Brief reportMobile Direct Observation Treatment for Tuberculosis Patients: A Technical Feasibility Pilot Using Mobile Phones in Nairobi, Kenya
Introduction
The rapid adoption of mobile phones in developing countries creates an unprecedented opportunity to reach and improve the level of care for underserved, at-risk populations with HIV/AIDS or tuberculosis (TB). The majority of studies in developing countries focus on the use of Short Message Service (SMS), also known as text messaging, for reminder systems, data gathering, and some health messaging.1 The Mobile Direct Observation of Treatment (MDOT) proof-of-concept pilot was conceived to assess the technical feasibility of a new application—remote Directly Observed Treatment (DOT) for TB patients using mobile phone video capture and transmission functionality.
The DOT generally requires a healthcare professional to observe patients face-to-face taking their daily TB medication. The most at-risk population for noncompliance and for developing multi-drug–resistant TB is the one that does not participate in daily observation. The MDOT project seeks to reduce the recognized burden of travel demands on patients and care providers while expanding the reach of DOT to TB patients not currently receiving regular DOT. Aligned with the global Stop TB initiative, MDOT focuses on expansion of DOT and TB health messaging grounded in behavioral health and social marketing principles.2, 3, 4
The primary objective was to assess technical feasibility, including patient and health provider receptivity to remote DOT through mobile video. The secondary objective was to assess patient preferences and receptivity to receiving TB health messages on a mobile phone.
Section snippets
Methods
Video-capable mobile telephones were provided to patients undergoing treatment for TB. Each patient's treatment supporter (a relative or friend) was asked to video-capture the patient taking his or her dose of TB medications with the mobile phone. Each day, the patient sent the new video via mobile messaging service (MMS) to a secure central database where it was automatically logged and time- and date-stamped. Monday through Friday, medical nurses reviewed these videos. Patients also received,
Results
Of the original 13 patients, 12 completed the program and 11 completed all three questionnaires (five men, six women). Each video was 5–9 seconds in length. Of the anticipated videos, it was estimated that 25% were not received as a result of technical issues preventing transmission during the first week; 15% for reasons unknown; and another 10% as a result of lost phones, one being stolen (subsequently replaced), and one patient was lost to follow-up. MDOT monitoring alerted the nurses to the
Receptivity
Survey comments from both patients and nurses indicated that access to each other for timely, ad hoc communications was empowering for both groups. Patients also indicated they now felt someone cared for them and they felt more optimism for being cured.
Nurse receptivity was high. They noted that MDOT provides a mechanism for providing a higher level of care and timely, proactive intervention to address real-time needs, such as medication side effects or counseling against compliance default.
Conclusion
Technical feasibility and receptivity to the MDOT solution was validated with both patients and TB healthcare professionals. These pilot results suggest there is value in conducting a larger-scale research project to evaluate whether MDOT (1) improves medication adherence, (2) is cost effective compared to other adherence technologies or methods, and (3) can be used to enhance medication adherence for the treatment of other diseases such as AIDS. The authors also believe the MDOT technology is
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Behavior change interventions delivered by mobile telephone short-message service
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WHO's new Stop TB strategy
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Janice R. Cunningham was an employee of Danya International, Ltd., when this research was completed.