<![CDATA[Tuberculosis (TB) remains a major global public health challenge, and poor adherence to anti-tuberculosis therapy contributes to treatment failure and the emergence of multidrug-resistant tuberculosis (MDR-TB). This study aimed to develop and evaluate the SMART-ADHERENCE PILLBOX (SAP), an electronic automatic pillbox with real-time monitoring designed to support medication adherence among TB patients. A prospective quantitative feasibility study was conducted, consisting of prototype validation and limited field implementation at the Purwokerto Pulmonary Clinic. Technical validation was performed using 100 operational simulation cycles across four independent replications, while the feasibility study involved eight TB patients in the intensive treatment phase who used SAP for 14 days. Evaluations included technical performance, timing performance, medication adherence, and acceptability based on the Unified Theory of Acceptance and Use of Technology (UTAUT). The results demonstrated that SAP achieved high technical reliability, with success rates exceeding 95% for alarm activation, medication dispensing, connectivity, notification delivery, and electronic logging. Alarm and logging deviations were close to zero, and notification delivery time consistently remained below five seconds, indicating good real-time monitoring capability. Following SAP implementation, adherence rates significantly increased from 83.9% to 97.4%, accompanied by reductions in missed doses and medication-taking delays (p<0.05). In addition, all acceptability domains showed high scores (4.3–4.5), indicating that SAP was well accepted by patients. Overall, SAP has the potential to become an applicable digital adherence technology innovation to support tuberculosis control programs in Indonesia.]]>
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