Low adherence rates to tuberculosis (TB) treatment are one of the major barriers to improving TB cure rates. Developing regions such as sub-Saharan Africa are adversely affected for a number of reasons, such as low patient follow-up, limited medical, and treatment resources. The use of mobile graphic-based reminders potentially offers a cost-effective, easy to use and time efficient strategy to increase adherence in order to improve cure rates among patients with TB. This paper shows the results of a study in Zanzibar, Tanzania, which investigated the effectiveness of graphic-based reminders in supporting TB patients with low literacy levels to adhere to treatment. Participants were randomly selected from a group of TB patients and assigned into three groups: control (no reminder) group, graphic-based reminder group and speech-based reminder group. A total of 29 participants were analysed. The treatment adherence rates of the control group, speech-based group and graphic-based group were 41.7%, 60% and 85.7%, respectively. The rates in the graphic-based group were significantly higher than in the speech-based and the control groups. Results also show that there were high efficacy and acceptability of mobile reminders in the graphic-based group, with the average response rates of 76.8% compared with 67.1% in the speech-based group (p<0.001 of 95% confidence intervals). The findings highlight that mobile phone reminders are improving treatment adherence of TB patients. The graphic-based reminder was more beneficial, cost-effective and accepted for use by the majority of patients including those with limited education
