, Kavindhran Velen¹, Salome Charalambous^{1

2}, Candice M Chetty-Makkan⁷

Affiliations

¹ The Aurum Institute, Aurum House, Parktown, Johannesburg, South Africa.
² University of Witwatersrand, School of Public Health, Johannesburg, South Africa.
³ Department of Medicine, Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa.
⁴ Desmond Tutu Health Foundation, Cape Town, South Africa.
⁵ Stellenbosch University, Stellenbosch, South Africa.
⁶ London School of Hygiene & Tropical Medicine, London, United Kingdom.
⁷ Faculty of Health Sciences, Health Economics and Epidemiology Research Office, University of the Witwatersrand, Johannesburg, South Africa.

Abstract

Background: The introduction of digital adherence technologies (DATs) such as medication monitors in tuberculosis (TB) programmes supports treatment adherence among people with tuberculosis (PWTB). We evaluated the acceptability of using medication monitors (Wisepill evriMED) prompting a stepwise differentiated care approach (DCA), involving short message service (SMS), phone calls, home visits and motivational counselling, among PWTB in South Africa.

Methods: We conducted 62 in-depth interviews with participants in local languages across three provinces (January-October 2020), purposively selected by treatment month, adherence history and gender. Interviews were audio recorded, transcribed verbatim and translated. Using a deductive approach and the Theoretical Framework for Acceptability (TFA), we explored acceptability across the sample attributes.

Results: PWTB across adherence histories showed a positive attitude to using the evriMED device and receiving the DCA support. PWTB described the SMS reminders and phone calls as effective reminders, though home visits were less acceptable, due to perceived stigma. Despite willingness to participate in the intervention, the large size of the monitor and sound of the alarm drew attention, potentially causing embarrassment and stigma. Due to perceived stigma, some PWTB adapted the intervention by leaving the monitor at home after removing the pills to ensure that someone else tracked usage, while the PWTB used alternative reminders such as cell phones to take their medication.

Conclusion: Although PWTB showed a positive attitude towards the intervention, perceived stigma contributed to participants adapting their lifestyle to meet treatment adherence requirements without using the monitor. However, the medication monitor was a tool that seemed to prompt this personal change in behaviour. Achieving people-centered TB care, including the introduction of DATs, will require that TB programmes incorporate PWTB insights to maximize their use and effectiveness.

Copyright: © 2023 Mukora et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Grants and funding

This work was supported by (1) Bill & Melinda Gates Foundation (Grant Number: OPP1205388; Grant Recipient: SC), (2) TB REACH Wave 6 project of Stop TB Partnership (Grant Number: STBP/TBREACH/GSA/W6-34; Grant Recipient: SC), and (3) South African Medical Research Council through the Strategic Health Innovation Partnerships (Grant Recipient: SC). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.