Utilization of mobilehealth technologies to improve treatment compliance among tuberculosis patients in Kisumu, Siaya and Homa bay counties of Kenya
Kirui, Joyce Chepkirui
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Tuberculosis is increasingly becoming one of the leading health concerns globally. There were 8.6 million new TB cases in 2012 and 1.3 million TB deaths (WHO, 2013).HIV/AIDS has profound impact on the TB epidemic in Kenya, where up to 60% of TB patients are feared to be HIV co-infected and the mortality rate attributed to TB in this group being above 130 per 100, 000 (DLTLD, 2009).Poor adherence to the antimicrobial regimen has been cited as one of the most challenging problems for TB treatment. Multidrug-resistant TB develops when the TB bacterium develops resistance to several TB drugs as a result of low drug levels. If doses are missed or treatment interrupted, resistance can emerge rapidly (Singleton et al., 1997). The bacterium adapts itself to reproduce in the presence of low drug levels, and gradually develops greater resistance to the drug. The MDR TB and XDR TB can also be transmitted from one person to another. However, widespread progress at controlling the pandemic is restricted by poor infrastructure and increasing health-system costs. As more patients are enrolled into the TB treatment regimen, health systems are compelled to find ways to improve treatment adherence through cost-effective, supportive interventions. mHealth (mobile technologies for health) has been advocated as an innovative tool for improving both access to and quality of health care in underserved and remote locations low and middle-income countries Mobile phone access in has risen dramatically, creating significant opportunities for creative and cost-effective implementation of mHealth interventions. However, despite the growing interest in mHealth, there remains limited evidence on their acceptability and impact on health care outcomes. Anti- TB drug adherence is only one of many modifiable health behaviours that can be targeted through the use of mobile phones. The list includes, among others, adherence to treatment regimens for HIV/AIDS, malaria and non-communicable diseases, and the uptake of preventive interventions, such as childhood vaccinations. The main objective of this study is to investigate the effects of utilization of mobile technologies in improving treatment compliance among Tuberculosis patients in Kisumu, Siaya and Homa Bay Counties of Nyanza North TB control region of Kenya. This will be a randomized, parallel, multi-site controlled trial. Patients will be randomly assigned (1: 1) by simple randomization to the intervention (SMS or voice calls) or to standard care (control group) using a table of random numbers. Once recruited, follow up will be undertaken for a period of 6-9 months. Urine tests at first, second, fourth and sixth months of treatment will be collected to evaluate patient adherence to therapy. Besides,a structured questionnaire will be administered to each participant at recruitment and during follow up visits while baseline data on the current treatment adherence will be obtained by Secondary data review. Besides, qualitative data will be collected using Focus Group Discussions and Key Informant Interviews. The ethical clearance to conduct the study will be sought from Kenyatta University and the National Council for Science, Technology and Innovation. Participants will be required to provide a written informed consent at enrolment in a language they understand. All patients will be assured of confidentiality and anonymity. The results of this study will provide evidence of whether or not policy makers can adopt mHealth adherence intervention as best practice to be used alone or in combination with other proven adherence interventions such as DOTs.