Tuberculosis Patients Had Unsuccessful Treatment Outcomes

For tuberculosis patients, complying with a full course of treatment can be daunting and difficult. But a new experiment conducted by MIT researchers in Kenya, in collaboration with the digital health company Keheala; shows that a digital program used on mobile phones helps patients successfully finish their treatments.

Patients with mobile platform

“Patients who we support with our mobile platform were two thirds less likely to fail to complete treatment,” says Erez Yoeli, a research scientist at the MIT Sloan School of Management and co author of a newly publish paper outlining the experiment’s results. The paper, “Mobile Self-verification and Support for Successful Tuberculosis Treatment,” appears today in the New England Journal of Medicine.

The co-authors are Yoeli; David Rand, an associate professor in the MIT Sloan School of Management; Jon Rathauser, CEO of Keheala, a digital health care firm based in Tel Aviv; Syon P. Bhanot, an assistant professor of economics at Swarthmore College; Maureen K. Kimenye and Eunice Mailu of the Kenya Ministry of Health; Enos Masini of the World Health Organization; and Philip Owiti of the International Union Against Tuberculosis and Lung Disease.

To conduct the study, the researchers teamed up with 17 health care clinics in Nairobi, the capital of Kenya; to create a randomized trial. There were 569 patients who participate in the intervention; also 535 patients in the control group who did not use the mobile digital program. The study was approve by the institutional review boards of Kenyatta National Hospital and the University of Nairobi.

Information about tuberculosis

In this way, Yoeli explains, the program use two key behavioral principles to improve patient actions: both “increased observability” of treatment adherence and “eliminating plausible deniability,” that is, reducing their ability to make excuses for not taking their medication. The program also provide information about tuberculosis; motivational messages, an “adherence contest,” and emphasized the community benefits of continuing treatment.

As a result, Rand adds, “this is a space where behavioral science can play a major role in improving health outcomes. To me, what is so exciting about this paper is that they show how an intervention which is technologically quite simple has a really large positive impact because it is designed in a psychologically sophisticated way.” Indeed, as the researchers acknowledge; any one study can have limitations. In this case, they would also like to see how the method fares in rural settings; which may present even greater health care access challenges.

“One key thing the next study needs to show is that this approach works not just in the city of Nairobi; but for a more diverse population, including rural patients,” Yoeli states. In fact, the researchers are now in the midst of a three year randomize controlled trial which expands the geographic scope of the experiment; also also evaluates its cost effectiveness more thoroughly. The team says it would also like to apply the concept to HIV treatment programs in the future as well.