Use of SMSes could help TB patients stick to treatment, in the world's remotest locations, according to a new report.
Treatment for tuberculosis (TB) is a combination of strong antibiotics that must be taken for at least six months - and this can cause side-effects such as nausea, which can put patients off taking their tablets.
To help people complete their treatment, WHO currently recommends the DOTS (directly observed, short course) strategy, in which a health worker watches the patient take their antibiotics every day.
While this strategy has helped dramatically improve TB control around the world, it is insufficient or inaccessible for thousands of patients. It is also expensive and human-resource intensive.
Several disease control and technology specialists are now looking to SMS as a cost-effective way to communicate with and monitor hard-to-reach patients in remote locations.
"The problem is enormous, and everything has to be done in order to prevent patients from defaulting," said Mario Raviglione, director of WHO's Stop TB department. "Anything that can be done technologically to help solve this issue like these cellphone technologies would be useful."
Although TB is a disease affecting the poor, even those living on $1 per day increasingly have access to mobile phones. There are more than 3.3 billion mobile-phone subscriptions worldwide.
By the end of 2006, according to the International Telecommunications Union, 68 percent of those subscriptions were in developing countries. South Africa has proven a fertile testing ground for new drug-compliance technologies - 71 percent of DOTS treated patients were cured of TB; most patients who were not successfully treated under DOTS had stopped taking their medication.
The way the SMS strategy could work is provided in this example: London-based company SIMpill have made a small pill bottle that contains a SIM card and when opened, the SIM card delivers a SMS with a unique pill box identification number to a central server.
The central server receives the incoming SMS and stores the data, but if no SMS is received at the designated time, the server contacts the patient via phone alerting them to take their medication, said a report written by Eliza Barclay for The Lancet.
If the patient does not respond, the server contacts a caregiver who can follow up with the patient. A trial at three clinics in Cape Town showed that after 10 months of SIMpill, treatment compliance among 155 TB patients was 86-92 percent with a treatment success rate of 94 percent.
However, not all experts believe that mobile phone technology is necessary.
According to Hamish Fraser, director of informatics and telemedicine for Partners in Health (PIH) and assistant professor at Harvard Medical School, the success of PIH's programmes without the use of SMS communication indicate that SMS-based health technologies may be unnecessary.
"I think in developing countries, having a DOTS worker visit patients in their home is extremely effective," said Fraser. "We don't immediately feel there's a big gap there so I'm less sold on cellphones."
The report, written by Eliza Barclay, appears in this week's edition of The Lancet.