A mixed methods evaluation of 99DOTS digital adherence technology uptake among adolescents treated for pulmonary tuberculosis in Uganda.

Background: Adolescents are at risk of poor adherence to tuberculosis (TB) treatment and subsequently worse treatment outcomes. Digital adherence technologies, including the mobile phone-based 99DOTS platform, can support TB treatment, but there is limited data on their use among adolescents. We evaluated factors associated with uptake of 99DOTS among adolescents with TB. Methods: We conducted an explanatory sequential mixed methods study that utilized quantitative data from adolescents collected at 30 health facilities in Uganda, in-depth and key informant interviews with adolescents diagnosed for TB who were offered 99DOTS, and healthcare workers at participating facilities. Findings were further mapped onto the Capability, Opportunity, Motivation, and Behavior model. Results: Overall, 299/410 (73 %) adolescents were enrolled in 99DOTS. Older adolescents 15-19 years old were more likely to enroll in 99DOTS than younger adolescents 10-14 years [aPR= 1.88, 95 % CI: (1.54-2.33)]. Conversely, adolescents treated at Health Center IV and General Hospitals were less likely to be enrolled compared to Health Center III (aPR= 0.8, 95 % CI, 0.67-0.94, and aPR= 0.71, 95 % CI 0.58-0.85, respectively). Technological savviness among older adolescents, access to training, caregiver involvement, and desire for wellness facilitated uptake of 99DOTS. In contrast, variable mobile phone access, concerns about TB status disclosure, and health worker workload in hospitals were barriers to the uptake of 99DOTS. Conclusion: 99DOTS uptake was high among adolescents with TB. Increased access to mobile phones, and appropriate support from care givers and health workers enable adolescents to engage more effectively with digital adherence technologies like 99DOTS.