The Aurum Institute, Johannesburg, South Africa.
School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
PLoS One. 2018 Jul 3;13(7):e0199687. doi: 10.1371/journal.pone.0199687. eCollection 2018.
Tuberculosis (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.
An 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.
Pre-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.
We 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.
南非的结核病（TB）发病率在全球范围内位居前列。初始失访（ILFU），即检测呈阳性后 28 天内未开始进行 TB 治疗，这正在破坏控制工作。我们评估了移动健康应用程序减少 ILFU 的可行性、可接受性和潜力。
开发了一个移动健康应用程序来获取患者的 TB 调查数据，提供结果并监测治疗的启动。该应用程序在约翰内斯堡市中心的两个初级保健诊所（PHC）实施。通过比较同一患者在实施期间的个人详细信息记录（纸质登记簿和 Mhealth 应用程序），评估了可行性。通过比较在实施前（纸质登记簿）和实施期间（移动健康应用程序）48 小时内获得结果的患者比例，以及在检测 TB 阳性后 28 天内开始治疗的患者比例，评估了效果。对患者和提供者进行深入访谈，以评估应用程序的可接受性。
在实施前，有 457 名患者在纸质登记簿上记录[195 名（42.7%）男性，中位年龄 34 岁（四分位距 IQR（28-40），45 名（10.5%）痰液 Xpert 阳性]。在实施期间，有 319 名患者在纸质登记簿和移动健康应用程序上记录[131 名（41.1%）男性，中位年龄 32 岁（IQR 27-38），33 名（10.3%）痰液 Xpert 阳性]。完全个人详细信息的比例：[移动健康 95.0%对纸质登记簿 94.0%，（p = 0.54）]和记录结果的比例：[移动健康 97.4%对纸质登记簿 97.8%，（p = 0.79）]在两种方法中没有差异。48 小时内获得结果的比例：[移动健康 96.8%对纸质登记簿 68.6%，（p <0.001）]和 28 天内开始治疗的比例[移动健康 28/33（84.8%）对纸质登记簿 30/44（68.2%），（p = 0.08）]在实施期间有所增加，但没有统计学意义。深入访谈表明，提供者轻松地将移动健康应用程序整合到常规 TB 调查中，患者积极通过短信接收结果。从痰液采集到开始 TB 治疗的时间从 4 天（实施前）减少到 3 天，但没有统计学意义。
我们证明了移动健康应用程序的实施是可行的，得到了医疗保健提供者和患者的认可，并且具有减少初级保健环境中 TB 治疗启动和初始失访的潜力。
