The KNCV-led and Stop TB Partnership funded TB REACH project in Tanzania introduced 99DOTS (medication sleeves) as a Digital Adherence Technology (DAT) in the gold mining Geita region in northwestern Tanzania. 99DOTS is a low-cost, mobile phone-based technology that enables real-time remote monitoring of daily intake of treatment. Tuberculosis (TB) patients using 99DOTS call a phone number or send a text message they find on the packaging of their medication only revealed after the pill is removed from the blister. Missed doses trigger SMS notifications to health care providers, who follow up with personal, phone-based counseling, and home visits.
TB REACH’s goal is to enable treatment and adherence support for Drug Susceptible Tuberculosis (DS-TB) patients. Since 2018, KNCV has implemented several Digital Adherence Technology (DAT) demonstration projects in countries as the Philippines and Tanzania, as it has shown to be successful in the fight against TB.
These TB REACH projects are the predecessor of the ASCENT project, that is funded by Unitaid.
Alex: “I really like the system”
Alex* (35 years), a miner and TB patient, was enrolled on the 99DOTS system. Since the start of his treatment, he takes his medication daily. When interviewed on his experience with 99DOTS, he said “After I was diagnosed with TB, I was registered to a program where I have to make a free phone call every day after taking the pills. The doctors gave me my medication, which came in an envelope with hidden numbers, and I was asked to call this after taking my medication”.
Alex points out that his improved adherence of the medication is rooted in the 99DOTS system. He also understands the implication of missing a dose better. Alex had an adherence of 99%, and states that this can be attributed to the 99DOTS system automated reminder messages, which has been very helpful in reminding him to take his medication on the days he forgets.
Alex says “We, who work in the mines, are usually very busy. We go out in the morning and come back in the evening, it is very easy to forget taking your drugs on days like that. It happened to me the other day. I forgot to take my medication. Late in the evening, I received a message, politely reminding me to take the drugs and make the call. That really helped me, I took the drugs and made the call. I really like the system; it has even created friendship between me and the health worker. He shows me my adherence calendar when I come to the facility for my drugs, it’s completely green and I want to keep it up!”
Riziki: “I encourage any TB patient to use 99DOTS if they can”
“I am stable now. The cough I had sustained the last 6 months is gone. I have regained my health! The 99DOTS system has helped me a lot completing the treatment this successfully.” These are comments from Riziki William (29 years), who is now back to his normal activities in the mines.
Riziki was diagnosed with pulmonary TB at Kharumwa Health Centre in Nyang’hwale District. He explains, “I was losing weight and sustained a severe cough for a couple of weeks. I was definitely sick. I went to the hospital for a checkup, where a doctor told me I had tuberculosis. I was told to start a six month TB treatment. A DOT nurse informed me about a system with which I had to take pills and make a free phone call. This system would send me messages to remind me to take my drugs when I didn’t call.”
On the same day his TB treatment started, Riziki was registered to 99DOTS. He never missed a single dose. Which gave him 100% adherence from enrolment to treatment completion.
Picture insert: Patient adherence calendar for Riziki William from the 99DOTS platform.
When asked what factors helped him completing his treatment so successfully, Riziki said the following: “The system of me taking my pills and making a phone call was very important the entire treatment. I underline this because I got a motivational message every time I made that call. I remember one day where I almost forgot to take the pills, I was very busy working in the mines. In the evening I received a message reminding me to take my medicine. I would have missed that dose if I did not get that message. The DOT nurse in the hospital showed me my adherence calendar every time I went to pick up my pills. Seeing a completely green calendar made me so happy! So I made sure to maintain it.”
Riziki further explains that the process of using 99DOTS is not time consuming. “Not at all, it is an interesting practice actually. Imagine making a call then receiving a message from the Ministry of Health, congratulating you for taking your medicine! It is nice to see the authorities are concerned about your health. Really, I encourage any TB patient to use 99DOTS if they can. It supports patients through the complete treatment. It made my treatment easier and I wish the same for others.”
Do you want to read more success stories about 99DOTS? Read the patient story of Angelito from the Philippines.
* The name of the patient interviewed is changed here because of privacy.