Beyond the Digital Adherence Technology: Experiences of the electronic pillbox implemented with differentiated care coupled with psychosocial intervention among people with Rifampicin Resistant TB in South Africa (Preprint)

BACKGROUND Adherence to Rifampicin Resistant Tuberculosis (RR-TB) remains a challenge and digital adherence technologies such as the pillbox have been introduced to support adherence. OBJECTIVE We investigated the experience of acceptability of the pillbox we implemented with differentiated care and psychosocial intervention among PWRR-TB irrespective of HIV status in three districts in South Africa METHODS A multi method study using quantitative and qualitative methods was used to assess acceptability of the electronic pillbox during implementation with differentiated care and psychosocial intervention in three South African districts. Fifty interviews were conducted with purposively sampled male and female individuals with RR-TB all who had used the pillbox, and a subsample had also received psychosocial intervention. Quantitative data were drawn from psychosocial assessment data collected by social workers. A hybrid of inductive and deductive analysis based on the unified theory of acceptance and use of technology (UTAUT) framework was used to analyse qualitative data. Descriptive analysis was used to analyse quantitative data. RESULTS Of those assessed for psychosocial support, 141 (68%) of participants who were assessed by the social worker were referred because of mental health issues, early side effects, substance use, poverty or lack of identification documents. The psychosocial support was well received, and participants recommended sustainable interventions such as receiving food parcels until treatment completion. The pillbox was helpful in identifying psychosocial barriers to TB treatment adherence early. Positive features reported were ease of use, an alarm reminder at a convenient time, storage, and improving relationship with the Health Care Worker (HCW). The acceptability of the technology was influenced by the presence of social support, which helped users feel more confident and engage. Barriers to using the pillbox were portability, perceived stigma, technical glitches and lack of trained HCWs to support. Differentiated care was well received, but participants preferred different follow-up methods. CONCLUSIONS People with RR-TB face several psychosocial which may affect their adherence to TB treatment. The electronic pillbox used with psychosocial support was positively received by individuals with RR-TB, indicating that with some design changes, could be a promising tool. to support adherence.