Impact of mobile message reminders on tuberculosis treatment outcomes in Pakistan

Abstract

The International Initiative for Impact Evaluation (3ie) is an international grant-making NGO promoting evidence-informed development policies and programmes. We are the global leader in funding, producing and synthesising high-quality evidence of what works, how, why and at what cost. We believe that better and policy-relevant evidence will make development more effective and improve people's lives. 3ie impact evaluations3ie-supported impact evaluations assess the difference a development intervention has made to social and economic outcomes. 3ie is committed to funding rigorous evaluations that include a theory-based design, use the most appropriate mix of methods to capture outcomes and are useful in complex development contexts. About this report3ie accepted the final version of this report, Impact of mobile message reminders on tuberculosis treatment outcomes in Pakistan, as partial fulfilment of requirements under grant OW1.48 issued under Open Window 1. The content has been copy-edited and formatted for publication by 3ie. All of the content is the sole responsibility of the authors and does not represent the opinions of 3ie, its donors or its board of commissioners. Any errors and omissions are the sole responsibility of the authors. Any comments or queries should be directed to the corresponding author, Shama Mohammed at shama@post.harvard.edu SummaryTuberculosis (TB) is the second leading cause of death from infectious disease globally. The treatment is long and results in side effects. Adherence to TB treatment regimens is essential for TB control, as failure to adhere can result in multi-drug-resistant TB. Mobile health offers the opportunity for remote delivery of health. We conducted a randomized controlled trial to gauge the impact of daily two-way SMS reminders on the treatment outcomes of people with drug-susceptible TB in Karachi, Pakistan.We enrolled 2,207 people with drug-susceptible TB into the trial. Once enrolled, mobile phone-based randomization was used to allocate them to either the Zindagi SMS system or a control group that received the standard of care offered by the treating clinic.The Zindagi SMS system was designed to increase adherence to TB treatment. The system is a two-way SMS reminder system in which patients were sent daily SMS messages and were asked to respond via SMS or a missed (unbilled) call to indicate that they had taken their medication. Patients who did not respond for seven days in a row were followed up over the phone. Over the study period, participants who were on the Zindagi SMS system throughout their treatment had a mean response rate of 29 per cent. Response rates started at 48 per cent in the first two weeks in the study and fell to 24 per cent (for participants in the eight month treatment regimen) or 20 per cent (for participants in the six-month treatment regimen). Eighty-five per cent of participants on the Zindagi SMS system responded to the system at least once.The study found no difference in treatment success rate between the Zindagi SMS and contro...