Infectious Disease · Medical Literature
Patient experiences and motivations in tuberculosis treatment: Insights from a digital adherence technology trial.
Abstract
Non-adherence to Tuberculosis (TB) treatment remains a global health challenge, particularly in low- and middle-income countries. Digital Adherence Technologies (DATs) have shown promise in improving treatment outcomes, yet little is known about user perceptions. Through an exit survey, this study evaluated the acceptability to participants of the Tuberculosis Treatment Support Tools intervention, which combines a mobile app for reporting of medication, direct contact with healthcare team, and a metabolite test to support self-administered TB treatment in Argentina. A pragmatic clinical trial was conducted at four public hospitals in Buenos Aires, in which 80 participants completed exit surveys. The app was rated highly for ease of use (4.3/5) and was strongly recommended to others (4.7/5). Features like medication reminders, direct messaging with treatment supporters, and an anonymous patient forum were praised for enhancing adherence and reducing isolation. The metabolite test, generally well-received, faced minor usability challenges. Participants highlighted need for simplified reporting and improved reminders. Motivation for adherence stemmed from health improvement goals, family support, and professional guidance. Recommendations for improvement included personalized features and addressing technical barriers. The intervention demonstrates potential for enhancing adherence by meeting practical and emotional needs, offering insights for the refinement of digital tools in TB treatment care.
Clinical relevance
Among patients with tuberculosis receiving self-administered treatment in Argentina, is a multicomponent Digital Adherence Technology (DAT) intervention — comprising a mobile application, direct healthcare team messaging, and a metabolite-based adherence test — acceptable and usable from the patient perspective? __SNAPSHOT__ {"studyDesign":"Cross-sectional exit survey nested within a pragmatic clinical trial (the TB Treatment Support Tools [TB-TST] trial)","setting":"Four public hospitals in Buenos Aires, Argentina (low- and middle-income country context)","sampleSize":"n=80 (participants who completed exit surveys)","population":"Adult patients with tuberculosis enrolled in the TB-TST pragmatic clinical trial and receiving self-administered treatment; specific inclusion/exclusion criteria not reported in the abstract","intervention":"TB Treatment Support Tools (TB-TST) intervention: a multicomponent DAT combining (1) a mobile app for medication reporting, (2) direct messaging with healthcare team treatment supporters, and (3) an anonymous peer patient forum; supplemented by a metabolite urine test to objectively support self-reported adherence","comparator":"Not applicable (single-arm acceptability/exit survey; no comparator group evaluated in this sub-study)","primaryOutcome":"Patient acceptability of the TB-TST intervention, assessed via exit survey ratings of app ease of use and likelihood to recommend; secondary domains included usability of the metabolite test, valued app features, adherence motivations, and patient suggestions for improvement","followUp":"Not reported (exit survey administered at treatment completion or study exit; duration not specified in the abstract)","fundingSource":"U.S. National Institutes of Health — National Institute of Allergy and Infectious Diseases (R01AI147129) and National Institute of Nursing Research (K23NR017210)"}
Key findings
Among 80 participants who completed exit surveys, the mobile application received high acceptability ratings: ease of use was rated 4.3 out of 5, and likelihood to recommend to others was rated 4.7 out of 5 (absolute values reported; no confidence intervals, p-values, or comparative statistics reported in the abstract). Specific app features highlighted positively included medication reminders, direct messaging with treatment supporters, and an anonymous patient peer forum, which participants credited with enhancing adherence and reducing treatment-related social isolation. The metabolite urine test was generally well-received but encountered minor usability challenges (nature and frequency not specified in the abstract). Participants suggested simplification of medication reporting workflows and improved reminder functionality. Primary motivational drivers for adherence included health improvement goals and family-related factors (abstract truncated; full motivational themes not reported). No adverse events, safety data, or clinical outcome data (e.g., treatment success rates) are reported in this sub-study. No NNT or NNH is calculable from the available data.
Practice implications
This exit survey establishes that a multicomponent DAT intervention combining a mobile app, peer forum, direct clinician-patient messaging, and a metabolite adherence test was highly acceptable to TB patients in a public hospital setting in Buenos Aires. However, this study was not designed to assess — and does not establish — whether the TB-TST intervention improves clinical outcomes (treatment success, cure rate, default rate) compared to standard care; that question is addressed by the parent pragmatic randomized controlled trial (NCT protocol published 2021). The findings are most applicable to literate, smartphone-owning adults with drug-susceptible TB in urban Argentine public hospital settings; generalizability to rural populations, those without smartphone access, patients with drug-resistant TB, or TB settings in other LMICs remains uncertain. The truncated abstract suggests that motivational themes related to family support are present but not fully reported, limiting complete appraisal. Importantly, this is an exit survey — respondents are likely those who remained engaged with the intervention, introducing substantial survivorship bias; patients who defaulted or disengaged may hold materially different perspectives. High acceptability ratings are encouraging for implementation feasibility but do not independently justify a practice change without evidence of clinical efficacy. Additionally, only the abstract was available for this review; full-text review is required to assess complete methodology, response rates, and all reported themes. __LIMITATIONS__ Survivorship/selection bias: exit surveys capture only patients who persisted in the trial; those who dropped out or defaulted — and who may have had the lowest acceptability — are systematically excluded, likely inflating acceptability ratings.,Small sample size (n=80): limits precision, statistical power for subgroup analyses, and generalizability.,Absence of a comparator group: this is a single-arm acceptability assessment; causal attribution of adherence improvement to any specific DAT component is not possible.,No clinical outcome data reported: treatment success, cure rates, time to culture conversion, and default rates are not reported in this sub-study.,No inferential statistics: the abstract reports descriptive ratings only (mean Likert scores); no confidence intervals, p-values, or measures of variability are provided, precluding assessment of precision.,Truncated abstract: the abstract is cut off mid-sentence, meaning full motivational themes and potentially other findings are not available for this review.,Social desirability bias: exit survey format in a clinical trial setting may lead participants to report more favorable experiences than are truly held.,Single-country, single-city, public hospital setting: findings may not generalize to rural TB patients, privately insured populations, or TB programs in other LMICs with different infrastructure.,Only abstract available: full methodological details (survey instrument validation, response rate, missing data handling, ethics reporting) cannot be assessed. __BOTTOM_LINE_CATEGORY__ promising_but_preliminary __BOTTOM_LINE__ This exit survey demonstrates high patient acceptability of a multicomponent digital adherence technology intervention for tuberculosis treatment in an Argentine public hospital setting, with app ease-of-use rated 4.3/5 and recommendation likelihood 4.7/5. Critically, this sub-study does not establish clinical efficacy; evidence of improved treatment outcomes must come from the parent pragmatic RCT. These acceptability data support implementation feasibility but should not independently change clinical practice pending full clinical outcome data.