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A low-cost digital adherence engagement tool

Medication Sleeves

99DOTS is a low-cost digital adherence technology built into the Everwell Hub that uses inexpensive packaging (envelopes or stickers) with medication that enables people taking medication to engage with their treatment daily. Providers distribute medication with custom packaging to people taking medications. When someone dispenses a dose, they reveal a hidden number behind perforated flaps on the external envelope; in some cases, the number may be fixed on the outside of the medication blister or pill bottle. This number can be a toll-free number that can be called to register daily adherence, or a code that can be sent by SMS, USSD, or other communication channel. Calling or messaging the number is free! For those taking medication, the Everwell Hub sends reminders and alerts based on engagement, and providers can view daily reported adherence so they can provide differentiated care to those under their care.

Benefits of 99DOTS

  • Affordable - 99DOTS is designed for cost-effectiveness at scale, and only requires access to a basic mobile phone (no smartphone required for users)

  • Scalable - 99DOTS has been scaled to over 500,000 TB-affected people in India, and deployed in 9 other countries

  • Adaptable - 99DOTS is customizable based on disease and context. In some environments we use toll free calling, while in others we leverage SMS. We have deployed with both blister-wrapped envelopes, or stickers affixed to blisters or pill bottles.

  • Accessible - where other prerequisites are met (users daily access to phones living under mobile coverage, staff capacity and training to follow up with non-adherence signals, and appropriate packaging/ supply chain to add the 99DOTS packaging), 99DOTS is acceptable to users across demographics

99DOTS - A Global Good, with Global Access

The 99DOTS innovation was designed to be an adaptable intervention for use or adaptation by any government or health care organization seeking a real-time, low-cost solution for monitoring and improving medication adherence. While developed at Microsoft Research and championed by Everwell, the idea is a global resource and we aspire to empower organizations to use it, and ideas inspired by our learnings, for the global good.

As such, the 99DOTS innovation, research, designs, lessons learned, and deployment documentation are made available to the world because problems in the global health domain affect everyone; innovative, cost-effective, and implementable solutions to problems like adherence to life-saving medications are a global resource. Since inception, 99DOTS has been adapted to disease environments outside of TB including HIV and mental health, and engagement mechanisms have also expanded to include IVR and SMS.

As 99DOTS and other digital adherence technologies have been integrated and made available on the Everwell Hub, the philosophy that inspired 99DOTS remains our driving force behind all of our innovations. All of our software developed is available under open source licensing, and the associated materials are also available to anyone, including:

  • The designs of our envelopes (or stickers, or other form factors) and advice for how to print and procure them

  • Access to all training materials used across our global deployments


For more information on 99DOTS or our philosophy on these policies, please reach out to us at

Please do contact us to support you in getting 99DOTS envelopes. These can be use in conjunction with the Everwell Hub to run an adherence program in your context.

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