HEALTH | TUBERCULOSIS | DR. NABUYE 

KAMPALA - Public health specialists have come up with a smartphone-based approach to boost efforts against Tuberculosis (TB). 

This followed a study dubbed “DOT Selfie” also known as Video Directly Observed Therapy or VDOT they conducted among 144 randomly selected TB patients in six TB clinics around Kampala last year. 

The clinics included Kisenyi, Kitebi and Kawaala health centres alongside Lubaga, Mulago and Mengo Hospitals. 

“We discovered that at least 78.9% of the patients can actually use smartphones to seek TB related treatment and care,” Dr. Juliet Nabuye Sekandi, the study principal investigator said. 

Nabuye said the study results also showed that there was limited adherence to treatment from among the patients that were enrolled on the usual care, with adherence at just 9.9%. 

“Some of the study participants highlighted lack of treatment supporters in the Usual Care DOT as well as stigma associated with health worker visits,” she said. 

The initiative she said allows for remote treatment monitoring through patients ‘recorded videos through a smartphone app showing their daily medication intake. 

She said during the study, each participant received a smartphone with a VDOT App, SMS text reminders for medication intake, a weekly internet bundle of 400MBs and weekly airtime incentive of Uganda Shillings 1,000 were provided. 

The patients then submit the videos to the health system for review by health workers to monitor treatment adherence. 

Directly Observed Therapy (DOT) for treatment adherence is the recommended standard for monitoring adherence although research has shown that it is challenging to implement at scale because it is labor-intensive. 

Nabuye who is also an assistant professor, Department of Epidemiology & Biostatistics & Global Health Institute at University of Georgia in the USA revealed that the study was motivated by the fact that TB is treatable and curable only if patients take their medication 

The mobile phone-based intervention according to Nabukenya aims at improving patient adherence and have been tried out in other countries, especially in the U.S.A and in India. 

“The system is automatically designed to review videos, document adherence and also document side effects in the medication videos,” she added. 

Vincent Kasiita, a qualitative researcher at MakSPH said most health workers interviewed viewed the use of VDOT method as increased workload especially if not well-trained. 

Kasiita said some TB clinics had no computers to use for the VDOT practical trials. 

“It was also difficult for some of the patients to operate smartphones since most of these participants were of less or had no education,” he said.   

Uganda remains among the high TB/HIV burden countries in the world. 

The first national population-based TB disease prevalence survey in 2014/15 estimated the prevalence of TB at 253 cases in every 100,000 people. 

The survey also showed that Tuberculosis caused 80,000 new cases much higher than HIV (60,000 new cases). 

According to Dr. Paul Isiko, the executive director Uganda Stop TB Partnership said 53.1% of patients in Uganda are spending 20% of their household income on TB. 

Isiko noted that despite TB treatment being free, the patients may need other things including nutrition supplements. 

The WHO’s post-2015 End TB Strategy, adopted by the World Health Assembly in 2014, intends to end the global TB epidemic as part of the newly adopted Sustainable Development Goals. 

It also serves as a blueprint for countries to reduce TB incidence by 80%, TB deaths by 90%, and to eliminate catastrophic costs for TB-affected households by 2030. 

However, through the last decade, Dr. Nabuye revealed TB treatment success has not surpassed 90%, the global target. 

However, according to the health minister, Dr.Jane Ruth Aceng, TB treatment success rate has steadily increased over the years from 72% in 2018/19 to 78% in 2019/2020 to 84% currently against a national target of 90% 

“The progress in case identification has resulted in reducing further the missed TB cases to now about 15% from about 50% in 2015,’’ she said 

According to Dr. Sarah Zalwango, the Kampala Capital City Authority (KCCA) manager medical services and a clinical director, VDOT will offer flexibility in accessing TB health care for low-resource settings. 

“What we do as health workers, we have the Direct Observed Therapy where the patient is observed physically while swallowing the medicine. 

So, if you have this option of doing it in your own space, and you do not have to move to be observed and have a treatment supporter of course it will come a long way in helping to save on many things; transport, (human resource) constraints,” Zalwango said. 

According to Dr. Zalwango, VDOT fits well into the TB / Leprosy Control Program (NTLP) which emphasizes patient-centred care. 

She noted that since the National TB Program is currently piloting the same methodology in other districts across the country, it will be a game-changer in monitoring treatment adherence as well as improved outcomes.