BackgroundAdherence to TB treatment is challenging because of many factors. WHO has recommended the useof digital adherence monitoring technologies in its End-TB-strategy. However, there is paucity on itsevidence in improving adherence. EvriMED a real time medication monitoring (RTMM) which wasfound feasible and acceptable in few studies in Asia. However, in Tanzania, there may be challengesin implementing evriMED due to stigmatization, network and power access, accuracy and costeffectiveness which may have an implication for treatment outcomes. We propose a pragmatic clusterrandomized trial, to investigate the effectiveness of evriMED with reminder cues and tailoredfeedback on adherence to TB treatment in Kilimanjaro, Tanzania.

MethodsWe will create clusters in Kilimanjaro based on level of health care facility. Clusters will berandomized in an intervention arm, where evriMED will be implemented or a control arm, wherestandard practice DOTs will be followed. TB patients in intervention clusters will take their medicationfrom the evriMED pillbox and receive tailored feedback. We will use the ‘Stages of-change’ model,which assumes that a person has to go through the stages of pre-contemplation, contemplation,preparation, action and evaluation to change behaviour for tailored feedback on adherence reportsfrom the device.DiscussionIf the intervention shows a significant effect on adherence and the devices are accepted, accurateand sustainable, the intervention can be scaled up within the National Tuberculosis Programmes.