Digital Adherence Technologies and Differentiated Care forTuberculosis Treatment and Their Acceptability Among PersonsWith Tuberculosis, Health Care Workers, and Key Informants inthe Philippines:Qualitative Interview Study

Background: Digital adherence technologies (DATs) are being studied to determine their potential to support tuberculosis (TB)treatment and address the shortcomings of directly observed therapy. Previous research has shown inconclusive results on whetherDATs can enhance medication adherence among persons with TB.Objective: This study aims to understand the acceptability of DATs, namely, medication labels and smart pillboxes, amongpersons with TB, health care workers (HCWs), and key informants (KIs) in the Philippines. The objective is to gain valuableinsights that can inform the design and implementation of DATs in the Southeast Asian region, which meet the needs andpreferences of end users.Methods: Persons with TB, HCWs, and KIs were recruited from intervention facilities to participate in in-depth interviewsconducted between March 2022 and January 2023. These interviews were transcribed and translated into English. A thematicanalysis was carried out using NVivo software (Lumivero) to identify and analyze themes. Themes were then structured withina modified social-ecological model.Results: A total of 25 persons with drug-sensitive TB and 20 HCWs or KIs were interviewed. Both groups emphasized thatusers'technology literacy level, financial conditions, and motivation to be cured determined how they interacted with the DAT.They also acknowledged that DATs helped foster their relationship with HCWs and enabled efficient treatment support. Concerningtechnology, persons with TB found DATs easy to use and able to reduce clinic visits. HCWs mentioned that DATs added to theirworkload but also allowed them to support users who missed doses. However, both groups experienced technical challenges withDATs. Regarding program implementation, users appreciated the clear explanations and demonstrations provided by HCWs.Yet, some users reported inconsistencies between DAT settings and the information provided. HCWs stressed the importance ofcomprehensive training and sufficient resources for effective program implementation in the future. At the community level, bothgroups noted that DATs and program design protected users'privacy and reduced the risk of stigma. Finally, users and HCWsshared various contextual factors that influenced their experience with DAT, including infrastructure challenges and the impactof the COVID-19 pandemic