Improving tuberculosis treatment adherence: a qualitative study of patients' perspectives from a pragmatic trial of the tuberculosis treatment support tools intervention.

OBJECTIVE

To explore patient perspectives on using a digital adherence technology (DAT) for tuberculosis (TB) treatment, specifically, the TB Treatment Support Tools (TB-TST) intervention, which integrates a mobile app designed to enhance patient-centred support, monitoring and communication, alongside a drug metabolite test.

DESIGN

Qualitative study conducted as part of a pragmatic randomised controlled trial.

SETTING AND PARTICIPANTS

Four public reference hospitals in Argentina. All patients in the intervention group were invited to participate; 33 patients in the intervention group and five treatment supporters were included.

DATA COLLECTION AND ANALYSIS

semistructured interviews were conducted. The normalisation process theory guided analysis to understand factors that enable or hinder the intervention's integration into routine practice for TB treatment medication adherence.

RESULTS

Patients identified medication reminders, educational messages and direct communication with treatment supporters (TSs) as the most helpful components of the intervention. Many reported using the app to ask TSs questions they felt uncomfortable raising with physicians in person. Initially, many patients did not fully understand the purpose and use of the metabolite test. Over time, their understanding of the app improved, though some continued to misinterpret the test results. Motivation to adhere to TB treatment was primarily driven by a desire to protect family members and resume normal daily activities. Reported barriers to app use included time constraints due to work, technical issues, limited internet connectivity and the burden of medication side effects. While the intervention was generally perceived as supportive and user-friendly, patients suggested improvements such as faster response times from TSs, expanded availability and better technical reliability and internet access.

CONCLUSION

These findings highlight the importance of tailoring digital adherence interventions to meet the diverse needs of patients and reinforce the pivotal role of the TS as a trusted and accessible source of guidance throughout TB treatment.

TRIAL REGISTERATION NUMBER

NCT04221789; https://clinicaltrials.gov/ct2/show/NCT04221789.