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

A mobile health application use among diabetes mellitus patients: a systematic review and meta-analysis

Background

Mobile health technologies are increasingly acknowledged as a cost-effective and convenient means of delivering top-notch healthcare services to patients in low- and middle-income countries. This research explores the utilization of mobile health applications in managing, monitoring, and self-care for adult diabetes mellitus (DM) patients. The objective is to gain insight into how diabetic patients currently utilize Mobile health applications for self-management and their inclination to use them in the future.

Methods

The authors conducted a systematic review and meta-analysis using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. They included articles that reported on the use of mobile/smartphone applications for diabetic mellitus disorders, focusing on ownership, application use, future interest in use, and use patterns. The search was conducted in the PubMed, Web of Science, Embase, and SCOPUS electronic databases, with various published articles from January 2016 up to February 2024. The methodological quality was evaluated using the Joanna Briggs Institute critical appraisal tool. Statistical techniques were applied, including the heterogeneity test, publication bias assessment, Egger's test, and funnel plots. The pooled prevalence was calculated using meta-analysis proportion with a random-effects model.

Results

Thirteen studies were included, out of 4568 recognized articles. The pooled prevalence of mobile health application use for current diabetic management self-management, future interest in using the application for diabetic disorder self-management, and lack of belief in mobile health application users for self-management was 35%, 57%, and 39%, respectively. We observed significant heterogeneity (I2 = 97.7, p=<0.001), but no significant publication bias was detected on Egger's test.

Conclusions

Our meta-analysis results show that over one-third of individuals use mobile health applications for diabetic self-management, and more than half of individuals would like to manage their diabetes mellitus in the future by using mobile health applications. These mobile health apps may be promising in future diabetes mellitus self-management. However, we still need to study the effectiveness of these apps. In addition, adopting mobile health apps based on the cultural context makes this self-management more achievable, practical, and impactful for individuals with diabetes.

Systematic review registration

https://www.crd.york.ac.uk/prospero/, identifier 42024537917.

Using mHealth Technologies for Case Finding in Tuberculosis and Other Infectious Diseases in Africa: Systematic Review

BACKGROUND

Mobile health (mHealth) technologies are increasingly used in contact tracing and case finding, enhancing and replacing traditional methods for managing infectious diseases such as Ebola, tuberculosis, COVID-19, and HIV. However, the variations in their development approaches, implementation scopes, and effectiveness introduce uncertainty regarding their potential to improve public health outcomes.

OBJECTIVE

We conducted this systematic review to explore how mHealth technologies are developed, implemented, and evaluated. We aimed to deepen our understanding of mHealth's role in contact tracing, enhancing both the implementation and overall health outcomes.

METHODS

We searched and reviewed studies conducted in Africa focusing on tuberculosis, Ebola, HIV, and COVID-19 and published between 1990 and 2023 using the PubMed, Scopus, Web of Science, and Google Scholar databases. We followed the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines to review, synthesize, and report the findings from articles that met our criteria.

RESULTS

We identified 11,943 articles, but only 19 (0.16%) met our criteria, revealing a large gap in technologies specifically aimed at case finding and contact tracing of infectious diseases. These technologies addressed a broad spectrum of diseases, with a predominant focus on Ebola and tuberculosis. The type of technologies used ranged from mobile data collection platforms and smartphone apps to advanced geographic information systems (GISs) and bidirectional communication systems. Technologies deployed in programmatic settings, often developed using design thinking frameworks, were backed by significant funding and often deployed at a large scale but frequently lacked rigorous evaluations. In contrast, technologies used in research settings, although providing more detailed evaluation of both technical performance and health outcomes, were constrained by scale and insufficient funding. These challenges not only prevented these technologies from being tested on a wider scale but also hindered their ability to provide actionable and generalizable insights that could inform public health policies effectively.

CONCLUSIONS

Overall, this review underscored a need for organized development approaches and comprehensive evaluations. A significant gap exists between the expansive deployment of mHealth technologies in programmatic settings, which are typically well funded and rigorously developed, and the more robust evaluations necessary to ascertain their effectiveness. Future research should consider integrating the robust evaluations often found in research settings with the scale and developmental rigor of programmatic implementations. By embedding advanced research methodologies within programmatic frameworks at the design thinking stage, mHealth technologies can potentially become technically viable and effectively meet specific contact tracing health outcomes to inform policy effectively.

Healthcare workers' perspectives on the availability and use of mobile health technologies for disease diagnosis and treatment support in the Ashanti Region of Ghana

INTRODUCTION

Considering the usefulness of mobile health (mHealth) technologies in healthcare delivery in low- and middle-income countries, including Ghana; there is a need to explore healthcare professionals' perspectives on the availability and use of mHealth for disease screening and treatment of patients' conditions. The study's main aim is to explore healthcare professionals' perspectives regarding the availability and use of mHealth applications for disease screening and management at point-of-care in Ghana's Ashanti Region.

MATERIALS AND METHODS

We conducted in-depth interviews with healthcare professionals who use mHealth applications daily between July and September 2020. A purposive sampling strategy was employed to select healthcare professionals who have been using mobile health application tools to support healthcare delivery. The researchers conducted 14 in-depth interviews with healthcare professionals on the availability and use of mHealth applications to support disease diagnosis and treatment of patients' conditions. Data were transcribed, coded, arranged, and analyzed to determine categories and themes.

RESULTS

The study results demonstrated that healthcare workers had positive perceptions towards mHealth applications. Healthcare professionals identified significant challenges concerning mHealth applications: the high cost of data; lack of education or limited awareness; poor mobile networks; unstable internet connectivity; erratic power supply; and unavailability of logistics. Healthcare professionals identified the following prerequisite strategies to strengthen the use and scale-up of mHealth applications: stable internet connectivity; creating awareness; supplying logistics; reducing the cost of data; and developing local mobile apps.

CONCLUSIONS

The study results revealed the availability of mHealth applications at the individual level for disease screening and treatment support of patients' conditions. The study also showed several significant challenges facing mHealth applications which need to be addressed to guarantee the successful implementation and scaling-up of mHealth activities at all levels of healthcare delivery. Hence, future research should incorporate healthcare professionals' perspectives to completely understand mHealth implementation and scaling-up challenges and measures to inform policy regulations.

The trial of sending short message service multidrug-resistant tuberculosis patients in Indonesia: the chance to increase knowledge and motivation

Multidrug-Resistant Tuberculosis (MDR TB) is a threat for the future control of TB disease. In Indonesia, the success rate of MDR TB patient recovery is still very low, following the still low recovery rate of TB patients. This paper aims to discuss the trial result of message delivery containing knowledge and motivation to the MDR TB sufferers. There are about 34 MDR TB patients participating in this research. During the research, everyone received a message in their handphone or the handphone of their family members every day, contained information on medication and motivation to comply with the medication. At the end of the research, the measurement on knowledge and attitude, on the compliance with medication, and on the compliance with laboratory examinations was conducted. The results were compared with the assessment before this intervention was conducted. Out of 32 patients that managed to complete the intervention, the average means of their knowledge and attitude increased significantly. The average mean of knowledge before the intervention was 9.74 to become 10.94, and the average mean of attitude was from 7.06 to become 18.47 (P<0.05). Meanwhile, the medication compliance score and the laboratory examination compliance score also changed significantly (P<0.05). SMS delivery routinely even in a short period of time managed to change knowledge and motivation of MDR TB sufferers. To conclude, it is necessary to develop recent technology effort in order to scaling-up MDR TB patients. Existing social channels in the community must be used intensively to reduce this disease negative impact.

Direct-to-patient digital diagnostics in primary care: Opportunities, challenges, and conditions necessary for responsible digital diagnostics

BACKGROUND

Diagnostics are increasingly shifting to patients' home environment, facilitated by new digital technologies. Digital diagnostics (diagnostic services enabled by digital technologies) can be a tool to better respond to the challenges faced by primary care systems while aligning with patients' and healthcare professionals' needs. However, it needs to be clarified how to determine the success of these interventions.

OBJECTIVES

We aim to provide practical guidance to facilitate the adequate development and implementation of digital diagnostics.

STRATEGY

Here, we propose the quadruple aim (better patient experiences, health outcomes and professional satisfaction at lower costs) as a framework to determine the contribution of digital diagnostics in primary care. Using this framework, we critically analyse the advantages and challenges of digital diagnostics in primary care using scientific literature and relevant casuistry.

RESULTS

Two use cases address the development process and implementation in the Netherlands: a patient portal for reporting laboratory results and digital diagnostics as part of hybrid care, respectively. The third use case addresses digital diagnostics for sexually transmitted diseases from an international perspective.

CONCLUSIONS

We conclude that although evidence is gathering, the often-expected value of digital diagnostics needs adequate scientific evidence. We propose striving for evidence-based 'responsible digital diagnostics' (sustainable, ethically acceptable, and socially desirable digital diagnostics). Finally, we provide a set of conditions necessary to achieve it. The analysis and actionable guidance provided can improve the chance of success of digital diagnostics interventions and overall, the positive impact of this rapidly developing field.

Monitored Implementation of COVID-19 Rapid Antigen Screening at Taxi Ranks in Johannesburg, South Africa

Digital tools can support community-based decentralized testing initiatives to broaden access to COVID-19 diagnosis, especially in high-transmission settings. This operational study investigated the use of antigen-detecting rapid diagnostic tests (Ag-RDTs) for COVID-19 combined with an end-to-end digital health solution, in three taxi ranks in Johannesburg, South Africa. Members of the public were eligible if they were aged ≥18 years, could read, and had a cellphone. Over 15,000 participants, enrolled between June and September 2021, were screened for COVID-19 risk factors. A digital risk questionnaire identified 2061 (13%) participants as moderate risk and 2987 (19%) as high risk, based on symptoms and/or recent exposure to a known case. Of this group referred for testing, 3997 (79%) received Ag-RDTs, with positivity rates of 5.1% in the "high-risk" group and 0.8% in the "moderate-risk" group. A subset of 569 randomly selected participants received additional PCR testing. Sensitivity of the Ag-RDT in this setting was 40% (95% CI: 30.3%, 50.3%); most false negatives had high cycle threshold values (>25), hence low viral loads. Over 80% of participants who tested positive completed a 2-week phone-based follow-up questionnaire. Overall, the digital tool combined with Ag-RDTs enhanced community-based decentralized COVID-19 testing service delivery, reporting and follow-up.

Direct Access for Patients to Diagnostic Testing and Results Using eHealth: Systematic Review on eHealth and Diagnostics

BACKGROUND

The number of people with chronic diseases and the subsequent pressure on health care is increasing. eHealth technology for diagnostic testing can contribute to more efficient health care and lower workload.

OBJECTIVE

This systematic review examines the available methods for direct web-based access for patients to diagnostic testing and results in the absence of a health care professional in primary care.

METHODS

We searched the PubMed, Embase, Web of Sciences, Cochrane Library, Emcare, and Academic Search Premier databases in August 2019 and updated in July 2021. The included studies focused on direct patient access to web-based triage leading to diagnostic testing, self-sampling or testing, or web-based communication of test results. A total of 45 studies were included. The quality was assessed using the Mixed Methods Appraisal Tool.

RESULTS

Most studies had a quantitative descriptive design and discussed a combination of services. Diagnostic test services mainly focused on sexually transmitted infections. Overall, the use was high for web-based triage (3046/5000, >50%, who used a triage booked a test), for self-sampling or self-testing kits (83%), and the result service (85%). The acceptability of the test services was high, with 81% preferring home-based testing over clinic-based testing. There was a high rate of follow-up testing or treatment after a positive test (93%).

CONCLUSIONS

The results show that direct access to testing and result services had high use rates, was positively evaluated, and led to high rates of follow-up treatment. More research on cost-effectiveness is needed to determine the potential for other diseases. Direct access to diagnostic testing can lower the threshold for testing in users, potentially increase efficiency, and lower the workload in primary care.

The Role of GeneXpert MTB/RIF in Reducing Treatment Delay Among Multidrug Resistance Tuberculosis Patients: A Propensity Score Matched Analysis

Background

Methods

Results

Conclusion

Mobile health applications for disease screening and treatment support in low-and middle-income countries: A narrative review

The advances in mobile technologies and applications are driving the transformation in health services delivery globally. Mobile phone penetration is increasing exponentially in low-and middle-income countries, hence using mobile phones for healthcare services could reach more people in resource-limited settings than the traditional forms of healthcare provision. The review presents recent literature on facilitators and barriers of implementing mHealth for disease screening and treatment support in low-and middle-income countries. We searched for relevant literature from the following electronic databases: MEDLINE; CINAHL with full text via EBSCOhost; Science Direct; PubMed; Google Scholar and Web of Science using the keywords for relevant studies. We searched for published studies from 2015 to August 2020 with no language limitations. A total of 721 articles identified, 125 articles met the inclusion criteria and were included in the qualitative synthesis. The review demonstrates relevant facilitators for the implementation of mHealth, which includes knowledge, attitudes, and perceptions of stakeholders on the use of mHealth and the performance of mHealth for disease diagnosis in low and-middle-income countries. Barriers and challenges hindering the implementation of mHealth applications were also identified. We proposed a framework for improving the implementation of mHealth for disease screening and treatment support in low-and middle-income countries.

Study protocol and implementation details for a pragmatic, stepped-wedge cluster randomised trial of a digital adherence technology to facilitate tuberculosis treatment completion

INTRODUCTION

Low-cost digital adherence technologies (DATs) such as 99DOTS have emerged as an alternative to directly observed therapy (DOT), the current standard for tuberculosis (TB) treatment supervision. However, there are limited data to support DAT scale-up. The 'DOT to DAT' trial aims to evaluate the effectiveness and implementation of a 99DOTS-based TB treatment supervision strategy.

METHODS AND ANALYSIS

This is a pragmatic, stepped-wedge cluster randomised trial, with hybrid type 2 effectiveness-implementation design. The trial will include all adults (estimated N=1890) treated for drug-susceptible pulmonary TB over an 8-month period at 18 TB treatment units in Uganda. Three sites per month will switch from routine care (DOT) to the intervention (99DOTS-based treatment supervision) beginning in month 2, with the order determined randomly. 99DOTS enables patients to be monitored while self-administering TB medicines. Patients receive daily automated short message service (SMS) dosing reminders and confirm dosing by calling toll-free numbers. The primary effectiveness outcome is the proportion of patients completing TB treatment. With 18 clusters randomised into six steps and an average cluster size of 15 patients per month, the study will have 89% power to detect a 10% or greater increase in treatment completion between the routine care and intervention periods. Secondary outcomes include more proximal effectiveness measures as well as quantitative and qualitative assessments of the reach, adoption and implementation of the intervention.

ETHICS AND DISSEMINATION

Ethics approval was granted by institutional review boards at Makerere University School of Public Health and the University of California San Francisco. Findings will be disseminated through peer-reviewed publications, presentations at scientific conferences and presentations to key stakeholders.

TRIAL REGISTRATION NUMBER

PACTR201808609844917.

Availability and use of mHealth for disease diagnosis and treatment support by health workers in sub-Saharan Africa: a scoping review protocol

INTRODUCTION

Improving healthcare for all is one of the global health priorities, particularly in disease burdened settings such as sub-Saharan Africa (SSA). Considering the high penetration rate of mobile phones in SSA, mobile health (mHealth) could be used to achieve universal health coverage. The proposed study will map evidence on the availability and use of mHealth for disease diagnosis and treatment support by health workers in SSA.

METHODS AND ANALYSIS

This review will be guided by Arksey and O'Malley's scoping review framework and Levac et al's recommendations and guidelines from the Joanna Briggs Institute. A scoping review will be conducted to explore what is known about mHealth for disease diagnosis and treatment support by health workers in SSA and to identify areas for future research. In addition to searching the grey literature, the following databases will be explored from PubMed, MEDLINE and CINAHL with full text via EBSCOhost and ScienceDirect databases. A search in Google Scholar will be considered as an additional information source. The literature search will involve published studies from 2000 to 2020 in any language. This review will cover mHealth for disease diagnosis and treatment support by health workers in SSA. The primary investigator will conduct the title screening, and subsequently, two reviewers will independently conduct abstract and full article screening and data extraction. The results of this proposed review will be presented using the Preferred Reporting Items for Systematic Reviews and Meta-analysis: Extension for Scoping Review guidelines.

ETHICS AND DISSEMINATION

Ethical approval is not required for the scoping review, which is the first stage in a PhD study in public health on accessing mHealth for disease diagnosis and treatment support by health workers in Ghana. The final review will be submitted for publications to a scientific journal, and our results will be presented at appropriate conferences.

Implementation science to improve the quality of tuberculosis diagnostic services in Uganda

Nucleic acid amplification tests such as Xpert MTB/RIF (Xpert) have the potential to revolutionize tuberculosis (TB) diagnostics and improve case finding in resource-poor settings. However, since its introduction over a decade ago in Uganda, there remain significant gaps along the cascade of care for patients undergoing TB diagnostic evaluation at peripheral health centers. We utilized a systematic, implementation science-based approach to identify key reasons at multiple levels for attrition along the TB diagnostic evaluation cascade of care. Provider- and health system-level barriers fit into four key thematic areas: human resources, material resources, service implementation, and service coordination. Patient-level barriers included the considerable costs and time required to complete health center visits. We developed a theory-informed strategy using the PRECEDE framework to target key barriers by streamlining TB diagnostic evaluation and facilitating continuous quality improvement. The resulting SIMPLE TB strategy involve four key components: 1) Single-sample LED fluorescence microscopy; 2) Daily sputum transport to Xpert testing sites; 3) Text message communication of Xpert results to health centers and patients; and 4) Performance feedback to health centers using a quality improvement framework. This combination of interventions was feasible to implement and significantly improved the provision of high-quality care for patients undergoing TB diagnostic evaluation. We conclude that achieving high coverage of Xpert testing services is not enough. Xpert scale-up should be accompanied by health system co-interventions to facilitate effective implementation and ensure that high quality care is delivered to patients.