Pilot Study Using Video Cell Phones for Mobile Direct Observation Treatment (MDOT) to Monitor Medication Compliance of TB Patients

Danya Presents Findings of Pilot Study at East African Health Conference in Kenya

Silver Spring, Maryland (March 20, 2009) – Danya International, Inc. (Danya), a communications, research, and technology firm, will share the results of a pilot study on the effectiveness of mobile video-enabled phones in meeting requirements for monitoring medication adherence by tuberculosis (TB) patients during the 3rd East African Health and Scientific Conference. The findings of the Mobile Direct Observation Treatment (MDOT) Pilot Project, which received high positive ratings from the patients and healthcare workers who participated, will be unveiled during the Conference in Nairobi on March 25-27, 2009.

To view the final evaluation report for the Mobile Direct Observation Treatment (MDOT) project, please click here.

The World Health Organization (WHO) recommends directly observed treatment (DOT) of TB patients to monitor medication adherence. Compliance with DOT guidelines presents numerous challenges for healthcare workers and patients, especially in developing countries. Danya, in public-private partnership with Mbagathi District Hospital, the U.S. Centers for Disease Control and Prevention (CDC), Safaricom Limited, Nokia Siemens Networks, Mediae, Voxiva, and EPOS Health Consultants, launched the MDOT Pilot Project to assess the feasibility of using video-enabled mobile phones to assure patients were taking the prescribed medication. The study also examined the reactions of participants to text and video health messages sent via the mobile phone.    

“Mobile phone technology offers opportunities to expand and enhance medical treatment where direct observation of patients is required,” explained Dr. Jeffrey Hoffman, Chief Executive Officer of Danya and Principal Investigator of the pilot study. “We are encouraged by the acceptance of the patients and healthcare workers who volunteered to participate and see these results as a launching pad to a broader scale scientific study including a larger number of participants covering a longer time period. In addition, this pilot opens new doors for mobile direct observation treatment as a promising methodology for many health-related applications.”

The MDOT Pilot Project follows the experiences of 13 TB patients, their patient assistants, and healthcare workers over a 30-day period in Nairobi, Kenya. Patients were provided a mobile phone capable of sending and receiving video and text messages. Patients and their assistants video-captured the patient taking their prescribed dose of TB medication in their home and immediately transmitted it to a central database where healthcare workers viewed the video to assure compliance with the DOT protocol. Patients also received health messages in video and text formats on their mobile phones. At the end of 1 month, participants completed a brief questionnaire on their experiences. Participants expressed extreme satisfaction with the procedures and the use of the mobile phone technology for remote medication monitoring, health education, and communication.

According to WHO, TB is a highly contagious disease that currently infects about one-third of the world’s population. Left untreated, TB can lead to death. Africa experiences both the highest number of deaths and the highest mortality per capita. People co-infected with HIV and TB are at much greater risk for death. TB can be treated and potentially cured with strict adherence to a prescribed medication regimen over a 6- to 8-month period. Current WHO guidelines for TB treatment recommend DOT to monitor adherence. DOT recommendations pose challenges on an already over-burdened health care system. Patients are required to go to a clinic or hospital to be observed or the healthcare worker must make a home visit. For patients, the frequent and sometimes long distance travel, often requiring public transportation, puts a burden on the individual’s employment, lifestyle, and limited finances. For many patients in Kenya and other countries in Africa, patients are given a take-home packet of 1 to 2 weeks' medication where compliance cannot be monitored effectively. Noncompliance with the medication protocol can lead to the more dangerous multidrug resistant TB.

The goal of the MDOT Pilot Project was to determine if mobile technology would be an acceptable alternative for both the patient and the healthcare worker. As results indicate, participants expressed overall satisfaction with the MDOT Program. On a 5-point scale (5=strongly agree), healthcare workers rated the question of overall satisfaction with the program with a 5; patients and patient assistants ratings were 4.36 and 4.33 respectively. On the question of whether they agree that recording a patient taking their medication was a good option instead of meeting with someone in person, healthcare workers unanimously agreed with a rating of 5 and patients and their assistants rated this question at 4.27 and 4.29, respectively.

Aaron Sundsmo, Danya’s Regional Director for East Africa and onsite coordinator for the MDOT Pilot Project, will be joined by Dr. Andrew Suleh, who heads the TB program at Mbagathi District Hospital and provided medical oversight of the program, in presenting the findings at the East African Health and Scientific Conference. In addition to Mbagathi District Hospital and CDC’s National Center for Health Marketing, Global Communication Team, other partners who supported the MDOT Pilot Project were Safaricom Limited (provided telecommunication services), Nokia Siemens Networks (provided Nokia mobile video phones), Mediae (donated video media messages), Voxiva (provided database software services), and EPOS Health Consultants (provided data collection support). Danya, in collaboration with RTI International, along with their public and private partners, will be seeking Phase II funding to evaluate the scalability and cost-effectiveness of the MDOT program.

The 3rd East African Health and Scientific Conference is being held at the Kenyatta International Conference Centre (KICC), Nairobi , Kenya, March 25-27, 2009.  The Conference is hosted by the Ministries of East African Community, Public Health and Sanitation, Medical Services and the Kenya Medical Research Institute (KEMRI), with planning support from several public and private institutions and organizations. The Conference theme is “Climate Change, Environment and Health.” 

To learn more about the Conference go to www.kemri.org/eachome.html.

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