Using cell phones to fight TB

Tuberculosis (TB) patients in South Africa now have a new weapon in the fight against the disease - a cell phone. A pilot project in the coastal city of Cape Town is using the text message service on cell phones to remind patients to take their medication, saving the over-stretched public health services time and money. The country is said to be facing one of the worst TB epidemics in the world, with disease rates up to 60 times higher than those currently experienced in the United States. Treatment for the disease, however, is still a problem. TB patients must strictly follow a difficult drug regime of four tablets, five times a week, for six months. Patients end up being resentful of such an "oppressive" process, project creator Dr David Green, told IRIN. Consequently, they either forget to take their medication or interrupt their treatment. "This is a significant problem because they become more resistant to the treatment and MDR [multidrug resistant] TB is more expensive to treat," Green said. But now up to 300 patients in a local clinic in Cape Town have been receiving a text message on their cell phones reminding them to take their pills. Of the patients involved in the project, there has been only one treatment interruption. When patients complained that the initial message "take your medicine now" was too "boring", Green added disease information and tips about lifestyle management. "After a month of being on treatment, the service would send a message warning the patient that even though they were feeling better, they had to continue with the treatment," he said. The initiative uses technology in a simple, cheap and flexible way: a software application captures the patient's details into a database, a computer server reads the database, and then sends personalised messages to each patient. At a relatively inexpensive US $1.5 per patient per month for the short message service (SMS) reminder, the local health authority has decided to extend the pilot project to other clinics with high cell phone ownership. "Clearly if more people are likely to finish their treatment on SMS technology, it will save the health department a lot of money and it will relieve the burden on our health system," Green noted. Health experts were initially sceptical whether the uptake of cell phone technology was high enough to justify the project. Research into cell phone ownership, however, found that one in three people with TB in the township of Khayelitsha had cell phones. "Even the very poor have cell phones these days, that is no longer an excuse," Green said. At the clinic where the pilot study was conducted, 71 percent of TB patients had access to a cell phone. Medical experts have cautiously welcomed the project. "Its certainly an interesting and novel way to fight a major problem," Dr Karen Weyer, director of the Medical Research Council (MRC) TB Unit, said. But an increase in adherence could only be tested by randomised control trials, she noted. The MRC and the University of Cape Town will embark on trials to compare the effectiveness of the SMS reminder service against the cost of non-compliance to TB treatment. In the meantime, more TB patients in Cape Town will be reminded that TB is curable - with regular treatment.