Mobile phone interventions for tuberculosis should ensure access to mobile phones to enhance equity - a prospective, observational cohort study in Peruvian shantytowns.

Matthew J Saunders,Sumona Datta,Carlton A Evans,Claudio Rocha,Marco A Tovar,Karine Zevallos,Rosario Montoya,Niamh Herlihy,Eric Ramos,Tom Wingfield

doi:10.1111/tmi.13087

Abstract

ObjectivesMobile phone interventions have been advocated for tuberculosis care, but little is known about access of target populations to mobile phones. We studied mobile phone access among patients with tuberculosis, focusing on vulnerable patients and patients who later had adverse treatment outcomes.MethodsIn a prospective cohort study in Callao, Peru, we recruited and interviewed 2584 patients with tuberculosis between 2007 and 2013 and followed them until 2016 for adverse treatment outcomes using national treatment registers. Subsequently, we recruited a further 622 patients between 2016 and 2017. Data were analysed using logistic regression and by calculating relative risks (RR).ResultsBetween 2007 and 2013, the proportion of the general population of Peru without mobile phone access averaged 7.8% but for patients with tuberculosis was 18% (P < 0.001). Patients without access were more likely to hold a lower socioeconomic position, suffer from food insecurity and be older than 50 years (all P < 0.01). Compared to patients with mobile phone access, patients without access at recruitment were more likely to subsequently have incomplete treatment (20% vs. 13%, RR = 1.5; P = 0.001) or an adverse treatment outcome (29% vs. 23% RR = 1.3; P = 0.006). Between 2016 and 2017, the proportion of patients without access dropped to 8.9% overall, but remained the same (18%) as in 2012 among the poorest third.ConclusionAccess to mobile phones among patients with tuberculosis is insufficient, and rarest in patients who are poorer and later have adverse treatment outcomes. Thus, mobile phone interventions to improve tuberculosis care may be least accessed by the priority populations for whom they are intended. Such interventions should ensure access to mobile phones to enhance equity.

Highlights

In 2016, tuberculosis (TB) was estimated to have killed 1.6 million people and ranked as the leading cause of death from an infectious disease worldwide.[1]
Between 2016 and 2017, the proportion of patients without access dropped to 8.9% overall, but remained the same (18%) as in 2012 among the poorest third
Mobile phone interventions to improve tuberculosis care may be least accessed by the priority populations for whom they are intended

Summary

Introduction

In 2016, tuberculosis (TB) was estimated to have killed 1.6 million people and ranked as the leading cause of death from an infectious disease worldwide.[1]. In its End TB Strategy, WHO highlights the importance of patient-centred care to improve diagnosis and reduce adverse treatment outcomes.[4] To make the ambitious vision set out in this strategy a reality, innovative and low-cost solutions are required to complement traditional National. In 2015, WHO established a Global Task Force on Digital Health for TB and, together with the European Respiratory Society, published an agenda detailing how digital health interventions could be promoted and integrated into national operational plans to implement the End TB Strategy.[6,7] During this consultation, several “target product profiles” were developed to define the features of desired digital health solutions and stimulate further interest from potential developers.[8] These include interventions to improve patient care; support disease surveillance and monitoring; facilitate program management; and provide platforms for eLearning

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