SMS reminders to improve adherence and cure of tuberculosis patients in Cameroon (TB-SMS Cameroon): a randomised controlled trial

Abstract

BackgroundIn Cameroon, the National Tuberculosis Control Program that applies selective directly observed treatments faces difficulties in its implementation for a lack of resources, leading to only 65% of patients with sputum smear-positive pulmonary tuberculosis being cured after 6 months of treatment. This study aimed to evaluate the effectiveness of daily Short Message Service reminders to increase adherence and the proportion of adult tuberculosis patients cured after 6 months of treatment.MethodsA simple blinded, randomised controlled, multicentre study carried out in 12 Treatment and Diagnostic Centres of Yaoundé. The patients included were randomly assigned to two groups: patients in the intervention group received daily SMS reminders in addition to the usual treatment; those in the control group received the usual treatment only. The primary outcomes were the number and proportion of treatment success at 5 months, and the number and proportion of patients cured at 6 months. Data analysis was by intention to treat.ResultsTwo hundred and seventy-nine participants were randomized into intervention group (n = 137) and control group (n = 142). At five months, there were 111 treatment success (81%) in the intervention group and 106 (74.6%) in the control group (OR = 1.45 [0.81, 2.56]; p = 0.203). At 6 months, there were 87 patients cured (63.5%) in the intervention group and 88 (62%) in the control group (OR = 1.06 [0.65, 1.73]; p = 0.791). The number of drop-outs at 6 months was 47 (34.3%) in intervention group, and 46 (32.4%) in the control group. 48.9% (23/47) and 39.1% (18/46) of these drop-outs were sputum-negative at 5 months. At three different appointments, there were no significant differences between the two groups in any secondary outcomes. Very high and similar satisfaction was found for general management of patients in both groups: 99.5 and 99.2% (p = 0.41).ConclusionsOur study suggests that SMS reminders do not increase treatment success and cure proportions. However, the low proportion of patients cured at 6 month may be an underestimation due to a high dropout rate between the fifth and the sixth months of treatment. Future trials should focus on reducing the dropout rate.Trial registrationThe trial was registered on the Pan-African Clinical Trials Registry (PACTR201307000583416 of 22 July 2013) and the protocol was published.

Determinants of loss to follow-up among HIV positive patients receiving antiretroviral therapy in a test and treat setting: A retrospective cohort study in Masaka, Uganda

“…This cannot happen if one has no phone and so may lead to loss to follow up. Mobile phone technologies (mHealth), specifically SMS reminders have improved patient outcomes in other health service delivery settings [38][39][40] but were comparable to the standard of care for HIV retention in other settings [41,22,42]. It is however important to note that the level of interaction between provider and patient, and subset of activities under mHealth greatly determine the effectiveness of particular interventions.…”

Does Phone Messaging improves Tuberculosis Treatment Success? A Systematic review and Meta-analysis

“…Only eight studies [41][42][43][44][45][52][53][54] were found to be fitted for the pooled estimation of the effect of mobile phone messaging on successful TB treatment outcome. Six studies were exclude with the following reasons.…”

People–centred care versus clinic–based DOT for continuation phase TB treatment in Armenia: a cluster randomized trial

“…Using mobile phone text messages (SMS) to remind patients with chronic conditions, enhances treatment adherence and reduces transportation costs [15]. Although several studies have evaluated SMS messaging's effectiveness for TB treatment [16][17][18][19][20], the body of evidence remains limited and the need for further studies is warranted.…”