title: Impact of a Daily SMS Medication Reminder System on Tuberculosis Treatment Outcomes: A Randomized Controlled Trial.
abstract: OBJECTIVE
  The rapid uptake of mobile phones in low and middle-income countries over the past decade has provided public health programs unprecedented access to patients. While programs have used text messages to improve medication adherence, there have been no high-powered trials evaluating their impact on tuberculosis treatment outcomes.
  
  
  OBJECTIVE
  To measure the impact of Zindagi SMS, a two-way SMS reminder system, on treatment success of people with drug-sensitive tuberculosis.
  
  
  METHODS
  We conducted a two-arm, parallel design, effectiveness randomized controlled trial in Karachi, Pakistan. Individual participants were randomized to either Zindagi SMS or the control group. Zindagi SMS sent daily SMS reminders to participants and asked them to respond through SMS or missed (unbilled) calls after taking their medication. Non-respondents were sent up to three reminders a day.
  
  
  METHODS
  Public and private sector tuberculosis clinics in Karachi, Pakistan.
  
  
  METHODS
  Newly-diagnosed patients with smear or bacteriologically positive pulmonary tuberculosis who were on treatment for less than two weeks; 15 years of age or older; reported having access to a mobile phone; and intended to live in Karachi throughout treatment were eligible to participate. We enrolled 2,207 participants, with 1,110 randomized to Zindagi SMS and 1,097 to the control group.
  
  
  RESULTS
  The primary outcome was clinically recorded treatment success based upon intention-to-treat.
  
  
  RESULTS
  We found no significant difference between the Zindagi SMS or control groups for treatment success (719 or 83% vs. 903 or 83%, respectively, p = 0·782). There was no significant program effect on self-reported medication adherence reported during unannounced visits during treatment.
  
  
  CONCLUSIONS
  In this large-scale randomized controlled effectiveness trial of SMS medication reminders for tuberculosis treatment, we found no significant impact.
  
  
  BACKGROUND
  The trial was registered with ClinicalTrials.gov, NCT01690754.
authors: Interactive Research and Development, Karachi, Pakistan.
authors: Shama
authors: S
authors: Mohammed
authors: Abdul Latif Jameel Poverty Action Lab, Massachusetts Institute of Technology, Cambridge, MA, United States of America.
authors: Rachel
authors: R
authors: Glennerster
authors: Interactive Research and Development, Karachi, Pakistan.
authors: Aamir J
authors: AJ
authors: Khan
mesh_terms: D000328:Adult; D001071:Appointments and Schedules; D040421:Cell Phone; D005260:Female; D006801:Humans; D008297:Male; D008509:Medication Systems / Q000706:statistics & numerical data; D010154:Pakistan; D017010:Reminder Systems / Q000706:statistics & numerical data*; D012107:Research Design / Q000706:statistics & numerical data; D060145:Text Messaging / Q000706:statistics & numerical data*; D016896:Treatment Outcome; D014376:Tuberculosis / Q000188:drug therapy*; D016903:Drug Monitoring