Hermans Sabine M, Elbireer Sawsan, Tibakabikoba Harriet, Hoefman Bas J, Manabe Yukari C
Department of Research, Infectious Diseases Institute, Makerere University College of Health Sciences, Kampala, Uganda.
Department of Internal Medicine, School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda.
Patient Prefer Adherence. 2017 Aug 31;11:1479-1487. doi: 10.2147/PPA.S135540. eCollection 2017.
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).
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.
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; =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.
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.
撒哈拉以南非洲地区结核病（TB）治疗完成率较低是耐多药的一个重要驱动因素。基于移动技术的干预措施已被证明可提高撒哈拉以南非洲地区对抗逆转录病毒疗法的依从性。我们旨在测试短信服务（SMS）干预对失访（LFU）的影响。
在这项准实验研究中，2010年11月至2011年10月期间在乌干达一家城市诊所被诊断患有结核病且能使用手机的所有成年识字HIV感染患者，在结核病治疗的前8周有资格接收依从性和预约提醒以及教育测验。使用逻辑回归将他们在治疗前8周的失访风险与2009年3月至2010年8月开始治疗的患者进行比较。
干预期间，183名登记患者中有1名（0.5%）失访，而干预前对照组的302名患者中有6名（2.0%）失访（相对危险度0.27，95%置信区间0.03 - 2.07；P = 0.22）。96%的人认为短信干预非常有帮助。发现的障碍包括电话接入中断（26%，中位数为14天）以及通过短信回复困难。教育测验的回复率低于10%。由于该干预，未出现结核病或HIV状态的意外泄露。
在本研究中，短信提醒服务对短期失访风险未显示出明显效果，由于对照组的基线风险低于预期，该研究的效力不足。短信提醒服务得到了高度评价，且没有违反保密性。重要的技术障碍对大规模实施有影响，不仅针对结核病，也针对其他疾病模式。
