Date: 22 February 2019
Patients with tuberculosis (TB) are more likely to continue their drug treatment if they are supported using smartphones rather than by attending face-to-face appointments, a new study funded by the NIHR has found.
Just under 5,200 people in England have TB, of which nearly 40% are in London. Some patients with TB face difficulties finishing their full course of medication - such as people with substance misuse or mental health problems, and those who are homeless.
The World Health Organization recommends that TB patients at high risk of not taking all their treatment are monitored using directly observed treatment. This approach involves the patient being observed taking their treatment via three to five meetings a week with a healthcare or lay professional, at home or in a community or clinic setting.
Directly observed treatment can minimise the risk of relapse, and reduce the spread of infection and growth of drug resistant strains of TB, but it is time intensive for both the patient and NHS services.
This study, funded by NIHR Programme Grants for Applied Research, investigated supporting TB patients with a smartphone app, where they can film themselves taking the treatment and securely submit the recording so that the clinical team can be sure the dose was taken (video observed treatment).
The UCL researchers recruited 226 TB patients in London, Birmingham, Coventry and Leicester, 58% of whom had a history of homelessness, mental health issues, imprisonment or addiction. Half of these patients were supported by video observation using a smartphone, and half received directly observed treatment in clinical appointments.
The research, published in the Lancet, found that seven out of 10 patients who used a smartphone completed at least 80% of their scheduled treatments.
For patients had directly observed treatment at face-to-face appointments, fewer than half of treatment doses could be confirmed.
Lead researcher Professor Andrew Hayward, Director of the UCL Institute of Epidemiology and Health Care and UCL Professor of Infectious Disease Epidemiology and Inclusion Health, said: “Taking regular TB treatment is difficult, but if poorly treated, the disease can kill, infect others and become resistant to antibiotics. Patients told us that having to go to a TB clinic several times a week to have their treatment monitored was both inconvenient and stigmatising.
“Our NIHR-funded trial shows that patients can use a smartphone app to prove they have taken their treatment, and this is much more effective, cheaper and convenient than face-to-face meetings. This allowed us to support TB treatment even in people who are homeless or suffering from drug addiction. We are very excited about the potential of this technology to improve treatment of this killer disease.”
Professor Elaine Hay, Professor of Community Rheumatology at Keele University and Director of NIHR Programme Grants for Applied Research, said: “The positive results from this NIHR-funded research have the potential to make care simpler and more effective for people with TB, and help in the fight against antibiotic resistance - a priority for both the NHS and globally. This forms part of a wider £2 million programme of research to improve the management and control of TB among hard to reach groups and exemplifies the ambitious, real-world research we fund.”
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