Abstract
BackgroundTuberculosis (TB) incidence in South Africa is among the highest globally. Initial loss to follow-up (ILFU), defined as not starting on TB treatment within 28 days of testing positive, is undermining control efforts. We assessed the feasibility, acceptability, and potential of a mHealth application to reduce ILFU.MethodsAn mHealth application was developed to capture patients TB investigation data, provide results and monitor treatment initiation. This was implemented in two primary health clinics (PHC) in inner-city Johannesburg. Feasibility was assessed by comparing documentation of personal details, specimen results for same individuals during implementation period (paper register and Mhealth application). Effectiveness was assessed by comparing proportion of patients with results within 48 hours, and proportion started on treatment within 28 days of testing TB positive during pre- implementation (paper register) and implementation (mHealth application) periods. In-depth interviews with patients and providers were conducted to assess acceptability of application.ResultsPre-implementation, 457 patients were recorded in paper registers [195 (42.7%) male, median age 34 years (interquartile range IQR (28–40), 45 (10.5%) sputum Xpert positive]. During implementation, 319 patients were recorded in paper register and the mHealth application [131 (41.1%) male, median age 32 years (IQR 27–38), 33 (10.3%) sputum Xpert positive]. The proportion with complete personal details: [mHealth 95.0% versus paper register 94.0%, (p = 0.54)] and proportion with documented results: [mHealth 97.4% versus paper register 97.8%, (p = 0.79)] were not different in the two methods. The proportion of results available within 48 hours: [mHealth 96.8% versus paper register 68.6%), (p <0.001)], and the proportion on treatment within 28 days [mHealth 28/33 (84.8%) versus paper register 30/44 (68.2%), (p = 0.08)] increased during implementation but was not statistically significant. In-depth interviews showed that providers easily integrated the mHealth application into routine TB investigation and patients positively received the delivery of results via text message. Time from sputum collection to TB treatment initiation decreased from 4 days (pre-implementation) to 3 days but was not statistically significant.ConclusionsWe demonstrated that implementation of the mHealth application was feasible, acceptable to health care providers and patients, and has potential to reduce the time to TB treatment initiation and ILFU in PHC settings.
Highlights
There are an estimated 834 cases of tuberculosis (TB) per 100 000 population diagnosed annually in South Africa [1]
We demonstrated that implementation of the mHealth application was feasible, acceptable to health care providers and patients, and has potential to reduce the time to TB treatment initiation and Initial loss to follow-up (ILFU) in primary health clinics (PHC) settings
One of the reasons why the mHealth application reduced the time for patients to start TB treatment is that patients returned to the clinic when they were notified of result availability
Summary
There are an estimated 834 cases of tuberculosis (TB) per 100 000 population diagnosed annually in South Africa [1]. Initial loss to follow-up (ILFU) is defined as not starting TB treatment within 28 days of a microbiologically confirmed TB test. ILFU is estimated to occur among 17–25% of all persons diagnosed with TB in South Africa [3,4,5]. Health system-related reasons for ILFU include: delays in clinics receiving results or failure to receive results from laboratories; the need for patients to return repeatedly to clinics to enquire about results, and long waiting periods to receive care in health facilities. Initial loss to follow-up (ILFU), defined as not starting on TB treatment within 28 days of testing positive, is undermining control efforts. Acceptability, and potential of a mHealth application to reduce ILFU.
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