The long term goal of this training grant application is to support development of the applicant as a nurse scientist with the knowledge and skills to conduct research focused on improving infectious disease outcomes internationally. The fellowship will concentrate on dissertation research focused on evaluating an innovative intervention developed in collaboration with a TB specialized healthcare team and patients to improve treatment outcomes related to tuberculosis. Tuberculosis (TB) is a challenging global public health problem. The World Health Organization (WHO) recommends direct observation of treatment (DOT), in which a trained health care worker witnesses the daily administration of medication, as the standard for treating TB. Use of DOT is challenging and when DOT is not feasible, patient self-administration (SAT) is often used. In Argentina, treatment success rates remain well below the WHO recommended rates. In 2007 of the reported sputum smear-positive cases 54% were documented to have received DOT countrywide and only 20% in the Province of Buenos Aires, moreover default rate (patient-interrupted treatment for at least two months) was 14.5%. A current objective to improve TB care outcomes is to heighten TB patients'involvement in their own care, and improve communication between patients and care team. A promising tool to build on these goals is the use of text messaging or SMS (Short Message Service) via mobile phones, an increasingly ubiquitous global communications medium. The proposed research is a mixed-method, phased design pilot study guided by a socio-technical approach. The first phase will include finalizing the intervention protocol (e.g. socially and culturally appropriate educational text messages and a clinical workflow algorithm to address and respond to text messaging issues or other potential situations) in collaboration with the TB-specialized healthcare team at the reference hospital in Argentina. Phase 2 is an exploratory pilot study using mixed methods to evaluate the feasibility and initial efficacy of the text messaging based intervention.
Study aims are to: (1) develop and examine the efficacy of a text messaging computer-based system intervention on patient outcomes;(2) evaluate the structure and process of delivering the intervention;and (3) explore perceptions of acceptance, feasibility, and how to optimize the intervention from the perspective of TB patients. Forty eligible and consented participants will be randomized to a control group receiving standard of care self administration of treatment (SAT) or to an intervention group receiving SAT plus the text messaging intervention. In-depth individual or group interviews will be conducted at the end of the two month intensive TB treatment phase. Outcomes are medication adherence rates, sputum smear conversion rates, and acceptance and feasibility of intervention at the end of the two month intensive treatment phase. The SMS based intervention for TB management, addresses the National Institute of Nursing Research's priorities to adopt new technologies for better health care outcomes and to promote health and prevent disease.
Effective treatment of tuberculosis is critical to protect the health of the public world-wide. Mobile phone text messaging interventions have the potential to improve tuberculosis treatment outcomes where the direct observation of treatment is not available. Developing an intervention with healthcare workers who will be using it and obtaining feedback from patients is a necessary process in implementing and evaluating a new intervention.