Interventions for Tobacco and TB control delivered by mobile phone.

Transcription

1 Interventions for Tobacco and TB control delivered by mobile phone. Dr Cari Free Senior lecturer in Clinical Epidemiology LSHTM Systematic review funding: WHO, Systematic review contributors: Free C, Sutherland J, Barnard S, Rezel E, Wynne A, Grigsby-Duffy L, Edwards S, Doel A, Perel P, McCarthy O. Improving health worldwide

2 Systematic review Search 1990-June 2014 MEDLINE, EMBASE, Global Health and CINAHL Search terms for mobile phones and NCD (hypertension, cardiovascular disease/s, cancer, respiratory disease/s, or diabetes) and/or their risk factors (tobacco use, harmful alcohol use, physical inactivity, unhealthy diet). 11,614 electronic records identified and screened Full texts of 97 potential studies reviewed 70 met inclusion criteria When the previous review was included, 102 total were eligible Separately search for TB control interventions- new identified

3 Trials of smoking cessation interventions 18 trials of interventions targeted smoking cessation, 2 trials low risk bias all quality criteria Intervention content: varied e.g. effective txtstop and STOMP interventions 19 behavior change techniques

4 Interventions delivered by text message on biochemically verified continuous abstinence (Russell standard) Study % ID RR (95% CI) Weight FREE (1.80, 2.65) YBARRA (0.62, 6.28) 2.69 Overall (I-squared = 0.0%, p = 0.866) 2.18 (1.80, 2.63) NOTE: Weights are from random effects analysis

5 Interventions delivered by text message on biochemically verified point prevalence smoking Study % ID RR (95% CI) Weight POLLAK (0.95, 1.63) RODGERS (1.12, 7.16) NAUGHTON (0.68, 3.73) YBARRA (0.50, 3.23) Overall (I-squared = 42.4%, p = 0.157) 1.50 (0.96, 2.35) NOTE: Weights are from random effects analysis

6 Smoking cessation: other interventions One trial counselling via mobile 24 hour point prevalence abstinence RR 3.59 (95% CI ) 7 day point prevalence RR 2.74 (95% CI ) One trial smart phone app- RR 1.16 (95% CI )

7 Other evidence Txt2stop intervention highly cost effective (Guierrera 2012) implemented nationally in England by DH 35,000 user first 12 months with similar or higher quit rates than in trial (measured at 4 weeks) implemented New Zealand (first) USA and Costs Rica- evaluations of implementation ongoing in Costa Rica

8 TB Control: treatment adherence 2 trials Kunawarak- telephone call reminder promising but not statistically significant in all arms In the MDR-TB group, the sputum conversion rate 20% (95% CI 8-45) in Model DOTS and 90% (95% CI 73-98) in Model 2 (DOTS plus call) (p<0.001). In the non-mdr-tb group, the sputum conversion rate was 52% (95% CI 36-70) in Model 1 and 37% (95% CI 22-56) in Model 2 (p=0.221). Iribarren pilot trial showed it was feasible and acceptable n=37 Intervention: interactive texts (to let know treatment taken, to ask questions), educational texts and monitoring texts

9 Adherence- screening to identify non adherent/ problems +HCP contact Lester (antiretrovirals) Adherence to ART was reported in 168/ 273 receiving the SMS intervention vs 132/ 265 in the control group (relative risk [RR] for non-adherence 0 81, 95% CI ; p=0 006). Smith (contraception) Self-reported effective contraception use at four months, (135/211(64 0%) vs. 101/220 (45 9%) RR 1 39, 95% CI ; p<0 001). Wall (heart disease prevention medication) 14/150 patients (9%) in the Text group self reported taking less than 80% of medication vs 38/151 (25%) (95% CI 7 to 24), p< BUT amount of service provider support unclear/ possibly too high for widespread implementation

10 Simple reminders for medication adherence delivered by text message - don t work see pooled analysis 2012 below plus new trials show same Study % ID RR (95% CI) Weight OLLIVIER SMS messages (28 days) 1.04 (0.69, 1.57) YANG SMS messages (9 days) 0.94 (0.70, 1.25) Overall (I-squared = 0.0%, p = 0.634) 1.00 (0.77, 1.30) MED decreases MED increases

11 SMS HCP feedback plus monitoring in hypertension- systolic BP Study % ID WMD (95% CI) Weight BLASCO (-10.89, 1.69) CARRASCO (-8.35, -0.25) MCKINSTRY (-6.84, -1.76) Overall (I-squared = 0.0%, p = 0.996) (-6.37, -2.30) NOTE: Weights are from random effects analysis

12 SMS plus monitoring in hypertension- diastolic BP Study % ID WMD (95% CI) Weight BLASCO (-4.20, 2.40) CARRASCO (-2.24, 2.64) MCKINSTRY (-2.90, 1.10) Overall (I-squared = 0.0%, p = 0.770) (-1.94, 0.86) NOTE: Weights are from random effects analysis

13 SMS targeting other barriers to adherence- promising Educational and informational automated SMS (contraception COCP) (2 behaviour change techniques) Self reported adherence- RR 1.19 (95% CI )- Castano 2012

14 Summary and challenges Further high quality trials of optimised interventions for TB needed Monitoring seems important Involving health care providers to deal with adverse effects whilst keeping interventions feasible Interventions may not be optimal: need to consider barriers to adherence/factors influencing adherence Identify which barriers can feasibly be addressed via mobile phones Include a wider range of behaviour change techniques (effective smoking cessation interventions delivered by mobile phone include 16 behaviour change techniques) Identify additional strategies to address other factors