Investigating user acceptability and effectiveness of the SIMpill device as a strategy to improve treatment adherence among TB patients enrolled in the SIMpill project:a pilot study in the Frances Baard District, Northern Cape Province

Abstract

INTRODUCTION: Sub-optimal adherence to prescribed medications is documented as a major cause of drug resistance in tuberculosis (TB). Directly observed treatment – short course (DOTS) remains the WHO gold standard for improving adherence. Concerns with DOT as the single solution have been raised and a range of adherence strategies are increasingly being recommended. RESEARCH QUESTION: Can the SIMpill electronic reminder system increase medication adherence amongst TB patients? METHODOLOGY: A cohort of TB patients in the Frances Baard District (Northern Cape) was recruited to the project. Each patient was given their TB medication in a special SIMpill container that uses cellular phone technology to remind those patients who forget to take their medication on time. Each time the container is opened an SMS is sent to a computer server. If the container is not opened at the prescribed time the SIMpill computer sends a reminder SMS to the patient. The data collected on the computer server was analysed to show which patients opened the medication container within the agreed tolerance time, which required to be reminded by SMS, and which failed to take their medication. After the treatment programme, patients were taken through a structured questionnaire to find out their views on the functioning and user acceptability of the SIMpill system. RESULTS: 65 patients completed the SIMpill project and were subsequently interviewed. 97% of patients felt the SMS reminders helped them take their medication. The aggregated data from the SIMpill computer server showed adherence levels averaged 83% with no SMS reminders, rising to 92% if SMS reminders needed to be sent. CONCLUSION: Poor adherence is a problem in long-term therapy programmes such as those required for TB treatment. Using the SIMpill system with a cohort of 65 patients, adherence increased from 83% to 92% if SMS reminders needed to be sent by the SIMpill system