Text messaging to decrease tuberculosis treatment attrition in TB-HIV coinfection in Uganda
SM Hermans, S Elbireer, H Tibakabikoba… - Patient preference …, 2017 - Taylor & Francis
SM Hermans, S Elbireer, H Tibakabikoba, BJ Hoefman, YC Manabe
Patient preference and adherence, 2017•Taylor & FrancisBackground 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 …
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 …
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.
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