Table 2.

Representative quotations on determinants of low patient acceptability and use of 99DOTS.

Determinant of low acceptability		Quotations
Performance expectancy
	Technology negatively affects patient-provider relationship	Q8. “One person came to see me since I started regularly taking TB tablets. They came and saw me once and that was it... I told them no one is visiting me and that I feel isolated. But nobody is interested in my worries.” (32-year-old man, HIV coinfected, continuation phase of therapy) Q9. “We wake up at 4 in the morning and we are fasting all day [for Ramadan], so in the morning there is no time to call... madam told me that I had not called and scolded me.” (50-year-old woman, HIV uninfected, continuation phase)
Effort expectancy
	Inability to call because of lack of phone access or restricted phone access	Q10. “I have a phone in my office. But students are not allowed to use mobile phones until we go home.” (19-year-old man, HIV coinfected, continuation phase of therapy)
	Inability to call because of shared phone use	Q11. Interviewer: “Has it ever happened that you had not made the call because of your phone problems?” Respondent: “[When f]ather is not at home whole day or when there is a SIM card network issue also.” (20-year-old woman, HIV uninfected, continuation phase of therapy) Q12. “My mother used to take [the cellphone] with her... for those days I couldn’t call... There was an alternative phone — my brother-in-law’s mobile phone. After taking medication I would tell my brother-in-law... But he ended up losing his SIM card.” (34-year-old man, HIV coinfected, intensive phase of therapy)
	Inappropriate calling of phone numbers in the envelopes (may lead to inaccurate adherence information)	Q13. “I saved the toll free number in the first blister [of the envelope] and called that number only. Later they said I should not call like that. They advised to call according to [the corresponding] blister [for each day].” (50-year-old man, HIV coinfected, continuation phase of therapy) Q14. “My daughter calls...but she does not call daily. She calls all the numbers on the strip at once after all the medication [in the blister pack] has been taken.” (55-year-old man, HIV coinfected, continuation phase of therapy)
	Other barriers to cell phone use or calling 99DOTS	Q15. “The first time I call, it gives a busy signal . . . after thinking that I dialed a wrong number, I dial the number again and it works... this has happened two or three times.” (43 year-old-woman, HIV coinfected, intensive phase of therapy) Q16. “I am staying in a hut, so I don’t have electricity in my home; we burn [wood] sticks to get light.” (49-year-old man, HIV coinfected, intensive phase of therapy) Q17. “My vision is not clear enough to see the small print [on the envelope]... I get help from my daughter or someone who can see the letters and call.” (42-year-old man, HIV coinfected, continuation phase of therapy) Q18. “Yes, sometimes there are network [cellular signal] issues at my house.” (25-year-old woman, HIV uninfected, continuation phase of therapy)
	Perceived high burden of calling or “technology fatigue”	Q19. “[I am] tired of calling daily.” (19-year-old man, HIV uninfected, continuation phase of therapy) Q20. “I forget to call Madam... I fall asleep as soon as I take [the medication].” (42-year-old man, HIV coinfected, continuation phase of therapy)
	Barriers to using SMS text messaging reminders	Q21. “If I receive a message in Tamil, I’ll try to read by spelling out the letters... but I don’t know how to read in English.” (30-year-old man, HIV coinfected, continuation phase of therapy) Q22. “Honestly I did not notice [the SMS reminders] or I did not check my phone for messages.” (25-year-old woman, HIV uninfected, continuation phase of therapy)
Social influences
	Stigma and lack of social support present barriers to patient engagement	Q23. “We do not take medication in front of others. People think TB is the worst disease and spreads by touching and that even if you talk, the disease will spread... all people think I am dirty; nobody wants to come close to me, so that’s why we take our pills behind closed doors.” (19-year-old woman, HIV uninfected, continuation phase of therapy) Q24. “Sometimes I take [medication] when nobody else is at home or... when everyone at home is sleeping... Sometimes I leave my home to take the tablets.” (19-year-old man, HIV coinfected, continuation phase of therapy) Q25. “[The HCPs visiting my house] revealed my status. They told others that I have TB... I feel unworthy to live after others came to know that I have AIDS.” (54-year-old man, HIV coinfected, intensive phase of therapy)
Facilitating conditions
	Poor counseling regarding 99DOTS	Q26. “One informational paper was given but... I thought it was useless and threw it out. Then when I came again to collect medicine, they asked me why I was not calling and I told them that I never received a number to call.” (27-year-old woman, HIV uninfected, intensive phase of therapy) Q27. “Sometimes I wonder, why do they ask us to call? What is the reason for calling?” (29-year-old man, HIV coinfected, intensive phase of therapy)
	Perceptions of inadequate or negative outreach by health care professionals	Q28. “They [HCPs] didn’t call... no one visited my house yet either.” (35-year-old man, HIV coinfected, intensive phase of therapy)