“99DOTS”techno-supervision for tuberculosis treatment – a boon or a bane? Exploring challenges in its implementation at a tertiary centre in Delhi, India

Summary Background In India, daily regimen with fixed-dose combination along with 99DOTS adherence tool and one-stop service at Anti-Retroviral Treatment (ART) centres for HIV infected Tuberculosis (TB) patients was launched in 2017. No systematic evaluation of its implementation has been done so far in a tertiary care setting in urban India. Methods A mixed-methods study was conducted at National Institute of Tuberculosis and Respiratory Diseases, Delhi in 2018-19. Missed doses, average adherence and treatment outcomes were compared across 99DOTS dashboard and TB treatment card. In-depth interviews of patients and health care providers were conducted to explore the implementation challenges and benefits. Results Median of missed doses recorded during intensive and continuation phase were 56 and 68 respectively in 99DOTS as compared to 0 in the TB Treatment card (p Conclusion Success of 99DOTS program under programmatic condition needs webtool stability, uninterrupted logistic supplies (envelops), training of staff and better coordination between TB and HIV program personnel. Despite the challenges in its implementation, the benefit of this tool in terms of greater convenience and reduced stigma for patients is encouraging.