Understanding tuberculosis patients and factors influencing adherence and outcomes

Duration: 2024-2027 
Funder/donor: Gates Foundation, Erasmus Trustfunds 
Main partners: Professor Ronelle Burger (Stellenbosch University), AURUM Institute

Despite being highly treatable, tuberculosis (TB) is a major cause of death and disability worldwide, primarily affecting those living in poverty. Approximately 300 000 individuals develop active TB each year in South Africa. Despite largely adequate healthcare coverage and no costs associated with seeking treatment, the country’s TB treatment success rate is significantly below global standards. A major reason for this is nonadherence to treatment driven by behavioural factors such as uncertainty, forgetfulness, and fear of stigma. 

South Africa has seen a substantial increase in smartphone ownership in the last decade, particularly among low-income individuals, which presents an opportunity to design mobile health interventions to address issues facing those living in poverty. Our study examines the impact of a WhatsApp based treatment support platform designed to target specific behavioural barriers to adherence on treatment success among patients at clinics in the Western Cape province in South Africa. 

The following quotes are from two patients interviewed after being involved in the pilot phase of the project: 

Research approach/method

We are conducting an individual-level randomised control trial at 10 clinics in urban and rural low-income communities in the Western Cape province of South Africa. Patients aged 18 years or older who have been diagnosed with drug-susceptible pulmonary tuberculosis and have access to phones that can access WhatsApp are randomly assigned to either the control or treatment group at the start of their six-month TB treatment journey. Control group patients receive standard care, and treatment group patients are enrolled on the WhatsApp-based treatment support platform. Information about socioeconomic status, patient wellbeing, health literacy and mobile phone use is collected at baseline and endline for all patients, with returns to the clinic recorded throughout the treatment period. Measures of treatment adherence are captured through self-reports on the platform and through tests conducted on hair and urine samples. The primary focus of the project is the impact of the intervention on treatment success (completion/cure), with adherence measures being studied to understand potential mechanisms driving this impact.