In Kenya, patients with tuberculosis who received daily text-based questions about treatment adherence and other mobile phone-based reminders were around two-thirds less likely to fail to complete treatment, according to findings published in The New England Journal of Medicine.
“Digital health interventions have the potential to address shortfalls in the current standard of care,” Erez Yoeli, PhD, a research scientist at Massachusetts Institute of Technology’s Sloan School of Management, and colleagues wrote.
“Although access to the internet, smartphones, and other forms of technology is still limited in areas with a high tuberculosis burden, mobile ‘feature’ phones (ie, phones that lack the advanced functionality of smartphones but can be used to make calls, send text messages, and access some simple internet features through a text-based interface) are ubiquitous.”
Yoeli and colleagues collaborated with 17 clinics in Nairobi for their study. They developed a digital health platform compatible with these phones to provide support for patients with TB. The platform sent daily text messages asking patients to verify adherence to treatment, and if they did not, two additional messages were sent at 1-hour intervals, the researchers explained. If delays in verification persisted, study team members who had successfully completed TB treatment themselves followed up with phone calls. Finally, if there was still no response, a notification was sent to the clinic.
According to the researchers, the platform’s design addressed nonadherence in a timely manner and provided patients with a resource for overcoming barriers to treatment, which included stigma and a lack of information.
“It also made patients feel accountable to others for their adherence or nonadherence; social science research suggests that such accountability motivates cooperative behavior,” they wrote.
The platform also provided information about TB through weekly motivational messages, such as, “Taking your pills will help you get better and keep you from infecting family and friends.” An “adherence contest” allowed patients to compare reported adherence. Those with adherence of 90% or higher qualified for a “winner’s circle.”
Among 535 patients in the control group and 569 in the intervention group, 70 patients (13.1%) experienced unsuccessful treatment outcomes in the control group and 24 patients (4.2%) in the intervention group, Yoeli and colleagues reported.
“Our results suggest that interventions delivered with feature phones can help to address shortfalls in the current standard of care for patients with tuberculosis,” the researchers wrote.
Yoeli E, et al. NewEnglJ Med. 2019;doi:10.1056/NEJMc1806550.