Facilitators and barriers to uptake of digital adherence technologies in improving TB care in Ethiopia: A qualitative study.

The role of digital adherence technologies (DATs) in improving tuberculosis (TB) treatment adherence is an emerging area of policy discussion. Given that the directly observed therapy (DOT) has several shortcomings, alternative approaches such as DATs are vital to enhancing current practices by rendering person-centered models to support the completion of TB treatments. However, there is a lack of evidence that informs policy and program on facilitators and barriers to the uptake of DATs in the context of country-specific real-world situations. The purpose of this study was to explore the facilitators and barriers to the uptake of DATs by drawing from the accounts of people with TB (PWTB), healthcare workers (HCWs) and other key policy stakeholders in Ethiopia. A qualitative study was conducted to capture the perspectives of participants to help understand the contextual factors that are important in the uptake of DATs. The overall response from participants highlighted that uptake of DATs was high despite some critical implementation barriers. DATs were useful in reducing the burden of treatment management on both PWTB and HCWs, improving adherence and flexibility, and enhancing the patient-provider relationship. The relative simplicity of using DATs, positive feedback from important others, and current policy opportunities were seen as additional facilitators for the uptake of DATs in the Ethiopian context. Key barriers including network issues (mobile phone signals), lack of inclusivity and fear of stigma (as perceived by HCWs) were identified as key barriers that could limit the implementation of DATs. The findings of this qualitative study have provided a rich set of perspectives relevant to policymakers, providers and implementers in identifying the facilitators and barriers to the uptake of DATs in Ethiopia. The overall finding suggests that DATs are highly acceptable among the diverse categories of participants in the presence of critical barriers that limit uptake of DATs including poor infrastructure. However, key policy stakeholders believe that there are several opportunities and initiatives for feasible implementation, adaptation and scale-up of DATs in the current Ethiopian context.