A study protocol on assessing the acceptance and effectiveness of a digital adherence technology for TB preventive treatment in Bangladesh

Adherence to tuberculosis preventive treatment (TPT) remains a significant challenge in high-burden countries like Bangladesh, where approximately 44 million people are infected with latent tuberculosis. This study protocol describes a mixed-methods observational study to evaluate “iDOTS,” a locally developed digital adherence technology adapted from 99DOTS, for monitoring and improving TPT adherence among adult household contacts of bacteriologically confirmed pulmonary TB patients. The study will be conducted in two districts in Bangladesh with similar geographical and societal characteristics, with Narsingdi as the intervention site and Manikganj as the control site. Applying the Unified Theory of Acceptance and Use of Technology (UTAUT), we will assess technology acceptance, feasibility, implementation challenges, and effectiveness through quantitative and qualitative approaches. The quantitative component will compare TPT adherence between iDOTS users and non-users, while qualitative interviews will explore user experiences and attitudes among healthcare providers and patients. Adherence will be verified through a combination of digital records, self-reports, and random isoniazid urine testing. With an estimated sample size of 422 patients and 77 healthcare providers, this study aims to generate evidence that if digital adherence technologies can strengthen TPT implementation in resource-limited settings. The findings will address critical gaps in the TPT cascade and inform strategies for scaling up TPT nationally, ultimately supporting global efforts to reduce the TB disease burden through effective preventive measures.