Efficacy of mobile phone short message service (SMS) on malaria treatment adherence and post-treatment review

Artemisinin resistant falciparum malaria has emerged in south East Asia (SEA), an ominous repetition of the spread of chloroquine and later of sulfadoxine-pyrimethamine resistance, several decades ago. Recent evidence suggests artemisinin resistance foci in Western Cambodia, Western Thailand, and Burma. This poses a major global public health threat, with the greatest potential effects in sub-Saharan Africa where the disease burden is greatest and systems for resistance monitoring and containment are weakest. A public health disaster is imminent unless mitigation and early warning/early detection measures are urgently set up. The mechanisms underlying artemisinin resistance are currently not fully understood. The main phenotype associated with resistance is a substantial delay in parasite clearance, so far observed in SEA but not yet unequivocally confirmed in Africa. Poor patient adherence to treatment and drug misuse are of the drivers of antimalarial resistance. Poor adherence decreases cure rates because parasites are exposed to sub-therapeutic drug concentrations, favouring the emergence of resistance. Recent evidence suggests that the traditional approaches (provider counselling and caregiver aids) for improving patient adherence in routine settings are suboptimal. Urgent research is thus needed to investigate innovative approaches to address this problem. Secondly, the most widely used methodological approaches for adherence measurement, conducted after the completion of a full dose of artemether-lumefantrine (AL), the most widely used artemisinin combination therapy (ACT) in rural Africa, have inherent recall bias and do not capture the timing of dosing, which is critical for AL. Better patient adherence to malaria treatment is likely to improve health outcomes and mitigate the emergence of falciparum drug resistance in Africa. Detecting emerging artemisinin resistance in Africa is likely to require wide coverage surveillance, beyond the traditional sentinel surveillance. Better surveillance through routine health information systems (HIS), of the proportion of patients who remain parasite positive at day 3 and the proportion requiring rescue therapy during one month after ACT treatment, could offer new opportunities to track highly sensitive and pragmatic markers for emerging ACT resistance. However, malaria post-treatment review to capture these surrogate markers, outside the context of a clinical trial, is rare in most of rural Africa, and innovative ways of promoting this practice are urgently needed. Mobile phone communication has been suggested as a method to improve the delivery of health services in Africa, and its role has been investigated in improving health information reporting, provider performance, drug and diagnostic stock management, and patient adherence to treatment for chronic diseases such as HIV/AIDs. However, the efficacy of mobile phone text messaging in improving patients’ adherence and promoting posttreatment review for acute diseases such as malaria has not been investigated.

ISRCTN39512726

• Primary study design: Interventional
• Study design: Randomized controlled clinical trial
• Secondary study design: Randomised controlled trial

Project DetailsISRCTN - Project details

Digital Tools
Drug-based Strategies

Mar 2013 — Mar 2017

$1.98M

Kenya
United Kingdom