Impact of a Daily SMS Medication Reminder System on Tuberculosis Treatment Outcomes: A Randomized Controlled Trial
Impact of a Daily SMS Medication Reminder System on Tuberculosis Treatment Outcomes: A Randomized Controlled Trial
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DOI：
10.1371/journal.pone.0162944
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发表时间：
2016-11-01
期刊：
影响因子：
3.7
通讯作者：
Khan, Aamir J.
中科院分区：
文献类型：
--
作者：
Mohammed, Shama;Glennerster, Rachel;Khan, Aamir J.
重要性过去十年中低收入和中等收入国家移动电话的迅速普及为公共卫生项目提供了前所未有的接触患者的机会。虽然计划使用短信来提高药物依从性，但还没有高效的试验评估其对结核病治疗结果的影响。目的衡量 Zindagi SMS（一种双向短信提醒系统）对药物敏感结核病患者治疗成功的影响。设计我们在巴基斯坦卡拉奇进行了一项双臂、平行设计、有效性随机对照试验。个体参与者被随机分配到 Zindagi SMS 组或对照组。 Zindagi SMS 每天向参与者发送短信提醒，并要求他们在服药后通过短信或未接（未计费）电话进行回复。每天向未回复者发送最多3次提醒。设置巴基斯坦卡拉奇的公立和私营结核病诊所。参与者新诊断的涂片或细菌学阳性肺结核患者，治疗时间不足两周； 15 岁或以上；报告称可以使用手机；并打算在整个治疗期间居住在卡拉奇有资格参加。我们招募了 2,207 名参与者，其中 1,110 名随机分配至 Zindagi SMS，1,097 名分配至对照组。主要结果主要结果是基于治疗意向的临床记录治疗成功。结果我们发现 Zindagi SMS 组或对照组之间的治疗成功率没有显着差异（分别为 719 或 83% 与 903 或 83%，p = 0.782）。在治疗期间暗访期间报告的自我报告的药物依从性没有显着的计划效果。结论在这项结核病治疗短信用药提醒的大规模随机对照有效性试验中，我们发现没有显着影响。
ImportanceThe rapid uptake of mobile phones in low and middle-income countries over the past decade has provided public health programs unprecedented access to patients. While programs have used text messages to improve medication adherence, there have been no high-powered trials evaluating their impact on tuberculosis treatment outcomes.ObjectiveTo measure the impact of Zindagi SMS, a two-way SMS reminder system, on treatment success of people with drug-sensitive tuberculosis.DesignWe conducted a two-arm, parallel design, effectiveness randomized controlled trial in Karachi, Pakistan. Individual participants were randomized to either Zindagi SMS or the control group. Zindagi SMS sent daily SMS reminders to participants and asked them to respond through SMS or missed (unbilled) calls after taking their medication. Non-respondents were sent up to three reminders a day.SettingPublic and private sector tuberculosis clinics in Karachi, Pakistan.ParticipantsNewly-diagnosed patients with smear or bacteriologically positive pulmonary tuberculosis who were on treatment for less than two weeks; 15 years of age or older; reported having access to a mobile phone; and intended to live in Karachi throughout treatment were eligible to participate. We enrolled 2,207 participants, with 1,110 randomized to Zindagi SMS and 1,097 to the control group.Main OutcomeThe primary outcome was clinically recorded treatment success based upon intention-totreat.ResultsWe found no significant difference between the Zindagi SMS or control groups for treatment success ( 719 or 83% vs. 903 or 83%, respectively, p = 0.782). There was no significant program effect on self-reported medication adherence reported during unannounced visits during treatment.ConclusionIn this large-scale randomized controlled effectiveness trial of SMS medication reminders for tuberculosis treatment, we found no significant impact.