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MOBILE HEALTH IMPLEMENTATION “SMS gateaway” FOR PROMOTING ADHERENCE TO-ANTI TUBERCULOSIS TREATMENT: A SYSTEMATIC REVIEW Indah Nurul Khairunnisa, Leony Octavia, Nor Farzana binti Mahmood TOP 10 FINALIST FOR SCIENTIFIC PAPER
MOBILE HEALTH IMPLEMENTATION “SMS gateaway” FOR PROMOTING ADHERENCE TO-ANTI TUBERCULOSIS TREATMENT: A SYSTEMATIC REVIEW
Author: Indah Nurul Khairunnisa Leony Octavia Nor Farzana binti Mahmood
Asian Medical Students’ Association Indonesia (AMSA-Indonesia) 2018
ABSTRACT Background: Tuberculosis (TB) is one of the major public health problems in developing countries. In order to their adherence to the full treatment of 6 months , The possibility of patients not adhering to taking medication is very large because of the long treatment time, the large number of drugs, side effects, lack of awareness of patients of the disease and patients not taking drugs because they forget. Use of information and communication technologies, such as sending reminders through short message services (SMS), can bring potential innovations to address barriers to treatment adherence. And the most cost-effective way to communicate with people residing in difficult to reach areas. Material and Methods: We searched electronic databases (PubMed, EMBASE, Science Citation Index), reference lists of relevant articles, conference proceedings, and selected websites for eligible studies available started by 2011; regardless of language or publication status. Two authors independently screened selected eligible studies, and assessed risk of bias in included studies; resolving discrepancies by discussion and consensus. Result and Conclusion: Search results in the database, 16 articles were found and only 5 articles that met the inclusion criteria. The results of the articles found were the effect of using SMS on monitoring anti-tuberculosis drugs 72.94% - 100% and the effect of using telephone reminders on relationships taking medication increased 66% - 100%.
I.
Introduction Tuberculosis is a direct infectious disease caused by Mycobacterium tuberculosis (Depkes RI, 2005). Tuberculosis is transmitted to other people through inhalation. (Liu et al., 2014) Tuberculosis (TB) is a public health problem in the world. In the WHO report in 2014 stated that people around the world who suffer from pulmonary TB as many as 6.1 million TB cases and there are 5.7 million new cases and cases of TB relapse. India and China accounted for 37% of 5.7 million and the rest were in several countries such as African countries, Europe, America and Southeast Asia (WHO, 2014). Indonesia as one of the countries in Southeast Asia reported in 2014 that its population numbered 25,124,458 people and from that number suffered pulmonary TB as many as 285,254 people and there were 176,677 new cases of Positive AFB Pulmonary TB 176,677. In 2014 the cure rate for patients with pulmonary TB was 74.2%. (RI Ministry of Health, 2015). TB treatment lasts six to eight months and can cause side effects such as nausea, dizziness, skin rashes, and flu-like symptoms. Compliance with treatment regimens is very important for TB control. Failure to adhere to treatment can result in patients continuing to transmit the disease and can lead to the development of multi-drug resistant TB (MDR-TB). MDR-TB is more difficult to cure and requires a longer treatment regimen of up to two years. The World Health Organization WHO recommends the treatment of directly monitored TB called (DOTS). As a strategy to monitor patient compliance with medication. (Nglazi, Bekker, Wood, Hussey, & Wiysonge, 2013). One key to the success of TB treatment is adherence to pharmacotherapy. Forms of intervention to improve adherence is the provision of information according to the needs of patients so that patients understand the conditions and risks of their health understand the risks if not adherence. The form of Reminder (a reminder) that can be used and recommended is: Calendar, clear instructions, with large and conspicuous letters, letters, telephone pamphlets etc. (RI Ministry of Health, 2005) Several strategies to promote TB treatment compliance have been conducted. Providing communication about compliance; develop or improve support for medication compliance services offered by teams (nurses, doctors, pharmacies, patients, etc.) directly observed therapies (involving a health care worker, community care, or family members directly monitoring patients when taking TB drugs) (Nglazi et al., 2013). The use of text messages (sms services) has been proposed as a means to
promote compliance with TB treatment. Text messages are sent every day or weekly to remind patients to take drugs. (Nglazi et al., 2013). The global cellular mobile market is currently around 1.8 billion customers and estimated at 3 billion at the end of 2010 (Reid and Reid in Liliweri Alo, 2015). Mobile phones have changed the way in which all interpersonal interactions can occur in a society, therefore the sociological view of the presence of mobile phones is very relevant (Liliweri Alo, 2015). Based on the phenomena above, clinical questions are formulated in the form of PICO (Patients / Problem, Intervention, Comparison, Outcome). From one of the journal we can say that , P: Pulmonary TB patients, I: DOTS with SMS and reminders, C: DOTS Standard without O reminders: Compliance with anti-tuberculosis drugs. Clinical questions can be formulated from PICO to "is there any influence on the use of SMS and telephone reminders on compliance with taking anti-tuberculosis drugs?". To get the best evidence about cellphone use in the form of sms and telephone as one of the interventions to promote TB treatment compliance researchers conducted research using a systematic review.
II.
Materials and Methods I.
Data Sources Literature is taken based on the keywords included "Mobile Health Technology" "Short Massage System" "tuberculosis adherence treatment" "DirectlyObserved Treatment Short-course (DOTS)". The publication texts used ranged from 2013-2017. The type of research used is quantitative and qualitative research, both conducting direct research, systematic reviews, pilot studies and protocol studies. The search index used is Pubmed, Science Direct, Proquest and Google Scholar.
II. Selection Criteria Types of participants Adults (including pregnant women) or children receiving treatment for TB infection, in any setting. Types of interventions We included interventions in which mobile phone text messages were used to promote adherence to TB treatment. The text messaging had to be delivered to a patient with TB or, in the case of an infant or child, to a caregiver. We also included studies in which the intervention was compared to
no intervention or other interventions for promoting adherence. We excluded studies in which used mobile phone voice speaking, voice messaging, a beeper, a pager, or
multimedia messaging
service as interventions. In addition,
we
excluded studies in which text messages are bundled with other interventions unless it was possible to separate the effects of text messaging alone. Type of outcome measures The primary outcome considered TB cure,
for this review was treatment adherence.
suc-cessful completion of TB treatment and
We drug
resistance development as proxies for adherence. The secondary outcomes were exposure to stigma associated with TB as a result of the SMS revealing the patient’s disease status, and patient satisfication with the SMS intervention III.
Results The articles found through searching data on the ESBCO and PubMed database were 5 articles consisting of 2 articles with systematic review and 1 article with evaluation study type and 2 articles with Random Control Trial (RCT). The results of the articles found were the effect of using SMS on adherence to taking anti-tuberculosis drugs around 72.94% - 100% and the effect of using telephone reminders on medication compliance ranges from 66% to 100%. Complete results from five articles can be seen in table. No. 1.
Title
Author
Result
Mobile phone text messaging Mweete D Nglazi
The results of this study were
for promoting adherence to Linda Gail Bekker, that
at
60 days after the
antituberculosis treatment:
Robin
a
Gregory D Hussey intervention group had a higher
systematic
review
protocol
Charles
Tahun: 2013
Wiysonge
Wood, intervention was obtained, the
S level of adherence compared to the control group, but this difference was not statistically significant (RR 1.49, 95% CI 0.90- 2.42)
2.
Reminder systems to improve Liu Q, Abba K, The results of this study were patient
adherence
to Alejandria
MM, groups (sufferers) who were
tuberculosis
clinic Sinclair
D, treated with active TB increased
appointments for diagnosis Balanag
VM, attendance to the clinic and
and treatment
Lansang MAD
Tahun: 2014
treatment to completion was higher in the group that received phone
calls
before
the
appointment (attendance at the clinic was 66% versus 50%; RR 1.32, 95% CI 1.10-1.59, one trial (USA), 615 participants, low
quality
treatment
evidence,
completed:
TB 100%
versus 88%; RR 1.14, 95% CI 1.02-1.27, one trial (Thailand), 92 participants, proof of low quality). Clinical attendance and treatment of completed TB were also higher by using failure reminders
(letters
or
home
visits) (attendance clinic: 52% vs 10%; RR 5.04, 95% CI 1.6115.78, one trial (India ), 52 participants,
low
quality
evidence; completion treatment: RR 1.17, 95% CI 1.11-1.24, two trials (Iraq and India), 680 participants,
medium
quality
evidence). 3.
Tuberculosis treatment with Piyada mobile-phone
medication Kunawararak,
The results of this study are 1. In the MDR-TB group
reminders in northern thailand
Sathirakorn
treated for 18 months with
Tahun : 2011
Pongpanich,
Model 2 (treatment with DOTS
Sakarin
plus reminder telephone use)
Chantawong,
and non MDR-TB treatment
Pattana
Pokaew,
groups for 6 months with
Patrinee Traisathit,
Model 2, a 100% success rate
Kriengkrai
was obtained.
Srithanaviboonchai
2. In the MDR-TB group
and Tanarak Plipat
treated using Model 1 (Use of DOTs
without
phone
reminders) the success rate was obtained 73.7% and in the Non-MDR
Non-TB
group
treated with Model 1 obtained a
success
rate of 96.7%.
Significant differences for both MDR-TB groups (p = 0,0001) and non MDR-TB groups (p = 0.047)
between
the
two
models. 4.
TextTB:
Sarah Iribarren
Statistical analysis uses IBM
Susan Beck
SPSS,
Acceptance, Feasibility, and
Patricia F. Pearce,
Independent-sample
Exploring Initial Efficacy of a
Cristina
chi-square test for dichotomous
Text Messaging Intervention
Chirico,
to
Etchevarria
results of this study were that
Daniel
medication adherence in the
Cardinale, and
short
Fernando
group was 77% and in the
Rubinstein
calendar group as 53%.
Pilot
A
MixedMethod
Study
Evaluating
Support TB Treatment
Adherence Tahun: 2013
5.
Mirta
version
categorical
with
test
variables.
message
Effects of and satisfaction
HSiu-Ling
The results of the
with short message service
Huang,
research are:
reminders
for
Yu-Chuan
medication
adherence:
patient
20
and
The
intervention
Jack
In the control group decreased
Yueh-Ching
the incidence of delayed doses
randomized controlled study
Chou4, Yow-Wen
by 46.4% in the control group
Tahun: 2013
Hsieh, Frank Kuo,
and
Wen-Chen Tsai1,
intervention group, the missed
a
Li,
by
78.8%
in
the
Sinkuo
Daniel
dose decreased by 90.1% in
Chai1,
Blossom
the intervention group and
Yen-Ju Lin, Pei-
61.1% in the control group. In
Tseng Kung and
the logistic regression analysis
Chia-
the intervention group had a
Chuang
Jung
3.2-fold higher probability of having
a
decrease
compared
control
delayed
group.
dose to
the
Conclusion:
The use of SMS significantly affected the level of taking medication as scheduled.
IV.
Discussion DOTS Program in Management of Lung Tuberculosis. Directly-Observed Treatment Short-course (DOTS) is the implementation of Tuberculosis prevention strategies adopted in Indonesia through WHO recommendations (Kamelia, 2014). The DOTS program in Indonesia is also guided by the TB national strategy for 2011-2014 (Kamelia, 2014). The DOTS program aims to cure patients with tuberculosis with short-course drugs for 6 months. The implementation of the DOTS program was evaluated through several studies. Research conducted by Noveyani & Martini (2014) evaluated the implementation of the DOTS program in Tanah Kalikedinding health centers in 2014, the results of which were associated with the achievement of indicators of Tuberculosis. The results obtained from one component of the DOTS are that there are still patients who do not have a supervisor swallowing drugs and all (100%) patients have forgotten to take antituberculosis drugs. The DOTS program requires a supporting innovation to reach the target of successful treatment of tuberculosis. In addition, innovation must also consider technological progress so that health workers can continue to intervene remotely. SMS gateway is a one-way broadcast SMS. SMS gateway based on the scheduled time. The system will send an SMS automatically to several telephone numbers that have previously been entered in the database. The sending time of the SMS must be in accordance with the predetermined scheduling. A common feature developed in the SMS gateway application is autoreply, mass delivery / broadcast message and scheduled delivery
(Wicaksono & Triyono, 2015). SMS gateways are devices or services that offer SMS transit, change messages to cellular network traffic from other media or vice versa that allow the transmission of SMS messages with or without using a cellphone. The thing that is unique in SMS gateways is sending simple e-mails to message recipients quickly with mass delivery capacity (Katankar & Thakare, 2010) The first thing that SMS gateway users do is access web-based applications and compose SMS with basic headers, recipient's cellphone numbers and messages to be sent. Compiled messages are sent at the web server level that will modify the message, apply several headers and pass it to the SMS gateway. The SMS gateway will then send this message to the recipient's cellular telephone according to the telephone number input made in the first stage (Katankar & Thakare, 2010). Farooqi, Ashraf, & Zaman (2017) in their study also found that the rate of drug withdrawal in the group given daily mobile smsreminders was lower than the standard DOTS program. Liu et al. (2015) in his research also stated that reminders from health workers can increase patient compliance in consuming OAT.
Overall, the included studies suggest that patients receiving mobile phone text messa- ging interventions had rates of adherence to TB treatment comparable to or higher than those receiving no interven- tion. Therefore, the findings provide mixed evidence for the effectiveness of mobile phone text messaging interventions designed to
promote adherence to TB treatment. Though the evidence is mixed, we cannot ignore the potential of mobile phone text messaging to transform the delivery of health messages
to
patients.
Mobile
phones have spread globally; 45% of the world’s
population were estimated to have access to a mobile phone at the end of 2012 [1,3]. In addition, the use of SMS has become popular throughout the world. Globally, there were an estimated 5.9 trillion SMS messages sent in 2011 and SMS traffic is expected to reach 9.4 trillion messages by 2016 [4,5]. This increasingly popular mode of communication can be used to deliver short health messages to people anywhere and provide interactive feedback and support to people when they need it the most. Previous research has shown that
SMS interventions are effective as a means to promote
multiple healthy behaviors such as adherence to antiretroviral treatment [2], diabetes management and control [6], smoking cessation [7], and immunization compliance [8]. We have found that currently avail- able research utilizing SMS interventions to promote adherence to TB treatment is inconclusive. V.
Conclusion The findings of this systematic review indicate that SMS interventions have a potential for use to improve patients’ adherence to TB treatment, though the evidence is incon- clusive. To conclude that such an intervention is effective is difficult because there is a paucity of high-quality studies. The current evidence is of low quality implying that further research is very likely to have an important impact on our confidence in the effectiveness of this intervention and is likely to change the magnitude of the estimate of effect. The results of the systematic review also lay an important foundation on which future studies can build upon. In its development, this system has not been able to objectively ascertain whether the drug is being swallowed up by the patient but this can be developed for further research based on technology. .
References 1. GSMA Intelligence: Global mobile penetration — subscribers versus connections. 2013.
https://gsmaintelligence.com/analysis/2012/10/global-
mobile-penetration-
subscribers-versus-connections/354. 2. Horvath T, Azman H, Kennedy GE, Rutherford GW: Mobile phone text messaging for promoting adherence to antiretroviral therapy in patients with HIV infection. Cochrane Database Syst Rev 2012, 3, CD009756. 3. United Nations, Department of Economic and Social Affairs, Population (UN DESA): World
Population
Prospects,
2010
revision;
2010.
http://esa.un.org/unpd/wpp/Documentation/pdf/WPP2010_VolumeI_Comprehensive-Tables.pdf. 4. mobiThinking: Global mobile statistics 2012 Part C: Mobile marketing, advertising and messaging; 2012. http://mobithinking.com/mobile-marketing- tools/latest-mobilestats/c. 5. Informa Telecoms and Media. Press release: SMS will remain more popular than mobile messaging apps over next five years. United
Kingdom; 2012.
http://blogs.informatandm.com/4971/press-release-sms-will-remain-more-popularthan-mobile-messaging-apps-over-next-five-years/. 6. Liang X, Wang Q, Yang X, Cao J, Chen J, Mo X, Huang J, Wang L, Gu D: Effect of mobile phone intervention for diabetes on glycaemic control: a metaanalysis. Diabet Med 2011, 28:455–463. 7. Whittaker R, McRobbie H, Bullen C, Borland R, Rodgers A, Gu Y: Mobile phonebased interventions for smoking cessation. Cochrane Database Syst Rev 2009, 11, CD006611. 8. Stockwell MS, Kharbanda EO, Martinez RA, Lara M, Vawdrey D, Natarajan K, Rickert VI: Text4Health: impact of text message reminder-recalls for pediatric and adolescent immunizations. Am J Public Health 2012, 102:e15–21. 9. Subbaraman R, Mondesert L De, Musiimenta A, Pai M, Mayer KH, Thomas BE, et al. Digital adherence technologies for the management of tuberculosis therapy : mapping the landscape and research priorities. 2018;1–16. 10. Bediang G, Stoll B, Elia N, Abena J, Geissbuhler A. SMS reminders to improve adherence and cure of tuberculosis patients in Cameroon ( TB-SMS Cameroon ): a randomised controlled trial. 2018;1–14.
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