Text messaging intervention to improve adherence for TB patients in Argentina

描述(由申请者提供)：本培训资助申请的长期目标是支持申请者发展成为一名具有知识和技能的护士科学家，以开展专注于改善国际传染病结果的研究。该奖学金将集中在论文研究上，重点是评估与结核病专业医疗团队和患者合作开发的创新干预措施，以改善与结核病相关的治疗结果。结核病是一个具有挑战性的全球公共卫生问题。世界卫生组织(WHO)建议将直接观察治疗(DOT)作为治疗结核病的标准，在DOT中，受过培训的卫生保健工作者目睹每天给药的情况。DOT的使用具有挑战性，当DOT不可行时，通常使用患者自我管理(SAT)。在阿根廷，治疗成功率仍然远低于世卫组织的推荐率。2007年，在报告的痰涂片阳性病例中，有记录表明全国有54%的人接受过DOT，布宜诺斯艾利斯省只有20%，而且违约率(患者中断治疗至少两个月)为14.5%。当前改善结核病护理结果的一个目标是提高结核病患者对自身护理的参与度，并改善患者与护理团队之间的沟通。实现这些目标的一个有希望的工具是通过移动电话使用短信或短消息服务(SMS)，这是一种日益普遍的全球通信媒介。拟议的研究是一项混合方法、分阶段设计的先导研究，以社会技术方法为指导。第一阶段将包括与阿根廷参考医院的结核病专科医疗团队合作，敲定干预方案(例如，适合社会和文化的教育短信和临床工作流程算法，以解决和回应短信问题或其他潜在情况)。第二阶段是一项探索性的试点研究，使用混合方法评估基于短信的干预的可行性和初步效果。研究的目的是：(1)开发和检验基于短信的计算机系统干预对患者结局的有效性；(2)评估实施干预的结构和过程；(3)从结核病患者的角度探讨接受程度、可行性以及如何优化干预措施。40名符合条件并征得同意的参与者将被随机分为接受标准护理自我管理(SAT)的对照组或接受SAT加短信干预的干预组。在为期两个月的结核病强化治疗阶段结束时，将进行深入的个人或团体访谈。结果是药物依从率、痰涂片转换率，以及在两个月强化治疗阶段结束时干预的接受度和可行性。以短信为基础的结核病管理干预措施解决了国家护理研究所采用新技术以改善卫生保健结果、促进健康和预防疾病的优先事项。

DESCRIPTION (provided by applicant): The long term goal of this training grant application is to support development of the applicant as a nurse scientist with the knowledge and skills to conduct research focused on improving infectious disease outcomes internationally. The fellowship will concentrate on dissertation research focused on evaluating an innovative intervention developed in collaboration with a TB specialized healthcare team and patients to improve treatment outcomes related to tuberculosis. Tuberculosis (TB) is a challenging global public health problem. The World Health Organization (WHO) recommends direct observation of treatment (DOT), in which a trained health care worker witnesses the daily administration of medication, as the standard for treating TB. Use of DOT is challenging and when DOT is not feasible, patient self-administration (SAT) is often used. In Argentina, treatment success rates remain well below the WHO recommended rates. In 2007 of the reported sputum smear-positive cases 54% were documented to have received DOT countrywide and only 20% in the Province of Buenos Aires, moreover default rate (patient-interrupted treatment for at least two months) was 14.5%. A current objective to improve TB care outcomes is to heighten TB patients' involvement in their own care, and improve communication between patients and care team. A promising tool to build on these goals is the use of text messaging or SMS (Short Message Service) via mobile phones, an increasingly ubiquitous global communications medium. The proposed research is a mixed-method, phased design pilot study guided by a socio-technical approach. The first phase will include finalizing the intervention protocol (e.g. socially and culturally appropriate educational text messages and a clinical workflow algorithm to address and respond to text messaging issues or other potential situations) in collaboration with the TB-specialized healthcare team at the reference hospital in Argentina. Phase 2 is an exploratory pilot study using mixed methods to evaluate the feasibility and initial efficacy of the text messaging based intervention. Study aims are to: (1) develop and examine the efficacy of a text messaging computer-based system intervention on patient outcomes; (2) evaluate the structure and process of delivering the intervention; and (3) explore perceptions of acceptance, feasibility, and how to optimize the intervention from the perspective of TB patients. Forty eligible and consented participants will be randomized to a control group receiving standard of care self administration of treatment (SAT) or to an intervention group receiving SAT plus the text messaging intervention. In-depth individual or group interviews will be conducted at the end of the two month intensive TB treatment phase. Outcomes are medication adherence rates, sputum smear conversion rates, and acceptance and feasibility of intervention at the end of the two month intensive treatment phase. The SMS based intervention for TB management, addresses the National Institute of Nursing Research's priorities to adopt new technologies for better health care outcomes and to promote health and prevent disease.