Medication Sleeve or Label (99DOTS)
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Digital Adherence Technologies
Medication Sleeve or Label (99DOTS)
The medication sleeve/label, also called 99DOTS, use customized packaging such as a printed sleeves or labels that fit Fixed Dose Combination (FDC) medication. It was first piloted and used on a large scale in India.
The patient reports medication intake daily either by calling a toll-free phone number or sending a free SMS message using a code found on the customized packaging. The patient can utilize any type of mobile phone to submit the code to the adherence platform.
Considerations
To determine whether the medication sleeve/label, as digital adherence technology, is suitable for your target population and context, certain elements need to be considered.
Each consideration is scored according to a favourability scale as low, medium, or high. Low indicating less favourability, and high indicating increased favourability compared to the other digital adherence technologies.
EASE FOR PATIENT TO USE TECHNOLOGY: MEDIUM
- Medication intake is logged daily by the patient making a phone call or sending a SMS.
- Small packaging makes it versatile for travel purposes and reduces the risk of stigmatization.
EASE FOR HEALTHCARE WORKER TO USE TECHNOLOGY: MEDIUM
- The health care provider will need to repackage medication into the patient sleeves or attach the label with the unique code.
- The health care provider will need to ensure that patient phone number is up to date on the adherence platform, otherwise incoming medication intake phone calls or SMS messages cannot be linked to patient.
ACCESSIBILITY: LOW
- Patients need daily access to a phone that can make calls and/or can send and receive SMSs.
- The patient needs a positive airtime balance daily to report medication intake (even though the patient may not be charged for the call or SMS). Adherence reporting may be interrupted if the patient has a zero-airtime balance.
EASE OF IMPLEMENTATION: LOW
- Specialized in-country toll-free phone- or SMS based communication infrastructure needs to be set up and maintained to allow daily medication intake reporting by patient.
- A variety of medication blister packaging can exist within countries which makes forecasting and production of medication sleeves (99DOTS) very challenging.
SUITABILITY FOR USE WITH DIFFERENT DRUG TYPES: LOW
- Only suitable for patients treated with Fixed Dose Combination (FDC) medication, and therefore not usable for patients using multiple pills and package formats for their treatment.
Implementation Requirements
Phone Access
Patient has access to phone and can make/or receive phone calls or SMSs.
In-Country Communication Infrastructure
Specialized in-country toll-free or SMS-based communication infrastructure.
Production & Distribution
Sleeve or label production facility and distribution.
Adherence platform access for provider
Healthcare provider can use smartphone, tablet, or laptop to access online adherence platform.
Follow-up based on adherence
Targeted follow-up actions and support by healthcare providers and other staff based on adherence.
Country Implementers
Bangladesh
Patient Target
DS-TB
Scale
21000
India
Patient Target
DS-TB
Scale
763545
Publications
Philippines
Patient Target
DS-TB
DR-TB
Scale
16000
DAT combination
Medication sleeve, smart pill box, VOT
Publications
Democratic Republic of Congo
Patient Target
DS-TB
Scale
2500
Myanmar
Patient Target
DS-TB
Scale
13500
Publications
Tanzania
Patient Target
DS-TB
DR-TB
DS-TB among mining population (1000 patients)
Scale
1000
DAT Combination
Medication Sleeve, Smart Pill Box, VOT
Publications
Ethiopia
Patient Target
DS-TB
DR-TB
Scale
15000
DAT Combination
Medication Sleeve, Smart Pill Box
Nigeria
Patient Target
MDR-TB
Scale
7500
Uganda
Begin Implementation
Publications
Technical Brief: 5 Country Experiences with Digital Adherence Technologies
Cost and Cost-Effectiveness of a Digital Adherence Technology for Tuberculosis Treatment Support in Uganda
Outcomes and implementation challenges of using daily treatment regimens with an innovative adherence support tool among HIV-infected tuberculosis patients in Karnataka, India: a mixed-methods study
The impact of digital health technologies on tuberculosis treatment: a systematic review
Opportunities to improve digital adherence technologies and TB care using human-centered design