Brief report
Mobile Direct Observation Treatment for Tuberculosis Patients: A Technical Feasibility Pilot Using Mobile Phones in Nairobi, Kenya

https://doi.org/10.1016/j.amepre.2010.02.018Get rights and content

Background

Growth in mobile phone penetration has created new opportunities to reach and improve care to underserved, at-risk populations including those with tuberculosis (TB) or HIV/AIDS.

Purpose

This paper summarizes a proof-of-concept pilot designed to provide remote Mobile Direct Observation of Treatment (MDOT) for TB patients. The MDOT model combines Clinic with Community DOT through the use of mobile phone video capture and transmission, alleviating the travel burden for patients and health professionals.

Methods

Three healthcare professionals along with 13 patients and their treatment supporters were recruited from the Mbagathi District Hospital in Nairobi, Kenya. Treatment supporters were asked to take daily videos of the patient swallowing their medications. Patients submitted the videos for review by the health professionals and were asked to view motivational and educational TB text (SMS) and video health messages. Surveys were conducted at intake, 15 days, and 30 days. Data were collected in 2008 and analyzed in 2009.

Results

All three health professionals and 11 patients completed the trial. All agreed that MDOT was a viable option, and eight patients preferred MDOT to clinic DOT or DOT through visiting Community Health Workers.

Conclusions

MDOT is technically feasible. Both patients and health professionals appear empowered by the ability to communicate with each other and appear receptive to remote MDOT and health messaging over mobile. Further research should be conducted to evaluate whether MDOT (1) improves medication adherence, (2) is cost effective, and (3) can be used to improve treatment compliance for other diseases such as AIDS.

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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Janice R. Cunningham was an employee of Danya International, Ltd., when this research was completed.

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