Imagine your doctor telling you that you have an infection—one you don't feel and don't spread to others. And the medications for treatment are many months long and may be toxic to your liver or result in weakness or numbness in your hands and feet. You might be inclined to say "no thank you" and to move on with your life. Now imagine years later: You start feeling poorly, sweating at night, coughing and feeling tired. The bacteria from that infection, once contained, are now multiplying inside your body and spreading. Now you're contagious and risk spreading the germs to others in your family and community.

This scenario is all too-common and the primary reason for the continuing burden of tuberculosis (TB) in the United States. TB is an infectious disease that usually infects the lungs, but can attack almost any part of the body. Individuals are exposed to TB germs and inhale them, sometimes resulting in a condition known as latent TB infection, where their body contains the germs (often without the person even knowing). Years later, the disease progresses to active TB, and the bacteria can then be transmitted to others—and the cycle perpetuates.

While people who develop latent TB do not have symptoms and are not contagious, there's a 5 to 10 percent risk over one's lifetime that the latent TB will progress to active TB disease. Because of this risk, identification and treatment of latent TB are essential to prevent and eliminate tuberculosis.

A Lung Association-funded project is examining new ways to increase the likelihood that individuals will complete their treatment for latent TB through a series of text message reminders and motivators. The thought is that by tailoring a text reminder system for patients who self-administer medications to regularly take their medications, we may be able to improve adherence to latent TB treatment and provide evidence for adopting or expanding reminder and adherence systems. The popularity of text messaging provides an opportunity to harness a widely available and accessible technology tool to deliver healthcare. Mobility, instantaneous access and direct two-way communication are likely to make of healthcare delivery more efficient and save money through reduced costs to the health system and fewer missed appointments.

Our project is evaluating the use of daily text messaging as a mechanism to improve latent TB medication adherence by examining whether individuals receiving texts have increased treatment completion rates, higher self-reported medication adherence, fewer missed appointments and doses, and a shorter course of treatment. We will also investigate whether people like receiving the messages, and whether this approach is affordable for tuberculosis clinics. We hope to reduce the number of individuals progressing to active TB. Our hope is to eventually scale up our work so that mobile health technologies will be adopted in health departments across the United States.

The American Lung Association has a long history of supporting tuberculosis prevention and control. The organization was founded in 1904 as the National Association for the Study and Prevention of Tuberculosis, and devoted funds toward developing effective screening trials and treatment regimens for TB. Thanks to the Lung Association, our project will aim to reduce the burden of lung disease on patients and their families, and to support measures with the eventual goal of TB elimination. Research funding from the Lung Association and other non-profits allows for the introduction of novel, projects with direct public health impact. Additionally the American Lung Association funds young researchers at critical junctures in our careers, allowing us to expand our knowledge base, and provide a foundation for future funding and work preventing lung disease and promoting lung health.

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