Background
Methods
Criteria for considering studies for this review
Type of studies
Types of participants
Types of interventions
Type of outcome measures
Primary outcomes
Secondary outcomes
Search methods for identification of studies
Databases
Conference proceedings
Searching other sources
Reference lists
Data collection and analysis
Selection of studies
Study | Reason for exclusion |
---|---|
Mohammed[27] | No appropriate control group. |
Mahmud[33] | Text messaging intervention was delivered to community health care workers in order to improve patient-physician communication. Therefore, the study did not assess the use of SMS text messaging for promoting adherence to TB treatment in patients. |
No appropriate control group. | |
Liu[34] | The study did not report any of the outcomes of interest. |
Kao[30] | This is a descriptive study. No appropriate control group. |
Batra[31] | No appropriate control group. |
A pilot study in which text messages are bundled with video messages and is not possible to separate the effects of the text messages alone. |
Data extraction and management
Assessment of risk of bias in included studies
Measures of treatment effect
Dealing with missing data
Data synthesis and investigation of heterogeneity
Sensitivity analyses
Presenting and reporting of results
Study ID | Bridges.org [37] |
---|---|
Methods
| The evaluation used both qualitative and quantitative data collection methods. Structured interviews using a questionnaire were conducted among patients and staff. Additional information was collected from patient records, background documents and reports and clinic visits. |
Participants
| Patients, clinic staff, TB experts and managers at the City of Cape Town Health Directorate. |
Interventions
| Daily SMS reminders were used to remind patients who self-administer their medication (i.e. not on DOTS) to take their drugs. |
Outcomes
| 1) Health Outcomes serve as a proxy for TB treatment adherence |
On Cue Compliance service (from 221 patients with records available): | |
Cure rate = 62.35% | |
Completion rate = 10.59 | |
Treatment success rate = 72.94% | |
Clinic-based DOTS (in particular new smear-positive TB patients in the third quarter of 2003): | |
Cure rate = 66.4% | |
Completion rate = 3.0% | |
Treatment success rate = 69.4% | |
Health outcomes between groups were similar. | |
2) Patient satisfaction with the SMS intervention | |
Notes
| |
Study ID
|
Broomhead[38] |
Methods
| A retrospective analysis comparing the costs and health outcomes of the DOTS-SIMPill cohort with DOTs-only controls. |
Participants
| 24 New smear-positive TB patients who presented to Betty Gaetsewe Clinic and commenced the 6-month treatment on first line and anti-TB medication enrolled for SMS based medical adherence support (MAS) pilot in 2005 and 96 DOTs-only control patients presenting for the months during the pilot was running. |
Frequency matching was used to match MAS pilot participants with controls in a 4:1 ratio. Matching was on TB treatment, local clinic, gender and age. | |
Interventions
| Intervention: |
MAS system. It consists of a device that attaches to the standard pill bottle or blister pack and sends an SMS every time the patient opens the bottle to a Web-base application. This is taken as a proxy for TB treatment adherence. | |
Control: | |
DOTS-only controls | |
Outcomes
| Health outcomes (i.e. smear conversion rate and TB cure rate) served as a proxy for TB treatment adherence |
MAS group: | |
Smear conversion rate = 62.5% | |
TB cure rate = 75.0% | |
Control group: | |
Smear conversion rate = 38.4% | |
TB cure rate = 32.3% | |
Both the smear conversion rate and TB cure rate were significantly higher for the MAS group compared with the control group | |
Smear conversion rate: RR 1.62 (95% CI 1.09-2.42) | |
TB cure rate: RR 2.32 (95% CI 1.60 – 3.36) | |
Notes
| |
Study ID
|
Iribarren[40] |
Methods
| A parallel design randomized control pilot study |
Participants
| 37 newly diagnosed TB patients (18 in the intervention group and 19 in the control group) |
Interventions
| Intervention: |
Standard Care plus a SMS-based intervention which included instructing patients to “text in” after self-administration of medication; reminders/check-in when patient did not “text in”; receipt of bi-weekly SMS education messages; and the option to consult during the first two months intensive treatment phase. | |
FrontlineSMS network was employed. | |
Control: | |
Self-administration of TB treatment (standard of care) | |
Outcomes
| Of the intervention group, 77% (22%-100%) notified (i.e. self report via text message) that they took their medication over a 60 day period. The control group was asked to complete medication calendars over the same period but only 53% of them returned the calendars. We found that the SMS intervention did not statistically improve adherence to TB treatment (RR 1.49 [95% CI 0.90-2.42]). |
Notes
| Additional information obtained from the primary author. The full article for the corresponding conference abstract is yet to be published. |
Study ID
|
Owiti[39] |
Methods
| A feasibility pilot study |
Participants
| 187 TB patients with mobile phones |
Interventions
| Intervention: |
Receiving text messages in Ki-Swahili which were delivered one day prior to the patients’ clinic appointment | |
Control: | |
Not receiving text messages (due to technical reasons) | |
Clinic attendance on scheduled days | |
Outcomes
| • Received at least one text: 101/150 |
• Did not receive a text (due to technical reasons): 16/37 | |
RR 1.56 [95% CI 1.06-2.29]; p-value <0.0007. | |
Notes
| • We noted an error in the table presented by the authors which occurred in the rows for males and females, in particular, the cell containing data for males who did not receive a text message were transposed with that containing data for females who received at least one text message. However, we did not use that information. Instead, we used the data in the total row, that was corroborated with the information in the abstract text. |
• The full article for the corresponding conference abstract is yet to be published (Dr P. Owti, personal communication) |
Study ID | Bridges.org [37] | |
---|---|---|
Bias | Authors judgment | Support for judgment |
Blinding of participants and personnel (performance bias)
| Unclear risk | Blinding of participants and study personal were not reported. |
Blinding of outcome assessment (detection bias)
| Unclear risk | The blinding of outcome assessors was not specified. |
Incomplete outcome data (attrition bias)
| Unclear risk | 88/309 missing from the intervention group; missing data are not reported for the control group. It remains unclear whether the proportion of missing data was balanced across groups |
Selective reporting (reporting bias)
| Low risk | The outcome reporting in the study report was comparable with the outcomes pre-specified in the methods. |
Other bias
| Unclear risk | Given the observational nature of the study there might be confounding variables that were not accounted for in the analysis (comparisons for health outcomes which serve as a proxy for TB treatment adherence) |
Study ID
|
Broomhead [[38] | |
Bias
| Authors judgment | Support for judgment |
Blinding of participants and personnel (performance bias)
| Unclear risk | Blinding of participants and study personal were not reported. |
Blinding of outcome assessment (detection bias)
| Unclear risk | The blinding of outcome assessors was not specified. |
Incomplete outcome data (attrition bias)
| Low risk | No missing data in both the intervention and the control group. |
Selective reporting (reporting bias)
| High risk | Comparisons for health outcomes (i.e. smear conversion rate, cure rate and MDR TB rate) mentioned in text in the results but only smear conversion rate and cure rate (with significant results) were reported in the table. |
Other bias
| Unclear risk | Given the observational nature of the study there might be confounding variables that were not accounted for in the analysis (comparisons for health outcomes which serve as a proxy for TB treatment adherence) |
Study ID
|
Iribarren[40] | |
Bias
|
Authors judgment
|
Support for judgment
|
Random sequence generation
| Unclear risk | The random sequence generation process was not described. |
Allocation concealment
| Unclear risk | The method of concealment was not described. |
Blinding of participants and personnel (performance bias)
| Unclear risk | Blinding of participants and study personal were not reported. |
Blinding of outcome assessment (detection bias)
| Unclear risk | The blinding of outcome assessors was not specified |
Incomplete outcome data (attrition bias)
| High risk | Additional information obtained from the primary author revealed that no data are missing for the intervention group and 9/19 for the control group. Reasons for missing data were due to non-responsiveness of the intervention group. |
Selective reporting (reporting bias)
| High risk | Initial efficacy outcomes (notification rates and sputum conversion rates) and patient acceptability were mentioned in the methods, but only patient notification rates, follow sputum smear culture and patient acceptability reported in the results. Additional obtained from the primary author revealed that data on the final outcomes are yet to be collected and published. |
Other bias
| Unclear risk | The lack of description of the random sequence generation process and the method of concealment suggests that there might be confounding variables that were not accounted for in the analysis (comparisons for TB treatment adherence) |
Study ID
|
Owiti[39] | |
Bias
|
Authors judgment
|
Support for judgment
|
Blinding of participants and personnel (performance bias)
| Unclear risk | Blinding of participants and study personal were not reported. |
Blinding of outcome assessment (detection bias)
| Unclear risk | The blinding of outcome assessors was not specified |
Incomplete outcome data (attrition bias)
| Low risk | No missing data in those receiving text reminders and not receiving text reminders |
Selective reporting (reporting bias)
| Unclear risk | Inadequately information provided as this was a conference abstract. |
Other bias
| Unclear risk | Given the observational nature of the study there might be confounding variables that were not accounted for in the analysis (comparisons for scheduled clinic appointment attendance which serves as a TB treatment adherence) |
Results
Study flow and description of studies
Excluded studies
Included studies
Risk of bias in included studies
Effects of intervention
Ongoing studies
Item/study | Lester [41] | Mohammed [42] | Jiang [43] |
---|---|---|---|
Trial name or title
| A Randomized Controlled Trial to Examine the Effectiveness of Use of Mobile Phones and Text Messaging to Improve Adherence to Treatment of Latent TB | Monitoring Patient Compliance with Tuberculosis Treatment Regimens | Cluster randomized trial of using mobile text messaging and a medication monitor in tuberculosis (TB) case management |
Methods
| Open-label multicenter randomized controlled trial | Allocation: Randomized, Intervention Model: Parallel Assignment, Masking: Open Label, Primary Purpose: Supportive Care. | Cluster Randomized Controlled Trial |
Participants
| Subjects initiating treatment for latent TB infection who are aged above 18 years, who own a mobile phone or share mobile phone access with a household member who consents to participate. In addition, the subject should be able to read text-messages in English or has a family member or friend that can provide translation and assistance with text-messages during the duration of the study | Inclusion criteria: | Inclusion criteria: |
• New, spear-positive drug susceptible TB patients who have been on treatment for less than two weeks | • TB patients, smear-positive or smear-negative, recruited from the study clusters (county/district) | ||
• 15 years and older | • Willing to participate in the study | ||
• Conscious without any mental disease | |||
• Access to a mobile phone (self-report) | |||
• Conscious without any visual, auditory or language impairment | |||
• At least 18 years old | |||
• Intending to reside in Karachi for the duration of treatment |
• Patient or family member is able to read a short message service (SMS)/ text and use medication monitor after training | ||
Exclusion criteria: | |||
Exclusion criteria: | |||
• Does not meet inclusion criteria | |||
• Patients who do not have regular access to a mobile phone |
• Patients with tuberculosis pleurisy | ||
• Patients with no sputum smear data at tuberculosis diagnosis | |||
• Patients who have previously received treatment | |||
Patients who have another member in their household who is already a part of the study | |||
Interventions
| Weekly text messages will be sent to the participants in the intervention arm asking them how they are | Other: Interactive Reminders | This is a cluster randomized non blinded trial. Clusters are defined as a county or district. This is a four armed trial, three intervention arms and one control arm: |
Daily SMS reminders sent to TB patients at a pre-specified time. They are asked to respond to the reminders. If a response is not received within two hours, they are sent another reminder for up to three hours per day | |||
1. Mobile phone | |||
Patients are provided with mobile phones as a reminding tool to take their tuberculosis medication. On medication intake days patients are sent a SMS to remind them to take their medication. They respond with a brief message when medication is taken. Doctors in TB dispensary collect the SMS feedback from patients to assess how many doses are missed in a month. Based on the missed doses, additional intervention and incentive mechanisms are implemented such as visits from the township/village doctor and incentives per visit given to the township/village doctor. | |||
2. Medication monitor | |||
Patients are provided with a medication monitor box with reminding functions. This tool is used to remind patients to their tuberculosis medication and also records drug intake. Doctors at the TB dispensary collect the drug intake record from medication monitor monthly to assess that how many doses are missed in a month. Based on the missed doses, additional intervention and incentive mechanism are implemented as described in the mobile phone intervention (1) | |||
3. Mobile phone and medication monitor | |||
Patients are provided with both the mobile phone and medication monitor box with reminding function for as tools for communication, reminding and recording drug intake. The drugs intake record from medication monitor and SMS from patients are collected monthly, and the number of doses missed in a month is calculated using the drug intake record of the medication monitor. Based on the missed doses, additional intervention and incentive mechanism are implemented as described in the mobile phone intervention (1) | |||
4. Control | |||
Patients are managed based on the current standard of care. | |||
All patients will be followed up to the end of tuberculosis treatment. | |||
Outcomes
| Primary outcome: Successful completion of LTBI treatment regimens. [Time Frame: 4 or 9 months]. Successful treatment completion is defined as taking at least 80% of the doses of INH prescribed within 12 months or at least 80% of the disease of RIF prescribed within 6 months | Primary outcomes: | Primary outcome: |
• Treatment Outcomes [Time Frame: After 6 to 8 months of treatment] [Designated as safety issue: No]. The investigators will compare clinically reported treatment outcomes between the intervention and control groups. | |||
• The mean proportion of months on TB treatment where at least 3 doses were missed in a month (this is based on pill count data from the medication monitoring box) | |||
• Sputum conversion [ Time Frame: At 2, 5, and 6/7 months of treatment ] [ Designated as safety issue: No ]The investigators will look at sputum test results for patients at months 2, 5, and 6/7 of their treatment to compare when sputum conversion occurs between the intervention and control group at these three periods during their treatment. | |||
Secondary outcomes: | |||
• The mean proportion of months a patient has at least 7 doses missed | |||
• The mean proportion of overall missed doses | |||
• Treatment compliance [Time Frame: Monthly visits for 6 to 8 months of treatment ] [ Designated as safety issue: No ]The regularity of treatment will be measured using urinalysis tests that detect the presence of isoniazid or rifampicin, a first line drug for TB treatment, in patients' urine. These results will be collected through monthly "surprise" visits to the participants' houses. The number of negative results will be compared between treatment and control groups. | |||
• Proportion of patients defined as non-adherent (at least 10% of doses missed) | |||
• Proportion of patients defaulting during TB treatment | |||
• Proportion of smear positive TB cases who become smear negative at 2 months | |||
Secondary outcomes: | |||
• Physical fitness and mobility [Time Frame: Monthly visits for 6 to 8 months of treatment] [Designated as safety issue: No].The investigators will measure physical fitness and mobility through questionnaires conducted with patients during household visits each month that they are on treatment. The investigators are using two indices. The physical fitness index will record respondents’ ability to perform certain tasks. The mobility index will record the mobility of participants. | |||
• The proportion of patients with treatment outcome of cure or completed treatment | |||
• Psychological Impacts [ Time Frame: Monthly visits for 6 to 8 months of treatment ] [ Designated as safety issue: No ]In order to gauge the psychological impacts of the system, the investigators will be looking at participants' perceptions on the likelihood of being cured, how they feel on a given day using the pain scale, and how supported they feel. This data will be collected through questionnaires conducted at each monthly mid-line visit. | |||
Starting date
| April 2012 | 2011 | 2011 |
Estimated study completion date
| December 2014 | November 2014 | August 2012 |
Contact information
| Richard Lester: richard.lester@bccdc.ca Natasha Van Borek: natasha.vanborek@bccdc.ca | Shama Mohammed: shama.mohammed@irdresearch.org | Professor Shiwen Jiang: jiangsw@chinatb.org |
Notes
| ClinicalTrials.gov identifier: NCT01549457 | ClinicalTrials.gov identifier: NCT01690754 | Current Controlled Trials identifier: ISRCTN46846388 |