The Role of mHealth in the Fight against Tuberculosis

This 2012 paper from the mHealth Alliance and the Stop TB Partnership showcases the potential of mobile technologies for TB treatment, explores some applications of mobile technology, and seeks to catalyse the conversation about mobile health (mHealth) within the TB community. The following is a summary of the paper, which identifies five areas in which mHealth is starting to have an impact on TB care and control:

• Treatment adherence: "A variety of projects already show that text (SMS) messages, or other reminders like automatic call-backs on your personal phone, can be used in a wide array of methods to communicate with patients, who are otherwise required to visit a TB clinic or to be monitored by a visiting health worker....[For example:] A team at the Indus Hospital in Pakistan was supported by a TB REACH grant from the Stop TB Partnership to use an integrated real time mobile phone enabled database. This catalyzed a novel TB treatment compliance and case holding scheme that worked by sending a monetary reward as incentive to the patient’s or doctor’s personal mobile phone. The “X-out-TB” technology is one element in this project. It uses strips, which reveal a code when exposed to the urine of patients who have taken TB medication. When texting these codes back to the hospital, patients are rewarded via a mobile money model in which cash can be collected or forwarded to other phone customers anywhere in the country. Another incentive scheme pays out to doctors that identify additional cases and support treatment adherence from TB patients throughout the necessary treatment cycle." This project has resulted in a four-fold increase in detection and a treatment adherence of over 90 percent.

• Monitoring TB diagnosis and treatment: "mHealth components have been developed that streamline the collection and monitoring of patient information using mobile phones. There are additional benefits: mobile-based data collection software has early warning systems that can now be activated to indicate faulty or missing entries. Projects exist that integrate Global Positioning System (GPS) enabled phones to monitor the location of where field workers enter patient data, ensuring that fraudulent data are not being entered from the field workers’ homes. Other projects have sought ways to streamline the reporting system in laboratories – connecting lab technicians, lab directors, physicians, field workers and, ultimately, patients – via text (SMS) and mobile or web interfaces.... [For example:] In Kenya, one program assessed whether text-message reminders sent to health workers’ mobile phones could improve and maintain their adherence to treatment guidelines for outpatient paediatric malaria. The trial showed that correct management of fixed-dose combination therapy improved by almost 24 per cent immediately after intervention, and these results kept up even six months later."

• Mobile diagnosis: "Applications and accessory attachments can turn mobile phones into medical devices. This additional functionality of phones now makes diagnosis accessible in more geographic areas and outside health centres with laboratories.... [For example:] In Vietnam, the Stop TB Partnership’s TB REACH program supports CellScope, a project that mobilizes health workers at communal health posts to take pictures of sputum smear slides using camera-enabled phones. Images are sent to diagnostic hubs where they are analysed and results are sent back to the community health worker with minimal delay. This helps community health workers deliver their diagnosis while with the patient....Another example is a low-cost stethoscope, made of an eggcup that can be attached to mobile phones, which enables patients to monitor their heart. This is used for patients with a particular form of TB (tuberculous pericarditis) that leads to cardiac arrest."

• Disease surveillance: "With the use of mobile phones, electronic data capture can potentially make it easier for health care personnel to collect and manage large volumes of data and shortens the time needed for analysis. This process streamlines the reporting of patient data to their respective national TB programmes. In addition, GPS allows real-time mapping of disease outbreaks to accelerate the response time among governments and health workers alike. [For example:] Alerta DISAMAR is a national disease monitoring system in Peru that allows users to transmit or access data through multiple technologies, including mobiles, to increase the reach of its disease surveillance activities and to dramatically reduce the time for remote notifications to reach the central level. Health care workers in the field can enter information into this system with numeric codes through dial tones and voice messages. The information is immediately transmitted to a central system where it is processed and stored and then alerts are sent via short message service to mobile phones or by email to personnel who can act immediately on potential outbreaks."

• Health awareness and information dissemination: "There are also many ways to inform communities and people-at-risk about TB, and to send health messages about when to seek care. In addition, reducing the stigma associated with the disease by way of information might increase the willingness of people to see a counsellor or accept treatment. [For example:] The Mobile Alliance for Maternal Action (MAMA) is providing culturally sensitive and adaptable health information messages to expectant mothers via mobile phone. They piloted this scheme in three countries where mobile phones are widely used and maternal and infant mortality is high, including Bangladesh, India, and South Africa."

"Innovations will move forward only if knowledge and experience from the various actors engaged in mHealth for TB are gathered and disseminated....The next step will be to co-ordinate projects and exchange experiences with implementers from other health areas that have experience in mHealth....Health Unbound (HUB) is the interactive network and online knowledge resource center for the mHealth community. Through HUB, the mHealth Alliance brings together individuals from all disciplines of the mHealth community, from developers to doctors, to generate collective solutions and inspire new innovations that will transform health with technology."