Background:Mobile technology has great potential to improve adherence and treatment outcomes in healthcare settings.However,text messaging and phone calls are unaffordable in many resource-limited areas.This study inv...Background:Mobile technology has great potential to improve adherence and treatment outcomes in healthcare settings.However,text messaging and phone calls are unaffordable in many resource-limited areas.This study investigates the use of a no-cost alternative mobile phone technology using missed calls(‘buzzing’)to act as a patient reminder.The use of missed calls as a patient reminder was evaluated for feasibility and effectiveness as an appointment reminder in the follow-up of newly-diagnosed human immunodeficiency virus(HIV)positive patients in an HIV testing and counselling department in rural Swaziland.Methods:This pilot study uses a before-and-after operational research study design,with all patients with mobile phones being offered the intervention.The primary outcome was the rate of attendance at the HIV testing and counselling department for collection of results in those with mobile phones before and after the introduction of the intervention.Results:Over two-thirds,71.8%(459/639),of patients had a mobile phone.All patients with a mobile phone consented to being buzzed.There was no difference in attendance for follow-up at the clinic before and after the intervention was implemented(80.1%versus 83.3%,p=0.401),or after adjusting for confounding factors(OR 1.13,p=0.662).Conclusion:This pilot study illustrates that mobile technology may be feasible in rural,resource-poor settings as there are high rates of mobile phone ownership and the intervention had a 100%uptake rate,with positive feedback from staff and patients.In this particular setting,the intervention did not improve attendance rates.However,further research is planned to investigate the impact on adherence to appointments and medications in other settings,such as HIV chronic care follow-up and as part of an enhanced package to improve adherence.展开更多
Background:Financial issues are major barriers for rural-to-urban migrants accessing tuberculosis(TB)care in China.This paper discusses the effectiveness of providing financial incentives to migrant TB patients(with a...Background:Financial issues are major barriers for rural-to-urban migrants accessing tuberculosis(TB)care in China.This paper discusses the effectiveness of providing financial incentives to migrant TB patients(with a focus on poor migrants in one district of Shanghai using treatment completion and default rates),the effect of financial incentives in terms of reducing the TB patient cost,and the incremental cost-effectiveness ratio of the intervention.Results:Ninety and ninety-three migrant TB patients were registered in the intervention and control districts respectively.TB treatment completion rates significantly improved by 11%(from 78%to 89%)in the intervention district,compared with only a 3%increase(from 73%to 76%)in the control district(P=0.03).Default rates significantly decreased by 11%(from 22%to 11%)in the intervention district,compared with 1%(from 24%to 23%)in the control district(P=0.03).In the intervention district,the financial subsidy(RMB 1,080/US$170)accounted for 13%of the average patient direct cost(RMB 8,416/US$1,332).Each percent increase in treatment completion costs required an additional RMB 6,550(US$1,301)and each percent reduction in defaults costs required an additional RMB 5,240(US$825)in the intervention district.Conclusions:Overall,financial incentives proved to be effective in improving treatment completion and reducing default rates among migrant TB patients in Shanghai.The results suggest that financial incentives can be effectively utilized as a strategy to enhance case management among migrant TB patients in large cities in China,and this strategy may be applicable to similar international settings.展开更多
Background:Swaziland has the highest national incidence of tuberculosis(TB)in the world,with treatment success rates well below the 85%international target.Treatment support as part of comprehensive TB services is a c...Background:Swaziland has the highest national incidence of tuberculosis(TB)in the world,with treatment success rates well below the 85%international target.Treatment support as part of comprehensive TB services is a core component of the Stop TB Strategy.This study investigated the effects of financial incentives for treatment supporters on TB treatment outcomes in Swaziland.Methods:This was a controlled study that compared treatment outcomes for patients with a treatment supporter who received or did not receive a financial incentive.Results:The intervention group had a higher chance of treatment success as compared with the control group:73%(95%confidence intervals[CIs]66–80%)versus 60%(95%CIs 57–64%),respectively,p=0.003.This improvement remained significant when treatment success rates were adjusted for differences in baseline characteristics,with the effect of incentivised treatment supporters on treatment outcomes having an odds ratio(OR)of 1.8.There was also a significant improvement in the death rate in the intervention group,as compared with the control group(10.6 versus 23.5%,p=<0.001).Conclusion:Incentives provided to TB treatment supporters appear to significantly improve TB treatment outcomes.Incentivising treatment support may be appropriate as an effective addition to support and supervision measures(199 words).展开更多
文摘Background:Mobile technology has great potential to improve adherence and treatment outcomes in healthcare settings.However,text messaging and phone calls are unaffordable in many resource-limited areas.This study investigates the use of a no-cost alternative mobile phone technology using missed calls(‘buzzing’)to act as a patient reminder.The use of missed calls as a patient reminder was evaluated for feasibility and effectiveness as an appointment reminder in the follow-up of newly-diagnosed human immunodeficiency virus(HIV)positive patients in an HIV testing and counselling department in rural Swaziland.Methods:This pilot study uses a before-and-after operational research study design,with all patients with mobile phones being offered the intervention.The primary outcome was the rate of attendance at the HIV testing and counselling department for collection of results in those with mobile phones before and after the introduction of the intervention.Results:Over two-thirds,71.8%(459/639),of patients had a mobile phone.All patients with a mobile phone consented to being buzzed.There was no difference in attendance for follow-up at the clinic before and after the intervention was implemented(80.1%versus 83.3%,p=0.401),or after adjusting for confounding factors(OR 1.13,p=0.662).Conclusion:This pilot study illustrates that mobile technology may be feasible in rural,resource-poor settings as there are high rates of mobile phone ownership and the intervention had a 100%uptake rate,with positive feedback from staff and patients.In this particular setting,the intervention did not improve attendance rates.However,further research is planned to investigate the impact on adherence to appointments and medications in other settings,such as HIV chronic care follow-up and as part of an enhanced package to improve adherence.
基金This study was supported by the Communicable Disease Research Consortium(COMDIS)of the Department for International Development of the UK Government,however,the views expressed in this paper are those of the authors and do not necessarily reflect the opinions of the sponsor.
文摘Background:Financial issues are major barriers for rural-to-urban migrants accessing tuberculosis(TB)care in China.This paper discusses the effectiveness of providing financial incentives to migrant TB patients(with a focus on poor migrants in one district of Shanghai using treatment completion and default rates),the effect of financial incentives in terms of reducing the TB patient cost,and the incremental cost-effectiveness ratio of the intervention.Results:Ninety and ninety-three migrant TB patients were registered in the intervention and control districts respectively.TB treatment completion rates significantly improved by 11%(from 78%to 89%)in the intervention district,compared with only a 3%increase(from 73%to 76%)in the control district(P=0.03).Default rates significantly decreased by 11%(from 22%to 11%)in the intervention district,compared with 1%(from 24%to 23%)in the control district(P=0.03).In the intervention district,the financial subsidy(RMB 1,080/US$170)accounted for 13%of the average patient direct cost(RMB 8,416/US$1,332).Each percent increase in treatment completion costs required an additional RMB 6,550(US$1,301)and each percent reduction in defaults costs required an additional RMB 5,240(US$825)in the intervention district.Conclusions:Overall,financial incentives proved to be effective in improving treatment completion and reducing default rates among migrant TB patients in Shanghai.The results suggest that financial incentives can be effectively utilized as a strategy to enhance case management among migrant TB patients in large cities in China,and this strategy may be applicable to similar international settings.
基金The Global Fund to Fight AIDS,Tuberculosis and Malaria,COMDIS HSD,Department for International Development(UK)provided funding for this study。
文摘Background:Swaziland has the highest national incidence of tuberculosis(TB)in the world,with treatment success rates well below the 85%international target.Treatment support as part of comprehensive TB services is a core component of the Stop TB Strategy.This study investigated the effects of financial incentives for treatment supporters on TB treatment outcomes in Swaziland.Methods:This was a controlled study that compared treatment outcomes for patients with a treatment supporter who received or did not receive a financial incentive.Results:The intervention group had a higher chance of treatment success as compared with the control group:73%(95%confidence intervals[CIs]66–80%)versus 60%(95%CIs 57–64%),respectively,p=0.003.This improvement remained significant when treatment success rates were adjusted for differences in baseline characteristics,with the effect of incentivised treatment supporters on treatment outcomes having an odds ratio(OR)of 1.8.There was also a significant improvement in the death rate in the intervention group,as compared with the control group(10.6 versus 23.5%,p=<0.001).Conclusion:Incentives provided to TB treatment supporters appear to significantly improve TB treatment outcomes.Incentivising treatment support may be appropriate as an effective addition to support and supervision measures(199 words).
