This study evaluates a project led by On Cue, a small company based in Cape Town, South Africa, which sends SMS messages to patients via mobile telephones, reminding them to take their tuberculosis (TB) medication at pre-determined times. This service aims to provide an affordable solution to improve patient adherence to TB treatment and reduce the associated costs of the directly observed therapy system for both patients and clinics. This report presents the lessons learned so far, as well as other uses of cellular technology in the healthcare sector.

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Table of contents

Executive Summary
Acknowledgements
1 Introduction
2 Background on the treatment of Tuberculosis

2.1 Tuberculosis: a worldwide problem
2.2 How TB is detected, treated and controlled
2.3 The issue of patient adherence to treatment regimes
2.4 Tuberculosis in South Africa
2.5 TB in the Cape Town metropolitan area
2.6 Enhancing TB treatment adherence in Cape Town

3 About the on-cue TB compliance service
4 Evaluation objectives and methodology

4.1 The evaluation process

5 Findings of the evaluation

5.1 Treatment outcomes
5.2 Real Access to the Compliance Service

Physical access to cellular technology
Appropriateness of cellular technology to health care in this context
Cost impact: patient costs
Cost impact: health service costs
Capacity issues around using the
Compliance Service Privacy and data protection
Integration of the Compliance Service into daily routines
Patient support and enthusiasm for the Compliance Service

5.3 Project management and implementation of the Compliance Service

Doing homework and conducting a needs assessment
Implementing and disseminating best practice
Ensuring ownership, getting local buy-in, finding a champion
Setting concrete goals and taking small achievable steps
Critically evaluating efforts, reporting back, and adapting as needed
Address key external challenges
Making it sustainable
Involving traditionally-excluded groups and addressing socio-cultural factors

6 Discussion and analysis

6.1 Key findings
6.2 Obstacles to widespread rollout

7 Recommendations to the city council

7.1 Re-implementing the pilot
7.2 Suggested new procedure for a Compliance Service pilot
7.3 Scaling up the Compliance Service

8 Concluding remarks
Annex 1. Treatment outcomes from assessment of 221 patient records
Annex 2. The bridges.org Real Access/Real Impact criteria
Annex 3. Questionnaire for patient interviews
Annex 4. Results from a survey of patient satisfaction with the Compliance Service
Annex 5. Questionnaire for health worker interviews
Annex 6. Consent form
Annex 7. Results of a survey of health worker satisfaction with the Compliance Service
Annex 8. Details of how patient interviews were set up and conducted

 

Acknowledgements

This report was prepared for the City of Cape Town Health Directorate and the International Development Research Council (IDRC).

Bridges.org would like to recognise the work of Jennifer Huesler on this evaluation. We would like to thank Dr. Ivan Toms of the Cape Town City Health Directorate, and staff at Chapel Street clinic for their assistance with compiling data for this report and supporting the evaluator during visits. In particular, we would like to thank Dr. Virginia Azevedo of the Cape Town City Health Directorate for her invaluable input, and for lending us her time and expertise. Financial support for this evaluation was provided by the International Development Research Council (IDRC).