UCL Institute of Healthcare Engineering


Smartphones help patients complete TB treatment

1 March 2019

Patients with tuberculosis (TB) are more likely to continue their drug treatment if they are supported by smartphones rather than attending face-to-face appointments, a new UCL-led study has found.


This article was originally published by UCL News on 21 February 2019. 

The study, published today in the Lancet, is the first of its kind to compare patients with TB who received video observed treatment using a smartphone, with patients who were directly observed and attended clinical appointments. Researchers analysed 226 patients in London, of which 58% had a history of homelessness, mental health issues, imprisonment or addiction. TB rates are higher among these groups of people.

“Taking regular tuberculosis treatment is difficult, but if poorly treated, the disease can kill, infect others and become resistant to antibiotics. National TB authorities worldwide often require patients to meet health care workers daily to take their medications under direct observation, a standard of care that is often difficult to maintain over the many months that TB treatment lasts,” said Professor Andrew Hayward (UCL Epidemiology & Health Care), lead author and Director of the UCL Collaborative Centre for Inclusion Health.

“Our NIHR funded trial shows patients can use a smartphone app to prove they have taken their treatment and this is much more effective, cheaper and convenient than face-to-face meetings. This allowed us to support tuberculosis treatment even in people who are homeless or suffering from drug addiction.  We are very excited about the potential of this technology to improve treatment of this killer disease.” 

England still has one of the highest rates of TB in western Europe with just under 5,200 affected in 2017, of which nearly 40% of patients were in London. Helping patients adhere to TB treatment is critical as some patients face difficulties finishing the full course of medication, but this is vital in curing TB.

Researchers found that seven out of 10 patients completed at least 80% of their scheduled treatments when using their smartphone. Patients used the app to film themselves taking the treatment and securely submit this so that the clinical team were sure the dose was taken. For patients who had directly observed treatment at face-to-face appointments, fewer than half of treatment doses could be confirmed.

“Using an app has made life easier for very ill patients, both physically and mentally. Patients told us that having to go to TB clinic several times a week to have their treatment was both inconvenient and stigmatising. The smartphone app helped to get around both of these issues allowing patients to fit their treatment around their daily lives. This type of e-health service could have positive implications for all patients, not just those affected by TB,” explained Professor Hayward.

Dr Tereza Kasaeva, Director, Global TB Programme, World Health Organization (WHO), highlighted: “The reported results of video supported TB therapy trial is an important landmark towards improving the quality of evidence for a technology that is being scaled up in different settings worldwide. This innovative approach is fully aligned with WHO's strategic vision to provide patient-centred care, increase adherence and improve treatment outcomes for the people with TB.”

The research was funded by the National Institute for Health Research (NIHR)