Using the 99DOTS (directly observed treatment, short course) application for improved adherence to tuberculosis treatment in Namibia: A mixed-methods study

Abstract

Background. In Namibia, community-based directly observed tuberculosis (TB) treatment (C-DOT) has been effective for individuals living in settled villages, but it is problematic for mobile indigenous people who survive through hunting and gathering and have among the highest TB and multidrug-resistant TB rates and lowest adherence to TB treatment globally. Objectives. The 99DOTS (directly observed treatment, short course) programme was piloted in the Tsumkwe Healthcare Centre and the 25 villages in the catchment area from quarter 2, 2019 to quarter 1, 2020. Programme staff facilitated and monitored TB treatment adherence. Methods. Twenty patients and two healthcare workers who managed the patients were interviewed on treatment completion using a semi- structured interview process. Results. Respondents were of low socioeconomic status; many were not schooled and not employed, and few had a monthly household income >NAD100 (USD5.50). According to the programme server reports, only six of the respondents did not miss any doses of their TB treatment, although few doses were missed proportionally. Most respondents reported a supportive family structure and health system, with treatment support given by families and regular follow-up by health workers. Positive feedback was received about use of the 99DOTS application; respondents found the application easy to use and did not mind using it in front of other people, in and out of their homes. Conclusion. 99DOTS was a feasible, innovative and accessible treatment adherence component integrated directly into the existing C-DOT approach. National TB programmes in similar high-burden settings could consider this approach to improve adherence.

Keywords

• Operational research, infectious diseases, indigenous populations, San, Namibia