Using Mobile Technology for Monitoring Tuberculosis Treatment Among Women with Tuberculosis in Greater Accra Region, Ghana

Abstract

Background: Tuberculosis (TB) is an infectious disease which has been of great Public Health interest for years. Its effect on women varies at the different stages of their life and is more pronounced and complex in their reproductive years. Poor treatment adherence among diagnosed TB patients has been a major setback in the fight against TB resulting in new strains which are more difficult and expensive to treat. The dearth of information on context specific interventions to address TB treatment adherence necessitated this study. The use of mobile phones is limited for monitoring TB treatment especially among women, who are most affected. This study, therefore used SMS reminders for monitoring TB treatment adherence among women in the Greater Accra Region and examined the feasibility of Video Directly Observed Therapy in monitoring TB treatment. In addition, the study assessed knowledge of women on TB and factors influencing TB treatment adherence among them. Methods: The quasi-experimental design was used. The study was conducted in three phases. In phase one, a formative research was used to develop the Short Message Service (SMS) reminder messages. In-depth interviews were used to generate the SMS reminder messages and thereafter finalized through survey. The second phase of the study began with baseline data collection on participants’ sociodemographic characteristics, knowledge on TB, factors influencing adherence and measurement of baseline adherence rate. These were then followed with the implementation of the SMS intervention. The adherence rate was measured with the Medication Adherence Rating Scale -5 (MARS-5). The third phase measured participants’ end line adherence rate, their acceptance of the SMS intervention and feasibility of VDOT intervention. Both quantitative and qualitative methods were used for the data collection. Surveys and in-depth interviews (IDI) were used to collect quantitative and qualitative data respectively. STATA 15 was used to analyze the quantitative data. Univariable, bivariable and multivariable logistic analysis were done with p-value of <0.05 considered as statistically significant. The qualitative data were audio recorded and transcribed. It was analyzed using thematic content analysis using NVivo 12 software. Results: The study developed 10 SMS reminder messages for women with TB. Findings revealed that the SMS reminder messages had a positive effect on adherence of participant on the SMS intervention (OR=3.93, 95% CI=1.1745, 3.1789). Although participants exhibited high (70%) knowledge of TB, findings reveal some misconceptions among participants. Experiencing side effect of TB drug was shown to influence adherence. Regarding the feasibility of using mobile technology for monitoring TB treatment, majority 196 (86%) of participants had their personal mobile phones with the rest having regular access to the phones of others. Most (79%) participants from the control group were willing to accept the SMS intervention with majority (86%) from the intervention group willing to recommend use of SMS to others. Although close to half (49%) of the participants agreed that VDOT could be used to monitor TB treatment, only a third (32%) were willing to submit videos of themselves for monitoring by their nurses, with some citing mistrust for using internet as reasons for not transferring such information. Conclusions: Using mobile technology to monitor TB treatment is feasible. However, education and exploration of factors such as mistrust for the use of internet are required to improve the acceptance of VDOT in this context.