Using mHealth to improve tuberculosis case identification and treatment initiation in South Africa: Results from a pilot study

Abstract

BackgroundTuberculosis (TB) incidence in South Africa is among the highest globally. Initial loss to follow-up (ILFU), defined as not starting on TB treatment within 28 days of testing positive, is undermining control efforts. We assessed the feasibility, acceptability, and potential of a mHealth application to reduce ILFU.MethodsAn mHealth application was developed to capture patients TB investigation data, provide results and monitor treatment initiation. This was implemented in two primary health clinics (PHC) in inner-city Johannesburg. Feasibility was assessed by comparing documentation of personal details, specimen results for same individuals during implementation period (paper register and Mhealth application). Effectiveness was assessed by comparing proportion of patients with results within 48 hours, and proportion started on treatment within 28 days of testing TB positive during pre- implementation (paper register) and implementation (mHealth application) periods. In-depth interviews with patients and providers were conducted to assess acceptability of application.ResultsPre-implementation, 457 patients were recorded in paper registers [195 (42.7%) male, median age 34 years (interquartile range IQR (28–40), 45 (10.5%) sputum Xpert positive]. During implementation, 319 patients were recorded in paper register and the mHealth application [131 (41.1%) male, median age 32 years (IQR 27–38), 33 (10.3%) sputum Xpert positive]. The proportion with complete personal details: [mHealth 95.0% versus paper register 94.0%, (p = 0.54)] and proportion with documented results: [mHealth 97.4% versus paper register 97.8%, (p = 0.79)] were not different in the two methods. The proportion of results available within 48 hours: [mHealth 96.8% versus paper register 68.6%), (p <0.001)], and the proportion on treatment within 28 days [mHealth 28/33 (84.8%) versus paper register 30/44 (68.2%), (p = 0.08)] increased during implementation but was not statistically significant. In-depth interviews showed that providers easily integrated the mHealth application into routine TB investigation and patients positively received the delivery of results via text message. Time from sputum collection to TB treatment initiation decreased from 4 days (pre-implementation) to 3 days but was not statistically significant.ConclusionsWe demonstrated that implementation of the mHealth application was feasible, acceptable to health care providers and patients, and has potential to reduce the time to TB treatment initiation and ILFU in PHC settings.

Re-thinking Linkage to Care in the Era of Universal Test and Treat: Insights from Implementation and Behavioral Science for Achieving the Second 90

“…Reducing or eliminating the patient-level complexity and duration of evaluation for TB and other OIs may improve LTC [52]. Rapid near POC testing with Xpert MTB/RIF [53], POC testing with TB-LAM [54], co-locating TB and HIV diagnostic and treatment services [55], and telephonic delivery of test results to providers and patients (before or after ART initiation) have all shown promise for streamlining TB and HIV care integration [56].…”

Global eHealth capacity: secondary analysis of WHO data on eHealth and implications for kidney care delivery in low-resource settings

“…Given the wide coverage of mobile phone networks, mHealth holds promise as an important delivery tool for healthcare delivery in resource-constrained regions (figure 1). mHealth interventions are in use for diagnosis and management of various infectious diseases including malaria,39 tuberculosis40 and human immunodeficiency virus (HIV)41 and for improving maternal and fetal health42 in several developing countries. Although mHealth interventions are increasingly used for non-communicable diseases,43–45 some studies highlight only a modest impact in non-communicable disease (NCD) control, likely due to limited number of studies and impact on process of care alone 46 47.…”

Changes in Perceptions and Use of Mobile Technology and Health Communication in South Africa During the COVID-19 Lockdown: Cross-sectional Survey Study

“…Security and privacy issues have been well documented in South Africa, especially for mHealth platforms [ 22 , 41 , 42 ]. However, previous studies have shown that personal identification number (PIN)–protected mobile platforms for delivering sensitive health information are feasible and acceptable in South Africa [ 42 , 43 ]. Furthermore, a Japanese study that investigated online consumption suggests that the process of making online purchases for the first time during the lockdown has facilitated people becoming familiar with technology, thus alleviating some perceived barriers [ 44 ].…”