Text messaging to decrease tuberculosis treatment attrition in TB-HIV coinfection in Uganda
Year: 2017
Type: article
Study design: Clinical Trial
Abstract: Background: Low tuberculosis (TB) treatment completion rates in sub-Saharan Africa are an important driver of multidrug resistance. Mobile technology-based interventions have been shown to improve adherence to antiretroviral therapy in sub-Saharan Africa. We aimed to test the effect of a short-message service (SMS) intervention on loss to follow-up (LFU). Materials and methods: In this quasi-experimental study, all adult, literate, HIV-infected patients with mobile phone access diagnosed with TB between November 2010 and October 2011 in an urban clinic in Uganda were eligible to receive adherence and appointment reminders and educational quizzes during the first 8 weeks of TB treatment. Their risk of LFU in the first 8 weeks of treatment was compared with that of patients starting treatment between March 2009 and August 2010 using logistic regression. Results: One of 183 (0.5%) enrolled patients was lost to FU during the intervention compared to six of 302 (2.0%) in the preintervention control group (RR 0.27, 95% CI 0.03–2.07; P =0.22). The SMS intervention was rated as very helpful by 96%. Barriers identified included interrupted phone access (26%, median 14 days) and difficulties responding by SMS. The response rate to educational quizzes was below 10%. There were no unintentional disclosures of TB or HIV status due to the intervention. Conclusion: An SMS reminder service did not show a clear effect on short-term risk of LFU in this study, which was underpowered due to a lower baseline risk in the control group than expected. The SMS-reminder service was rated highly, and there were no breaches of confidentiality. Important technological barriers have implications for larger-scale implementation, not only for TB but also other disease modalities. Keywords: mHealth, mobile technology, short message service, text messaging, e-health, cellular phone, telemedicine, tuberculosis, adherence, Uganda, Africa
Source: Patient Preference and Adherence
DOI: 10.2147/ppa.s135540
Institutions: Utrecht University, Amsterdam UMC Location University of Amsterdam, University Medical Center Utrecht, Infectious Diseases Institute, MUJHU Research Collaboration, Amsterdam Institute for Global Health and Development, Makerere University, University of Amsterdam, Johns Hopkins University, Johns Hopkins Medicine
Language: English
Subfield: General Health Professions
Field: Health Professions
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $2,836
Funders: Microsoft Research, International Maternal Pediatric Adolescent AIDS Clinical Trials Network, European Commission, National Institutes of Health, National Institute of Allergy and Infectious Diseases, Fogarty International Center, Division of Microbiology and Infectious Diseases, National Institute of Allergy and Infectious Diseases
Awards: G1607662513, G5153287960, G6237093645
OpenAlex ID: W2751351201