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SMS technology for TB treatment

Introduction

Initiative Name:	SMS technology for TB treatment
Implemented by:	The Compliance Service
Timeframe:	Started in 2002
Country:	South Africa [ZA]
Theme:	Health
	Access

The Story

Background and context:

Dr. David Green's Compliance Service uses the Short Message Service (SMS) to alert tuberculosis (TB) patients to take their medication. The initiative has led to a significant increase in the recovery rate of patients and could lead to savings for healthcare authorities.

The population of Cape Town is divided along race and class lines. White people generally have access to middle and high-income jobs, good municipal services, and private healthcare, and they can afford comfortable housing. Coloured , and especially black citizens of Cape Town generally have low paid jobs or are unemployed, live in informal settlements where housing is often substandard, cannot rely on good municipal services, and have to use the overburdened public healthcare system. Cape Town's Mediterranean winters are cold and wet, and this poses an additional health hazard for people living in informal settlements. Large areas of these settlements are built below the waterline and are flooded during the winter months. Due to this combination of factors, poor black people are more prone to contracting TB. Unemployment countrywide is estimated at 41.5% and the GDP per capita is estimated at USD $8,500. (Global Insight, an international research company)

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The development problem/obstacle addressed:

Cape Town has one of the world's highest incidences of TB, largely due to socio-economic and climatic factors. TB patients must strictly follow a difficult drug regime -- four tablets five times a week for six months -- and they often forget to take their medication. Non-compliance with the drug treatment has exacerbated the high occurrence of TB and has created difficulties for the local, overburdened healthcare service. Precious medicines are wasted when people do not take their medication on schedule, and non-compliance causes the TB virus to become increasingly drug resistant.

Dr. David Green, a consultant in Managed Care, Disease Management and Information Systems, became so frustrated when his mother constantly forgot to take her medication for hypertension, that he started sending her SMS reminders -- and it worked. Thanks to research he did for his PhD in Pharmacology, he was able to take his idea further and apply it to public healthcare. Dr. Green's reading eventually led him to two important insights. Firstly, he concluded that interventions designed to prevent non-compliance of treatment was not effective because it was applied indiscriminately. He concluded it was necessary to identify those patients who were non-compliant and find out why they were not taking their medication. Secondly, he was struck by the overwhelming literary evidence that suggested people were not taking their medication simply because they forgot.

Dr. Green was aware of the need for interventions that increase TB medication adherence, and especially so in Cape Town, which has one of the highest rates of TB infection in the world.

It did not take him long to make the connection between the effectiveness that his SMS messages had on alerting his mother, the high incidence of TB in Cape Town, and the possibilities that bulk SMS messages could present. However, when he wanted to pilot his innovative idea with TB patients at a local clinic in Cape Town, he met with resistance. Healthcare professionals were skeptical about the number of patients who would have access to cell phones. Not deterred, Dr. Green went back, did research and persuaded them with statistics which indicated that over 50% of Cape Town residents have cell phones. In addition, he found that 71% of patients at the clinic he earmarked for the pilot had access to cell phones. The local health authority eventually agreed and paid R11.80 per patient per month to run the SMS reminder service. The results of the pilot have been outstanding: of the 138 patients involved in the pilot, there was only one treatment failure.

Impact Assesment

Awareness: Awareness in this project is most prominent among the project providers. Apparently they didn't know their target group as well as they thought and where surprised to find out that over 50% of Cape Town residents have cell phones.

Lessons Learned

General: The Medical Research Council of South Africa and the University of Cape Town has now embarked on a Randomised Control Trial to compare the cost-effectiveness of the SMS-reminder service against the cost of non-compliance to TB treatment. In the mean time, the pilot has been so successful that the World Health Organisation has singled it out as example of "Best Practice".

Technology: The initiative not only uses technology to address a real need effectively, but it does this in a simple, affordable and flexible way. Dr. Green uses a server, free software and a bulk SMS provider to send out the SMS messages. His system costs very little because he uses freely available open source software. In addition, his messaging system is flexible. When patients complained that the initial message ("Take your Rifafour now") was too drab, he added jokes, pearls of wisdom, and tips about lifestyle management to light up their day -- but it still reminded them to take their medication.

This article is part of the bridges.org/IICD Case Study Series on ICT-Enabled Development which sets out to illustrate how ICT contributes to development in Africa. The aim of this series is to help ground level initiatives imagine the possibilities of what can happen if they use ICT successfully to overcome development obstacles, and to contribute to the existing body of knowledge on the digital divide. The complete series can also be found on: http://www.bridges.org/iicd_casestudies/case_studies.html

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