Effect of mobile voice calls on treatment initiation among patients diagnosed with tuberculosis in a tertiary care hospital of Puducherry: A randomized controlled trial.

Objective In India, about one third of tuberculosis (TB) patients diagnosed at tertiary hospitals are missed during a referral to peripheral health institutes for treatment. To address this, we assessed whether mobile voice call reminders to TB patients after diagnosis at a tertiary hospital decrease the proportion of "pretreatment loss to follow-up" (PTLFU), compared with the conventional paper-based referral. Design A two-group parallel-arm randomized controlled trial was conducted. Setting The study was conducted in a tertiary care hospital at Puducherry, South India. Participants All newly diagnosed TB patients, both pulmonary and extrapulmonary, who were referred for treatment from the selected tertiary care hospital and possessed a mobile phone were eligible to participate. The participants were enrolled between March 2015 and June 2016 and were randomized to study groups using the block randomization with allocation concealment. Intervention The participants in the intervention arm received standardized mobile voice calls reminding them to register for anti-TB treatment on the second and seventh day after referral in addition to the conventional paper-based referral received by the control group. Primary outcomes Patients not started on anti-TB treatment within 14 days of referral were considered as PTLFU. The outcome of PTLFU was ascertained through phone calls made on the 14th day after referral. The intention-to-treat analysis was used, and the proportion of PTLFU in the study groups and the risk difference with 95% confidence interval (CI) were calculated. Results Of the 393 patients assessed for eligibility, 310 were randomized to the intervention (n = 155) and control (n = 155) arms. In the intervention arm, 14 (9%) out of 155 were PTLFU compared with 28 (18%) of the 155 patients in the control arm. The absolute risk difference was 9% (95% CI [1.5, 16.6], P = 0.01). Conclusion Mobile voice call reminder to patients is a feasible intervention and can reduce PTLFU among referred TB patients.