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Text messaging to decrease tuberculosis treatment attrition in TB-HIV coinfection in Uganda

Authors Hermans SM, Elbireer S, Tibakabikoba H, Hoefman BJ, Manabe YC

Received 24 February 2017

Accepted for publication 24 June 2017

Published 31 August 2017 Volume 2017:11 Pages 1479—1487


Checked for plagiarism Yes

Review by Single anonymous peer review

Peer reviewer comments 2

Editor who approved publication: Dr Johnny Chen

Sabine M Hermans,1–4 Sawsan Elbireer,5 Harriet Tibakabikoba,1 Bas J Hoefman,6 Yukari C Manabe1,2,7

1Department of Research, Infectious Diseases Institute, Makerere University College of Health Sciences, Kampala, Uganda; 2Department of Internal Medicine, School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda; 3Department of Global Health, Academic Medical Center, University of Amsterdam, Amsterdam Institute for Global Health and Development, the Netherlands; 4Department of Internal Medicine and Infectious Diseases, University Medical Centre Utrecht, Utrecht, the Netherlands; 5Makerere University–Johns Hopkins University Research Collaboration, Kampala, Uganda; 6TTC Mobile, Kampala, Uganda; 7Division of Infectious Diseases, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA

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

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