title: Reliability and validity of mobile teledermatology in human immunodeficiency virus-positive patients in Botswana: a pilot study.
abstract: OBJECTIVE
  Mobile teledermatology may increase access to care.
  
  
  OBJECTIVE
  To determine whether mobile teledermatology in human immunodeficiency virus (HIV)-positive patients in Gaborone, Botswana, was reliable and produced valid assessments compared with face-to-face dermatologic consultations.
  
  
  METHODS
  Cross-sectional study conducted in outpatient clinics and public inpatient settings in Botswana for 76 HIV-positive patients 18 years and older with a skin or mucosal condition that had not been evaluated by a dermatologist.
  
  
  METHODS
  We calculated the κ coefficient for diagnosis, diagnostic category, and management for test-retest and interrater reliability. We also determined sensitivity and specificity for each diagnosis.
  
  
  RESULTS
  The κ coefficient for test-retest reliability ranged from 0.47 (95% CI, 0.35 to 0.59) to 0.78 (0.67 to 0.88) for the primary diagnosis, 0.29 (0.18 to 0.42) to 0.73 (0.61 to 0.84) for diagnostic category, and 0.17 (-0.01 to 0.36) to 0.54 (0.38 to 0.70) for management. The κ coefficient for interrater reliability ranged from 0.41 (95% CI, 0.31 to 0.52) to 0.51 (0.41 to 0.61) for the primary diagnosis, 0.22 (0.14 to 0.31) to 0.43 (0.34 to 0.53) for diagnostic category, and 0.08 (0.02 to 0.15) to 0.12 (0.01 to 0.23) for management. Sensitivity and specificity for the top 10 diagnoses varied from 0 to 0.88 and 0.84 to 1.00, respectively.
  
  
  CONCLUSIONS
  Our results suggest that while the use of mobile teledermatology technology in HIV-positive patients in Botswana has significant potential for improving access to care, additional work is needed to improve the reliability and validity of this technology on a larger scale in this population.
authors.affiliation: Department of Dermatology, University of Pennsylvania, Philadelphia2Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia.
authors.forename: Rahat S
authors.initials: RS
authors.lastname: Azfar
authors.affiliation: Division of Dermatology, Department of Medicine, University of California-San Diego, San Diego.
authors.forename: Robert A
authors.initials: RA
authors.lastname: Lee
authors.affiliation: Department of Dermatology, University of Pennsylvania, Philadelphia.
authors.forename: Leslie
authors.initials: L
authors.lastname: Castelo-Soccio
authors.affiliation: Department of Oral Medicine, University of Pennsylvania School of Dental Medicine, Philadelphia.
authors.forename: Martin S
authors.initials: MS
authors.lastname: Greenberg
authors.affiliation: Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia.
authors.forename: Warren B
authors.initials: WB
authors.lastname: Bilker
authors.affiliation: Department of Dermatology, University of Pennsylvania, Philadelphia2Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia.
authors.forename: Joel M
authors.initials: JM
authors.lastname: Gelfand
authors.affiliation: Department of Dermatology, University of Pennsylvania, Philadelphia.
authors.forename: Carrie L
authors.initials: CL
authors.lastname: Kovarik
mesh_terms: D000328:Adult; D001902:Botswana; D003430:Cross-Sectional Studies; D003880:Dermatology; D005260:Female; D006679:HIV Seropositivity / Q000150:complications*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D015203:Reproducibility of Results; D012871:Skin Diseases / Q000175:diagnosis* / Q000209:etiology*; D017216:Telemedicine