ArticleGlobal health action2019
Outcomes and implementation challenges of using daily treatment regimens with an innovative adherence support tool among HIV-infected tuberculosis patients in Karnataka, India: a mixed-methods study.
Article in Global health action, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 34 papers, 5 of them syntheses that pooled it.
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Who cites it
34 citing papers in PubMed, 5 syntheses or guidelines pooled it, 81 citations in OpenAlex.
- The impact of digital adherence technologies on treatment outcomes, adherence, and patient-reported outcomes in tuberculosis: a systematic review and meta-analysis.BMC infectious diseases · 2025Pooled it
- The performance of digital technologies for measuring tuberculosis medication adherence: a systematic review.BMJ global health · 2024Pooled it
- Patient adherence to tuberculosis treatment in the Indian subcontinent: systematic review and meta-synthesis of qualitative research.BMJ open · 2023Pooled it
- eHealth in TB clinical management.The international journal of tuberculosis and lung disease : the official journal of the International Union against Tuberculosis and Lung Disease · 2022Pooled it
- Pooled it
- Digital adherence technology for tuberculosis treatment supervision: A stepped-wedge cluster-randomized trial in Uganda.PLoS medicine · 2021Trial
- Implementing Digital Respiratory Technologies for People With Respiratory Conditions: Scoping Review.Journal of medical Internet research · 2026Article
- A study protocol on assessing the acceptance and effectiveness of a digital adherence technology for TB preventive treatment in Bangladesh.BMC public health · 2025Observational
- A qualitative study on the barriers to tuberculosis treatment adherence using digital adherence technologies (DATs).The Indian journal of medical research · 2025Article
- Contextual factors influencing implementation of tuberculosis digital adherence technologies: a scoping review guided by the RE-AIM framework.BMJ global health · 2025Article
- A cluster-randomized trial of household vs incentive-based tuberculosis contact investigation in rural South Africa: implementation reach.PLOS global public health · 2025Article
- Facilitators and barriers to uptake of digital adherence technologies in improving TB care in Ethiopia: A qualitative study.PLOS digital health · 2024Article
- Impact of a pilot mHealth intervention on treatment outcomes of TB patients seeking care in the private sector using Propensity Scores Matching-Evidence collated from New Delhi, India.PLOS digital health · 2024Article
- Article
- Appraising perception, accessibility and uptake of DAT among patients with TB.Public health action · 2024Article
- Impact of the 99DOTS digital adherence technology on tuberculosis treatment outcomes in North India: a pre-post study.BMC infectious diseases · 2023Article
- Free drug provision for tuberculosis increases patient follow-ups and successful treatment outcomes in the Indian private sector: a quasi experimental study using propensity score matching.BMC infectious diseases · 2023Article
- Implementation, feasibility, and acceptability of 99DOTS-based supervision of treatment for drug-susceptible TB in Uganda.PLOS digital health · 2023Article
- Barriers and Facilitators to Implementing a Digital Adherence Technology for Tuberculosis Treatment Supervision in Uganda: Qualitative Study.Journal of medical Internet research · 2023Article
- Digital Adherence Technologies and Mobile Money Incentives for Management of Tuberculosis Medication Among People Living With Tuberculosis: Mixed Methods Formative Study.JMIR formative research · 2023Article
Corrections and comments
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Authors and funding
10 authors at 7 institutions in 2 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundIn India, a new care package consisting of (i) daily regimen with fixed-dose combination drugs, collected once-a-month and self-administered by the patient, (ii) 'one stop service' at antiretroviral treatment (ART) centre for both HIV and tuberculosis (TB) treatment and (iii) technology-enabled adherence support (99DOTS, which required patients to give a missed phone call after consuming drugs) was piloted for treatment of TB among HIV-infected TB patients. Conventional care included intermittent regimen (drugs consumed thrice-weekly) delivered under direct observation of treatment supporter and the patients needing to visit TB and HIV care facilities, separately for treatment.
objectiveTo assess the effect of new care package on TB treatment outcomes among HIV-TB patients registered during January-December 2016, as compared to conventional care and explore the implementation challenges.
methodsA mixed-methods study was conducted in four districts of Karnataka, India where new care package was piloted in few ART centres while the rest provided conventional care. Quantitative component involved a secondary cohort analysis of routine programme data. Adjusted relative risk(aRR) was calculated using Poisson regression to measure association between new care package and unsuccessful treatment outcome. We conducted in-depth interviews with healthcare providers and patients to understand the challenges.
resultsUnsuccessful TB treatment outcomes (death, loss to follow-up and failure) were higher in new care package (n = 871) compared to conventional care (n = 961) (30.5% vs 23.4%; P value<0.001) and aRR was 1.3(95% CI: 1.1-1.7). Key challenges included patients' inability to give missed call, increased work load for ART staff, reduced patient-provider interaction, deficiencies in training and lack of role clarity among providers and reduced involvement of TB program staff.
conclusionWith new care package, TB treatment outcomes did not improve as expected and conversely declined compared to conventional care. TB and HIV programs need to address the operational challenges to improve the outcomes.
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