Feasibility of a short message service (SMS) intervention to deliver tuberculosis testing results in peri-urban and rural Uganda

Abstract

BackgroundPre-treatment loss to follow-up is common for patients diagnosed with tuberculosis (TB) in high-burden countries. Delivering test results by Short-Messaging-Service (SMS) is increasingly being considered as a solution, but there is limited information about its feasibility as a public health tool in low resourced settings.ObjectiveWe sought to assess the feasibility of utilizing SMS technology to deliver TB test results during routine TB diagnostic evaluation in Uganda.MethodsWe conducted a single arm interventional pilot study at four community health centers in Uganda that referred sputum samples to a district hospital for GeneXpert-MTB/RIF (Xpert) testing (Cepheid, USA). Using existing GxAlert-software (SystemOne,USA), we set up an automated SMS platform to send Xpert results to patients and referring health centers. We assessed each step of the SMS delivery cascade for consecutive patients who presented to these four community health centers between December 2015 and March 2016 and underwent Xpert testing.ResultsOf 233 patients enrolled, 161 (69%) had phone numbers recorded on individual Xpert referral forms. Phone numbers were entered into Xpert device software in the correct format for 152 (94%) patients. GxAlert-software generated an automated SMS reporting Xpert results for 151 (99%) patients and delivered it successfully to mobile phone service providers for 145/151 (96%). Of the 123 patients reached by phone to determine receipt of test results, 114 (93%) confirmed SMS receipt. SMS-based delivery of Xpert results was verified for 114/233 (49%) patients overall. In contrast, phone calls to health centers confirmed that health centers received messages for 222/233 (95%) patients.ConclusionReporting Xpert results via automated SMS is technically feasible and results in approximately half of patients receiving their test results immediately. Additional research should be done to address process inefficiencies in order to maximize impact of this technology and link its successful utilization to improved patient outcomes.

Mobile health applications for disease screening and treatment support in low-and middle-income countries: A narrative review

“…The advent of mHealth interventions has a significant transformative effect on healthcare delivery, particularly in treatment support, diagnostic purposes, health monitoring, data accuracy, and many others [ 1 , 35 , 36 , 37 ]. The integration of mobile health technology into the current clinical services is providing new different channels of quality healthcare delivery [ 37 ].…”

“…The advances in mobile technologies and applications are driving the transformation in health services delivery globally. Mobile health (mHealth) is defined as the use of voice calls, short message service (SMS), wireless transmission of data, and mobile phone applications to support healthcare provision [ 1 ]. Other forms of technologies being employed to support healthcare delivery are telehealth, telemedicine, telecare, virtual health, digital health, and others.…”

Implementation science to improve the quality of tuberculosis diagnostic services in Uganda

“…With respect to Xpert utilization, 83% of smear-negative patients were referred for Xpert testing within one day and 76% of Xpert-positive patients initiated treatment within 14 days, both considerable improvements relative to routine care. In addition, automated notification of Xpert results reached referring health centers 95% of the time and patients 49% of the time [28]. These data demonstrate that the theory-informed SIMPLE TB strategy is feasible and effective at improving the quality of TB diagnostic evaluation.…”

Scale-up and impact of digital and molecular diagnostic technologies on TB diagnosis and timely linkage to care in Tajikistan

“…Sufficient funding should be secured to support the routine maintenance for GxAlert and OpenMRS systems so that servers are always functioning and data can be transferred in a timely way to all stakeholders including patients. Research similar to that done in Uganda [23] must be carried out on how well health workers, health centers and patients themselves can receive, interpret and act upon SMS messages being sent from GxAlert systems. Digital technology experts need to link the two systems together and consider issues such as interoperability, confidentiality, data ownership, unique patient identifiers and data security [24], so that GeneXpert test results can be reliably and safely sent straight from the GxAlert system to Open MRS thus missing out the human element.…”