Impact of a pilot mHealth intervention on treatment outcomes of TB patients seeking care in the private sector using Propensity Scores Matching – Evidence collated from New Delhi, India
Authors: Sodhi Ridhima , Vatsyayan Vindhya , Panibatla Vikas , Sayyad Khasim , Williams Jason , Pattery Theresa , Pal Arnab 
Published: December 2023

Mobile health applications called Digital Adherence Technologies (DATs) are increasingly used for improving treatment adherence among Tuberculosis patients to attain cure, and/or other chronic diseases requiring long term and complex medication regimens. These DATs are found to be useful in resource limited settings because of their cost efficiency in reaching out to vulnerable groups (providing pill & clinic visit reminders, health information and awareness on the disease along with motivational messages and support to be retained in care) or those staying in remote or rural areas. Despite their growing ubiquity, there is very limited evidence on how they improve healthcare outcomes. We analyze the uptake of such an intervention in an urban setting (DS-DOST, powered by Connect for LifeTM, Johnson & Johnson) among different patient groups accessing TB services in New Delhi, India, and subsequently assess its impact in improving patient engagement and treatment outcomes. This study aims to understand the uptake patterns of a digital adherence technology and its impact in improving follow ups and treatment outcomes among TB patients. Propensity choice modelling was used to create balanced treated and untreated patient datasets, before applying simple ordinary least square and logistic regression methods to estimate the causal impact of the intervention on the number of follow ups made with the patient and treatment outcomes.

After controlling for potential confounders, it is found that patients who installed and utilized DS-DOST application received an average of 6.4 (95% C.I. [5.32 to 7.557]) additional follow-ups, relative to those who did not utilize the application. This translates to a 58% increase. They also had 245% higher likelihood of a treatment success (Odds ratio: 3.458; 95% C.I. [1.709 to 6.996]). Descriptive results indicate that young females, and those suffering from pulmonary tuberculosis have a slightly higher propensity to use the CfL™ app, and benefit through their treatment duration.

Author Summary

The research tries to understand the impact of using cost-effective digital adherence tools, in improving treatment outcomes among patients diagnosed with drug-sensitive Tuberculosis (TB). As the treatment duration for TB is fairly long (at least 6 months) and complicated (multiple drugs, typically given in two distinct phases), there are challenges associated with ensuring treatment adherence. The research finds that digital tools such as a mobile application – can be a useful aid, albeit only when they are used in conjunction with the support of a healthcare worker. The digital tool analyzed, while sending medication reminders to patients, also enabled healthcare workers in tracking adherence for their assigned patients. The latter, as the research finds, ensured that they follow up with their patients to ensure adherence, resulting in increased odds of their getting a favourable treatment outcome. Further, the study underscores that a digital intervention used in isolation might not draw a favourable impact among patients – highlighting the role of healthcare workers and tailored interventions. In conclusion, digital adherence technologies can act as cost-effective measures in empowering healthcare workers to support their patients, and subsequently improve treatment outcomes.