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JAMA Dermatol. 2014 Jun;150(6):601-7. doi: 10.1001/jamadermatol.2013.7321.

Reliability and validity of mobile teledermatology in human immunodeficiency virus-positive patients in Botswana: a pilot study.

Author information

1
Department of Dermatology, University of Pennsylvania, Philadelphia2Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia.
2
Division of Dermatology, Department of Medicine, University of California-San Diego, San Diego.
3
Department of Dermatology, University of Pennsylvania, Philadelphia.
4
Department of Oral Medicine, University of Pennsylvania School of Dental Medicine, Philadelphia.
5
Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia.

Abstract

IMPORTANCE:

Mobile teledermatology may increase access to care.

OBJECTIVE:

To determine whether mobile teledermatology in human immunodeficiency virus (HIV)-positive patients in Gaborone, Botswana, was reliable and produced valid assessments compared with face-to-face dermatologic consultations.

DESIGN, SETTING, AND PARTICIPANTS:

Cross-sectional study conducted in outpatient clinics and public inpatient settings in Botswana for 76 HIV-positive patients 18 years and older with a skin or mucosal condition that had not been evaluated by a dermatologist.

MAIN OUTCOMES AND MEASURES:

We calculated the κ coefficient for diagnosis, diagnostic category, and management for test-retest and interrater reliability. We also determined sensitivity and specificity for each diagnosis.

RESULTS:

The κ coefficient for test-retest reliability ranged from 0.47 (95% CI, 0.35 to 0.59) to 0.78 (0.67 to 0.88) for the primary diagnosis, 0.29 (0.18 to 0.42) to 0.73 (0.61 to 0.84) for diagnostic category, and 0.17 (-0.01 to 0.36) to 0.54 (0.38 to 0.70) for management. The κ coefficient for interrater reliability ranged from 0.41 (95% CI, 0.31 to 0.52) to 0.51 (0.41 to 0.61) for the primary diagnosis, 0.22 (0.14 to 0.31) to 0.43 (0.34 to 0.53) for diagnostic category, and 0.08 (0.02 to 0.15) to 0.12 (0.01 to 0.23) for management. Sensitivity and specificity for the top 10 diagnoses varied from 0 to 0.88 and 0.84 to 1.00, respectively.

CONCLUSIONS AND RELEVANCE:

Our results suggest that while the use of mobile teledermatology technology in HIV-positive patients in Botswana has significant potential for improving access to care, additional work is needed to improve the reliability and validity of this technology on a larger scale in this population.

PMID:
24622778
PMCID:
PMC4167027
DOI:
10.1001/jamadermatol.2013.7321
[Indexed for MEDLINE]
Free PMC Article
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