Effect of ‘mHealth’ Interventions on adherence to treatment and outcomes in Tuberculosis patients of district Shimla, Himachal Pradesh, India: A Randomised Control Trial

Background: Of all cases of Tuberculosis worldwide, India bears the major burden. Application of Mobile technology can prove to be a boon in complementing patient centric approach in otherwise hard to reach areas. This study envisagedto study the effects of „mHealth‟ interventions in TB patients a district with tough terrain but excellent literacy rates and avery high tele-density. Methods: A Randomized controlled trial design was adopted to study the effectiveness of„mHealth‟ interventions in the form SMS reminders and voice calls. The intervention arm received the messages in'Devanagri' script of the national language „Hindi‟ on their scheduled days of treatment and follow-up. Educational andreminder messages were also sent. Queries related to all aspects of treatment were received by the investigators through anadvertised mobile number. Patients enrolled in the comparison group were followed as per the usual DOTS program tillcompletion of treatment. The groups were compared in terms of treatment outcomes and number of doses and follow upsmissed. Results: Out of the 312 patients enrolled for the study, risk of adverse outcomes was 43% statistically lower inintervention group as compared to control group (OR; 95% CI: 0.57 (0.35-0.96)). Also the risk of >10% of missed dosesof treatment was 67% lower in intervention group (OR; 95% CI: 0.33 (0.12- 0.90)). Risk of missing more than two followups was 50% lower in intervention group. Conclusions: The study helps to build further evidence about the effective useof mobile technology in strengthening patient centric approach in TB management particularly in difficult to access areas.Software with system generated reminders incorporated into the existing NIKSHAY portal can be formulated to facilitateadherence. Availability of a dedicated “Counselling service” using voice calls may be incorporated to address patients‟queries which will help improve adherence ultimately contributing to favourable outcomes.