Digital tool iDOTS to boost TB preventive treatment adherence in Bangladesh

Adherence to tuberculosis preventive treatment (TPT) is a persistent problem in countries with a high TB burden. The situation is particularly urgent in Bangladesh, where the study notes that approximately 44 million people are infected with latent tuberculosis. To confront this challenge, Sayera Banu and colleagues have written a study protocol that lays out plans to test a locally developed digital adherence technology called iDOTS. iDOTS is adapted from the previously used 99DOTS platform and is designed for adult household contacts of bacteriologically confirmed pulmonary TB patients. The protocol describes a mixed-methods observational study that will run in two districts with similar geography and social conditions: Narsingdi will serve as the intervention site where iDOTS is offered, and Manikganj will serve as the control site. Using the Unified Theory of Acceptance and Use of Technology (UTAUT) as a framework, the researchers plan to examine whether people accept iDOTS, what practical challenges arise during implementation, and whether the technology can improve adherence to TPT in a real-world program setting.

The protocol combines quantitative and qualitative approaches to give a rounded picture of iDOTS in practice. The quantitative component will compare TPT adherence between people using iDOTS and those not using the system, while the qualitative component will use interviews to explore experiences and attitudes among healthcare providers and patients. Adherence will be checked in multiple ways: by reviewing digital records from iDOTS, by collecting self-reports from participants, and by conducting random isoniazid urine testing to provide an objective biological check. The study plans an estimated sample of 422 patients and 77 healthcare providers, allowing the team to measure differences in adherence and to capture barriers and enablers reported by users and staff. The observational design means the protocol focuses on how iDOTS performs in routine care rather than in a tightly controlled trial, keeping the evaluation grounded in the realities of local health services.

If carried out as planned, this study aims to generate practical evidence about whether a digital adherence tool can strengthen TPT delivery in resource-limited settings. The authors state that findings should help fill important gaps in the TPT cascade — from offering preventive treatment to ensuring it is completed — and point to whether technologies like iDOTS are acceptable and feasible for patients and providers. Results are intended to inform strategies for scaling up TPT nationally in Bangladesh and could contribute to broader global efforts to reduce the TB disease burden through effective preventive measures. As a protocol, the paper sets out methods and goals rather than final outcomes, and it notes that trial registration is not applicable for this observational study design.