Characteristics of study participants.

Background
The introduction of digital adherence technologies (DATs) such as medication monitors in tuberculosis (TB) programmes supports treatment adherence among people with tuberculosis (PWTB). We evaluated the acceptability of using medication monitors (Wisepill evriMED) prompting a stepwise differentiated care approach (DCA), involving short message service (SMS), phone calls, home visits and motivational counselling, among PWTB in South Africa.
Methods
We conducted 62 in-depth interviews with participants in local languages across three provinces (January—October 2020), purposively selected by treatment month, adherence history and gender. Interviews were audio recorded, transcribed verbatim and translated. Using a deductive approach and the Theoretical Framework for Acceptability (TFA), we explored acceptability across the sample attributes.
Results
PWTB across adherence histories showed a positive attitude to using the evriMED device and receiving the DCA support. PWTB described the SMS reminders and phone calls as effective reminders, though home visits were less acceptable, due to perceived stigma. Despite willingness to participate in the intervention, the large size of the monitor and sound of the alarm drew attention, potentially causing embarrassment and stigma. Due to perceived stigma, some PWTB adapted the intervention by leaving the monitor at home after removing the pills to ensure that someone else tracked usage, while the PWTB used alternative reminders such as cell phones to take their medication.
Conclusion
Although PWTB showed a positive attitude towards the intervention, perceived stigma contributed to participants adapting their lifestyle to meet treatment adherence requirements without using the monitor. However, the medication monitor was a tool that seemed to prompt this personal change in behaviour. Achieving people-centered TB care, including the introduction of DATs, will require that TB programmes incorporate PWTB insights to maximize their use and effectiveness.

研究背景
在结核病（tuberculosis, TB）防控项目中引入服药监测设备等数字依从性技术（digital adherence technologies, DATs），有助于提升结核病患者（people with tuberculosis, PWTB）的治疗依从性。本研究针对南非的结核病患者，评估了使用Wisepill evriMED服药监测设备配合阶梯式差异化照护方案（stepwise differentiated care approach, DCA）的可接受性，该照护方案涵盖短消息服务（short message service, SMS）提醒、电话提醒、家庭访视及动机性咨询等内容。

研究方法
本研究于2020年1月至10月期间，在南非三个省份按照治疗月份、依从性病史及性别进行目的性抽样，共招募参与者开展62次深度访谈，访谈采用当地语言进行。访谈内容进行录音、逐字转录并翻译。本研究采用演绎法及可接受性理论框架（Theoretical Framework for Acceptability, TFA），围绕样本特征维度探索干预措施的可接受性。

研究结果
不同依从性病史的结核病患者均对使用evriMED设备及接受差异化照护支持持有积极态度。参与者认为短消息提醒与电话提醒是有效的服药提醒方式，但家庭访视的接受度较低，原因在于参与者感知到的病耻感。尽管参与者愿意参与本干预研究，但监测设备体积较大且报警声响明显，容易引人注意，可能引发尴尬与病耻感。受感知病耻感影响，部分参与者对干预措施进行了调整：取出药物后将设备留在家里，由他人代为追踪服药情况；同时，参与者会采用诸如手机之类的替代提醒方式来辅助服药。

研究结论
尽管结核病患者对本干预措施持有积极态度，但感知病耻感促使参与者调整自身生活方式，在不使用监测设备的情况下满足治疗依从性要求。不过，服药监测设备仍是能够推动个体行为改变的工具。要实现以患者为中心的结核病照护，包括推广数字依从性技术的应用，结核病防控项目需纳入结核病患者的反馈意见，以最大化其应用价值与效果。