029 - Mobile-assisted Medication Adherence Support intervention among Tuberculosis Patients: A Parallel Group Randomized Control Trial

Background: As mobile phones are widely available, health providers and patients can communicate directly through SMS text messages and phone calls to support overcoming barriers to adherence to TB medication. However, there is conflicting evidence regarding the efficacy of SMS texts to promote TB medication adherence. Additionally, most mobile-based adherence interventions are not designed in theory based. We developed a mobile-assisted medication adherence support (Ma-MAS) intervention using the medical research council (MRC) framework based in a local context targeting audience needs and the effectiveness of this intervention evaluated in a sample of TB patients in Addis Ababa, Ethiopia.
Methods: A parallel group randomized control trial design was used to evaluate the effectiveness of Ma-MAS intervention. In total, 186 adult TB patients (93 per group) were randomly assigned 1:1 to one of the two groups using a computer-generated algorithm. Participants in the Ma-MAS group received daily SMS texts and weekly phone calls regarding their daily medication intake and reminders to attend clinic visits for 8 weeks. Participants in the control group did not receive SMS texts or phone calls but received the same routine standard care as the Ma-MAS group. All participants were followed for 8 weeks during intervention period at the continuation phase of treatment. The primary outcome was the proportion of adherence measured by urine tests for isoniazid (INH) metabolites at the end of the 4th and 8th week of follow-up period. The outcome assessors were blinded to participants group assignment. Analysis of a multivariable binomial generalized linear model was employed to evaluate the effect of Ma-MAS at a significance level of (P value) < 0.05.
Results: Ma-MAS significantly improved adherence to TB medications by 15.25% (95%CI: 5.38, 25.12; P-value=0.0065) after 8 weeks of intervention compared to the standard care alone in the control group. At the end of the 8 weeks follow-up period, the predicted probability of adherence to TB medication in the Ma-MAS group was 86% (95%CI: 81, 93), and in the control group was 70% (95%CI: 61, 79). Ma-MAS also improved adherence to TB medication by 15.30% (95%CI: 6.68, 23.90; P-value=0.0022) after 4 weeks of intervention compared with the control group.
Conclusion Ma-MAS intervention based on information-motivation-behavioural skills model and behavioural change techniques is useful to improve adherence to TB medication.
Funding: The research is partially funded by Flinders University and supported by the Fogarty International Center and of the National Institutes of Health under Award Number D43TW009127. The funder and sponsor had no role in design, implementation, analysis, and interpretation of the findings. All content is the responsibility of the authors and does not necessarily represent the official views of the Flinders University or National Institutes of Health.

Mobile health

Digital health

SMS text messages

Phone calls

Tuberculosis medication Adherence