According to the Lancet, the use of text messaging technologies, which has had "promising preliminary results," could be more cost-effective than DOTS, which can be "insufficient or inaccessible" for many TB patients.
One product, manufactured by the London-based company SIMpill, is a small pill bottle that sends text messages to a central server when the bottle is opened to verify that patients have taken their medication. The device includes a SIM card and a unique pill box identification number that is linked to a central server. If the server does not receive a text message at a designated time, it contacts patients via phone to remind them to take their medication. A caregiver is contacted by the server for a follow up if the patient does not respond to the phone call.
The Lancet reports that a trial of the device at three clinics in Cape Town, South Africa, found a 94% treatment success rate among 155 TB patients after 10 months of using the technology. Ann-Mari Albertson, managing director of SIMpill, said that in addition to increasing treatment adherence, the product enables health workers to focus on "counselling, training and actual follow-up with patients who need more attention, instead of keeping up with tablets and glass[es] of water."
Another product called SIMmed, developed by CompuTainer, requires patients to press the speed dial button on their cell phones after taking their medication. The call is transferred to a server that records treatment adherence and reminds patients who do not call to take their medication via a text message.
A third product called X out TB tracks patients' adherence to treatment and provides economic incentives, such as cell phone minutes, based on compliance. Jose Gomez-Marquez - program director of the Innovations for International Health project at the Massachusetts Institute of Technology, which developed the technology - said TB patients have a "bigger incentive" to comply with treatment regimens if there is an economic incentive.
According to the Lancet, some experts are sceptical of the use of text messaging technology for monitoring TB patients. Hamish Fraser, assistant professor at Harvard Medical School and director of information and telemedicine for Partners in Health, said that having a DOTS worker monitor patients in developing countries is "extremely effective." He added that PIH does not "immediately feel there's a big gap there," so he is "less sold on cell phones."
Mario Raviglione, director of World Health Organisation's Stop TB Department, said that the "problem" of monitoring TB patients in remote areas is "enormous," adding that "everything has to be done in order to prevent patients from defaulting" on treatment. Raviglione added that although the "human aspect" of TB treatment "must not be forgotten or underemphasised, there's always great value in increasing communication between the patients and the clinicians" (Barclay, Lancet, 1/3).
