Randomized trial evaluating an mHealth intervention for the early community-based detection and follow-up of cutaneous leishmaniasis in rural Colombia.

BackgroundIn Latin America, cutaneous leishmaniasis primarily affects dispersed rural communities, that have limited access to the public health system and medical attention. Mobile health (mHealth) strategies have shown potential to improve clinical management and epidemiological surveillance of neglected tropical diseases, particularly those of the skin.MethodsThe Guaral +ST app for Android was designed to monitor cutaneous leishmaniasis treatment and assess therapeutic response. We carried out a randomized trial in the coastal municipality of Tumaco in southwestern Colombia, with parallel arms comparing a) follow-up aided by the app to b) standard institution-based follow-up. Treatment was prescribed according to national guidelines. Follow-up of therapeutic response was scheduled at the end of treatment and at 7, 13 and 26 weeks after the start of treatment. The primary endpoint was the proportion of participants who were monitored at or around week 26, allowing outcome and effectiveness of treatment to be determined.ResultsFollow-up of treatment and outcome assessment was achieved in significantly more patients in the intervention arm than the controls, Of the 75 participants in the two randomized arms, 74 had information on whether or not treatment was followed and outcome determined at or around week 26. Among these, 26/49 (53.1%) were evaluated in the intervention arm, and none (0/25, 0%) in the control arm (difference = 53.1%, 95% confidence interval 39.1-67.0%, pConclusionThis study provides proof of concept for mHealth to monitor treatment of CL in remote and complex settings, deliver improved care and to provide information to the health system on the effectiveness of treatment as it is delivered to affected populations.Clinical trial registrationISRCTN54865992

Randomized Trial Evaluating an mHealth Intervention for the Early Community-Based Detection and Follow-Up of Cutaneous Leishmaniasis in Rural Colombia

Cutaneous leishmaniasis is a parasitic disease which causes sores on the skin than can spread to other skin or mucosal locations and lead to permanent scaring and disfigurement. In Latin America, cutaneous leishmaniasis primarily affects remote rural communities with limited health services. Mobile health (mHealth) strategies, such as mobile phone apps, have potential to improve care and surveillance of cutaneous leishmaniasis and other skin diseases. We developed a mobile phone app called Guaral +ST for use by community health volunteers to monitor cutaneous leishmaniasis treatment. We carried out a randomized trial in the coastal municipality of Tumaco in southwestern Colombia. Patients with cutaneous leishmaniasis were treated in accordance with national guidelines, and randomly allocated to either follow-up aided by the app, or to standard institution-based follow-up. Of the 74 randomized participants with the necessary data, 26/49 (53.1%) were evaluated in the intervention arm, and none (0/25, 0%) in the control arm. Hence follow-up was achieved more frequently by community health volunteers supported by the mHealth app than conventional institutional-based monitoring of treatment. This study shows that mHealth apps can help deliver improved care of cutaneous leishmaniasis in remote settings