Department of Infectious Diseases, Huashan Hospital, Fudan University, Shanghai, China.
Department of Tuberculosis Control, Shanghai Municipal Center for Disease Control and Prevention, Shanghai, China.
Front Public Health. 2023 Apr 27;11:923319. doi: 10.3389/fpubh.2023.923319. eCollection 2023.
Poor adherence increases the risk of unfavorable outcomes for tuberculosis (TB) patients. Mobile health (mHealth) reminders become promising approaches to support TB patients' treatment. But their effects on TB treatment outcomes remain controversial. In this prospective cohort study, we evaluated the effect of the reminder application (app) and the smart pillbox on TB treatment outcomes compared with the standard care in Shanghai, China.
We recruited new pulmonary TB (PTB) patients diagnosed between April and November 2019 who were aged 18 or above, treated with the first-line regimen (2HREZ/4HR), and registered at Songjiang CDC (Shanghai). All eligible patients were invited to choose the standard care, the reminder app, or the smart pillbox to support their treatment. Cox proportional hazard model was fitted to assess the effect of mHealth reminders on treatment success.
260 of 324 eligible patients enrolled with 88 using standard care, 82 the reminder app, and 90 the smart pillbox, followed for a total of 77,430 days. 175 (67.3%) participants were male. The median age was 32 (interquartile range [IQR] 25 to 50) years. A total of 44,785 doses were scheduled for 172 patients in the mHealth reminder groups during the study period. 44,604 (99.6%) doses were taken with 39,280 (87.7%) monitored by the mHealth reminders. A significant time-dependent downward linear trend was observed in the monthly proportion of dose intake ( < 0.001). 247 (95%) patients were successfully treated. The median treatment duration of successfully treated patients in the standard care group was 360 (IQR 283-369) days, significantly longer than those in the reminder app group (296, IQR 204-365, days) and the smart pillbox group (280, IQR 198-365, days) (both < 0.01). Using the reminder app and the smart pillbox was associated with 1.58 times and 1.63 times increase in the possibility of treatment success compared with the standard care, respectively (both < 0.01).
The reminder app and the smart pillbox interventions were acceptable and improved the treatment outcomes compared with the standard care under the programmatic setting in Shanghai, China. More high-level evidence is expected to confirm the effect of mHealth reminders on TB treatment outcomes.
较差的依从性会增加结核病（TB）患者不良结局的风险。移动医疗（mHealth）提醒成为支持 TB 患者治疗的有前景的方法。但它们对 TB 治疗结局的影响仍存在争议。在这项前瞻性队列研究中，我们评估了提醒应用程序（app）和智能药盒与中国上海标准护理相比对 TB 治疗结局的影响。
我们招募了 2019 年 4 月至 11 月期间诊断为新的肺结核（PTB）的年龄在 18 岁及以上、接受一线方案（2HREZ/4HR）治疗并在松江疾控中心（上海）登记的患者。所有符合条件的患者均被邀请选择标准护理、提醒 app 或智能药盒来支持他们的治疗。Cox 比例风险模型用于评估 mHealth 提醒对治疗成功的影响。
在 324 名符合条件的患者中，有 260 名入组，其中 88 名接受标准护理，82 名接受提醒 app，90 名接受智能药盒，共随访 77430 天。175 名（67.3%）参与者为男性。中位年龄为 32 岁（四分位距[IQR] 25 至 50 岁）。在研究期间，mHealth 提醒组有 44785 剂计划剂量，172 名患者接受了治疗。44604 剂（99.6%）被服用，其中 39280 剂（87.7%）通过 mHealth 提醒进行了监测。剂量摄入的月比例呈显著的时间依赖性下降线性趋势（<0.001）。247 名（95%）患者成功治疗。标准护理组成功治疗患者的中位治疗持续时间为 360 天（IQR 283-369 天），显著长于提醒 app 组（296 天，IQR 204-365 天）和智能药盒组（280 天，IQR 198-365 天）（均<0.01）。与标准护理相比，使用提醒 app 和智能药盒分别使治疗成功的可能性增加了 1.58 倍和 1.63 倍（均<0.01）。
提醒 app 和智能药盒干预措施在上海的项目环境下是可以接受的，并改善了治疗结局，优于标准护理。预计会有更多的高级证据来证实 mHealth 提醒对 TB 治疗结局的影响。
