Abstract
In Morocco, there are challenges in the management of high-risk tuberculosis (TB) patients, including paper-based management and a shortage of healthcare workers related to TB. Additionally, TB management has not been accounted for in various patient types, which affects treatment adherence. This study aims to examine the delivery model of TB management and the outcomes of an integrated patient management system that uses a patient-centered and community-based approach, along with mobile health technology. A total of 3605 TB patients were enrolled in this program in Morocco’s five prefectures (Rabat, Salé, Kénitra, Khemisset, Skhirat–Témara) from January 2018 to December 2019. Patients were managed based on demographic characteristics, socioeconomic status, areas (rural or urban), health literacy levels, and distance to primary health centers. Our mobile health intervention “smart pillbox” was interposed with high-risk TB patients, along with patient education. The rate of successful treatment was 92.2%, which was higher than the national rate (88%). The “lost to follow-up” rate was 4.1%, which was significantly lower than the existing non-adherence rate of 7.9%. Therefore, integrated patient management for TB patients in Morocco is more effective than the existing conventional programs. This comprehensive approach provides an alternative method for countries with limited resources.
Highlights
We analyzed a total of 3438 patients enrolled from 2018 to 2019 in integrated patient management
3169 patients enrolled in monitoring-based Integrated Disease Management System (MIDMS) and 204 patients used smart pillbox
During the previous stage of the program (2014–2018), smart pillbox, telephone, and TB patient’s management platform, MIDMS, were used by most beneficiaries. During this stage, we found that the treatment success rate could be increased with only MIDMS and telephone communication depending on the type of city, patient’s living condition, and educational level
Summary
Tuberculosis (TB) is one of the leading causes of death worldwide, with a total. The cumulative reduction between 2015 and 2018 was only 6.3%, which is not enough to reach End TB Strategy target of 20% [1]. Pharmacotherapy is an important case management strategy, alongside TB case finding in countries with high TB burden [2]. Treatment adherence interventions are challenging for TB patients [3]. When patients are lost to follow-up, they increase the risk of treatment failure and drug resistance [4]. Lost to follow-up situations often occur to a larger extent in re-treatment cases than in new treatment cases and within the first two months of treatment initiation [5]. Because TB requires long-duration treatment, it is important to monitor
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