Mobile phone interventions for tuberculosis should ensure access to mobile phones to enhance equity - A prospective, observational cohort study in Peruvian shantytowns

Objectives

Mobile phone interventions have been advocated for tuberculosis care, but little is known about access of target populations to mobile phones. We studied mobile phone access amongst patients with tuberculosis, focusing on vulnerable patients and patients who later had adverse treatment outcomes.

Methods

In a prospective cohort study in Callao, Peru, we recruited and interviewed 2,584 patients with tuberculosis between 2007‐2013 and followed them until 2016 for adverse treatment outcomes using national treatment registers. Subsequently, we recruited a further 622 patients between 2016‐2017. Data were analysed using logistic regression and by calculating relative risks (RR).

Results

Between 2007‐2013, the proportion of the general population of Peru without mobile phone access averaged 7.8% but for patients with tuberculosis was 18% (p<0.001). Patients without access were more likely to hold a lower socioeconomic position, suffer from food insecurity and be older than 50 years (all p<0.01). Compared to patients with mobile phone access, patients without access at recruitment were more likely to subsequently have incomplete treatment (20% versus 13%, RR=1.5; p=0.001) or an adverse treatment outcome (29% versus 23% RR=1.3; p=0.006). Between 2016 and 2017, the proportion of patients without access dropped to 8.9% overall, but remained the same (18%) as in 2012 among the poorest third.

Conclusion

Access to mobile phones among patients with tuberculosis is insufficient, and rarest in patients who are poorer and later have adverse treatment outcomes. Thus, mobile phone interventions to improve tuberculosis care may be least accessed by the priority populations for whom they are intended. Such interventions should ensure access to mobile phones to enhance equity.