Background: Tuberculosis is a leading cause of death in South Africa, with poor adherence undermining treatment success. Findings from recent research on the impact of mHealth (mobile health) interventions on tuberculosis treatment outcomes show promise, yet many interventions remain untested in African contexts. Rising smartphone ownership in South Africa enables more complex mHealth interventions, offering an opportunity to deploy behavioral tools within high-burden, resource-constrained settings. Objective: This pilot study evaluates the feasibility and effectiveness, among low-income patients at a South African clinic, of a WhatsApp (Meta)-based conversational mHealth platform designed to tackle specific behavioral barriers to adherence. Aims include the following: (1) evaluating coverage by studying the proportion of patients within the target group who own smartphones, (2) describing patterns of engagement with the platform and the role of mobile data scarcity as a barrier to use, and (3) producing evidence on the impact that a behavioral mHealth intervention can have on tuberculosis treatment success. Methods: Patients newly diagnosed with drug-susceptible pulmonary tuberculosis between August 2022 and October 2023 completed a screening survey. Those owning compatible mobile phones were invited to enroll. The platform provided reminders alongside behavioral support features. Coverage was studied by estimating smartphone ownership among screened patients and comparing characteristics between enrolled patients (n=42) and those receiving standard care (n=102) using standardized differences. Engagement was analyzed using local polynomial regressions for usage trends and logistic regressions to estimate the impact of mobile data top-ups. The marginal effect of enrollment on the probability of successfully completing tuberculosis treatment was studied using a test and logistic regressions with and without covariates. Results: A total of 34% (49/146) of screened participants owned a phone that could use WhatsApp. There were differences in characteristics by enrollment status. Further, 50% of patients engaged with the platform each day until the end of treatment. Overcoming an initial inability to send unprompted messages to inactive patients was associated with an immediate 13-percentage-point increase in aggregate engagement the following month. Mobile data scarcity hindered use—receiving mobile data top-ups within the previous week was associated with a 3.37-percentage-point increase (95% CI 0.0007 to 0.0666) in platform engagement. The estimated marginal effect of enrollment was a 17.6-percentage-point (95% CI 0.003 to 0.348) increase in treatment completion, becoming attenuated after adjusting for patient characteristics (12.8 percentage points, 95% CI −0.048 to 0.304). Conclusions: While phone ownership and mobile data constraints represent barriers to feasibility, findings suggest that smartphone-based mHealth interventions may aid successful treatment completion—alleviating health system burdens by automating care for less vulnerable patients. Engagement with the platform throughout tuberculosis treatment was high and stable, and enrolled users experienced a higher success rate. A randomized controlled trial is required for impact evaluation.
<img src="https://jmir-production.s3.us-east-2.amazonaws.com/thumbs/6c33a091172729d435db0219a572586a" />
Radically different