From 99DOTS to 99DOTSLite in Gujarat: A Pragmatic Leap in TB Treatment Adherence

In 2013, Microsoft Research India launched a digital adherence technology (DAT) called 99DOTS which was created to overcome low treatment adherence in India's tuberculosis (TB) program. It employed the use of envelope-based medication delivery with concealed numbers which were unlocked and dialed by the patient to record compliance. Although successful in small-scale pilots, widespread adoption revealed several weaknesses such as dependence on packaging, complexity, and imprecision. To address these, the Central TB Division introduced a simplified version of its system, 99DOTSLite, in 2023, which relies on district-specific toll-free numbers (TFNs) printed on the medication packs or ID cards. Patients verify intake by making a missed call which gets automatically registered in Ni-kshay and thus followed up in real time in case of missed doses. In comparison to the previous systems, 99DOTSLite is affordable, compatible with any TB regimen, user-friendly, and easily integrated with the digital TB environment of India. Even though issues with phone access, connection, and possible false reporting are possible, 99DOTSLite is an open-ended, patient-centered innovation essential to India TB elimination activities.