Mobile phone interventions for tuberculosis should ensure access to mobile phones to enhance equity – a prospective, observational cohort study in Peruvian shantytowns

Abstract

ObjectivesMobile phone interventions have been advocated for tuberculosis care, but little is known about access of target populations to mobile phones. We studied mobile phone access among patients with tuberculosis, focusing on vulnerable patients and patients who later had adverse treatment outcomes.MethodsIn a prospective cohort study in Callao, Peru, we recruited and interviewed 2584 patients with tuberculosis between 2007 and 2013 and followed them until 2016 for adverse treatment outcomes using national treatment registers. Subsequently, we recruited a further 622 patients between 2016 and 2017. Data were analysed using logistic regression and by calculating relative risks (RR).ResultsBetween 2007 and 2013, the proportion of the general population of Peru without mobile phone access averaged 7.8% but for patients with tuberculosis was 18% (P < 0.001). Patients without access were more likely to hold a lower socioeconomic position, suffer from food insecurity and be older than 50 years (all P < 0.01). Compared to patients with mobile phone access, patients without access at recruitment were more likely to subsequently have incomplete treatment (20% vs. 13%, RR = 1.5; P = 0.001) or an adverse treatment outcome (29% vs. 23% RR = 1.3; P = 0.006). Between 2016 and 2017, the proportion of patients without access dropped to 8.9% overall, but remained the same (18%) as in 2012 among the poorest third.ConclusionAccess to mobile phones among patients with tuberculosis is insufficient, and rarest in patients who are poorer and later have adverse treatment outcomes. Thus, mobile phone interventions to improve tuberculosis care may be least accessed by the priority populations for whom they are intended. Such interventions should ensure access to mobile phones to enhance equity.

The impact of COVID-19 on TB: a review of the data

“…This can be used, alongside contact surveys where the location of contact was recorded, to estimate likely reductions in contacts. A major caveat is that those surveyed include mobile phone owners only, which may underrepresent both TB patients 98 and potentially those unable to practice physical distancing.…”

COVID-19, tuberculosis and poverty: preventing a perfect storm

“…Importantly, any economic support should involve engagement with patient civil society organisations, as they have a potentially critical role in providing psychosocial support to tuberculosis-affected households, reducing stigma and discrimination [19,20]. This may harness digital technology to improve equity and efficiency, and overcome the infection control challenges associated with both tuberculosis and COVID-19 [21]. Tuberculosis-specific social protection should improve equitable access to tuberculosis care and prevention, reduce poverty-related tuberculosis risk factors, and therefore improve outcomes [22][23][24].…”

Digital adherence technologies for the management of tuberculosis therapy: mapping the landscape and research priorities

“… 62 52 However, a recent study from Peru highlights that, although cellphone access may be high in the general population, access may be considerably lower in patients who suffer from TB and in particular for patients with TB with poor treatment outcomes. 63 Implementation studies from high-income and middle-income countries (USA, Canada, Belarus, Mexico) have suggested that VDOT has high feasibility, 53 64–66 though some patients had to be shifted back to in-person DOT 53 and low video or audio quality sometimes made dose observation difficult. 65 67 Ingestible sensors had high feasibility in studies conducted in the USA and Mexico, with >95% of sensor signals detected after ingestion.…”