Feasibility of a short message service (SMS) intervention to deliver tuberculosis testing results in peri-urban and rural Uganda

Diana Babirye; Priya B Shete; Katherine Farr; Talemwa Nalugwa; Christopher Ojok; Mariam Nantale; Denis Oyuku; Irene Ayakaka; Achilles Katamba; J Lucian Davis; Diana Nadunga; Moses Joloba; David Moore; Adithya Cattamanchi

doi:10.1016/j.jctube.2019.100110

Feasibility of a short message service (SMS) intervention to deliver tuberculosis testing results in peri-urban and rural Uganda

J Clin Tuberc Other Mycobact Dis. 2019 Jun 19:16:100110. doi: 10.1016/j.jctube.2019.100110. eCollection 2019 Aug.

Authors

Diana Babirye¹, Priya B Shete^{1

2

3}, Katherine Farr^{1

2}, Talemwa Nalugwa¹, Christopher Ojok¹, Mariam Nantale¹, Denis Oyuku¹, Irene Ayakaka¹, Achilles Katamba^{1

4}, J Lucian Davis^{1

5}, Diana Nadunga⁶, Moses Joloba⁶, David Moore⁷, Adithya Cattamanchi^{1

2

3}

Affiliations

¹ Uganda Tuberculosis Implementation Research Consortium, Makerere University, P.O. Box 21696, Kampala, Uganda.
² Division of Pulmonary and Critical Care Medicine, University of California San Francisco and Zuckerberg San Francisco General Hospital 5K1, 1001 Potrero Avenue, San Francisco, CA 94110, USA.
³ Curry International Tuberculosis Center, University of California San Francisco, 300 Frank H. Ogawa Plaza, Suite 520, Oakland, CA 94612-2037, USA.
⁴ Clinical Epidemiology Unit, Department of Medicine, Makerere University, P.O. Box 7072, Kampala, Uganda.
⁵ Department of Epidemiology of Microbial Diseases, Yale School of Public Health, 60 College Street P.O. Box 208034 New Haven CT 06520-8034, New Haven, CT, USA.
⁶ National Tuberculosis Reference Laboratory, Ministry of Health, Plot 106-1062 Butabika Road, Luzira, Kampala, Uganda.
⁷ London School of Hygiene and Tropical Medicine, Keppel St, Bloomsbury, London WC1E 7HT, UK.

Abstract

Background: Pre-treatment loss to follow-up is common for patients diagnosed with tuberculosis (TB) in high-burden countries. Delivering test results by Short-Messaging-Service (SMS) is increasingly being considered as a solution, but there is limited information about its feasibility as a public health tool in low resourced settings.

Objective: We sought to assess the feasibility of utilizing SMS technology to deliver TB test results during routine TB diagnostic evaluation in Uganda.

Methods: We conducted a single arm interventional pilot study at four community health centers in Uganda that referred sputum samples to a district hospital for GeneXpert-MTB/RIF (Xpert) testing (Cepheid, USA). Using existing GxAlert-software (SystemOne,USA), we set up an automated SMS platform to send Xpert results to patients and referring health centers. We assessed each step of the SMS delivery cascade for consecutive patients who presented to these four community health centers between December 2015 and March 2016 and underwent Xpert testing.

Results: Of 233 patients enrolled, 161 (69%) had phone numbers recorded on individual Xpert referral forms. Phone numbers were entered into Xpert device software in the correct format for 152 (94%) patients. GxAlert-software generated an automated SMS reporting Xpert results for 151 (99%) patients and delivered it successfully to mobile phone service providers for 145/151 (96%). Of the 123 patients reached by phone to determine receipt of test results, 114 (93%) confirmed SMS receipt. SMS-based delivery of Xpert results was verified for 114/233 (49%) patients overall. In contrast, phone calls to health centers confirmed that health centers received messages for 222/233 (95%) patients.

Conclusion: Reporting Xpert results via automated SMS is technically feasible and results in approximately half of patients receiving their test results immediately. Additional research should be done to address process inefficiencies in order to maximize impact of this technology and link its successful utilization to improved patient outcomes.

Keywords: Information and communication technology; Mobile technology; SMS.

Grants and funding

UL1 TR001863/TR/NCATS NIH HHS/United States