Using Text Messaging to Improve Appointment Adherence among Burkitt Lymphoma Patients in Uganda

Publication Type:

Journal Article


Journal of Investigative Medicine, Volume 62, Number 1, p.176-176 (2014)


2014, July 2014, Vaccine and Infectious Disease Division, Vaccine and Infectious Disease Division July 2014 2014Q2


Purpose of Study: Uganda has the highest incidence rate of Burkitt Lymphoma (BL) in the world, and while the cure rate for BL in the United States and Europe is about 90%, it hovers around 50% in Uganda. The poor response to therapy has been attributed to several factors, including incomplete courses of chemotherapy, late stage of disease at presentation, biological differences and anemia. This project aims to address poor outcomes due to incomplete courses of chemotherapy by increasing appointment and treatment adherence through the use of text messaging, which has been shown to improve adherence to HIV/AIDS and TB drug regimens, but has never been used in a resource-limited oncologic setting. Methods Used: Caretakers of BL patients were informally interviewed to assess their interest and capacity to receive and respond to text messages. Peer reviewed medical literature was consulted to help determine the most effective types of messages and the frequency for sending them. Sample messages were created and reviewed by BL patient caretakers. The most well liked messages were chosen for the program. A triggering system was coded into Salesforce so that electronic data automatically trigger the sending of text messages. A mobile provider was then contracted to send the messages. Summary of Results: The program is being implemented at the Uganda Cancer Institute. The BL Case Managers now have more free time to work clinically, as they no longer have to call every patient. Patient response has been positive of the program thus far. Due to ongoing and recent implementation however, there is not yet sufficient data to quantitatively assess the cost-effectiveness of the program. Conclusions: Text messaging can be used in resource-limited, oncologic settings to potentially increase appointment adherence and improve rapport with patients. With growing mobile penetration, this work also suggests that other m-health programs should be considered, including pictures and diagnostic techniques. However, studies measuring the cost-effectiveness of texts in oncologic settings need to be conducted. Finally, research and funding is still needed to address the morbidity and mortality inequities between BL in Uganda and that of the Western world.


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