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Mobile teledermatology shows potential for HIV patients
Mobile teledermatology showed significant potential in improving access to care for HIV-positive patients in a resource-limited setting, according to recent study results.
“While several studies have evaluated diagnostic agreement, relatively few have investigated the reliability and validity of mobile teledermatology compared with the gold standard of face-to-face evaluation by a dermatologist,” researchers wrote in JAMA Dermatology. “Moreover, to our knowledge, this technology has not been tested in sub-Saharan Africa among HIV-positive patients.”
The study included 76 HIV-positive patients aged at least 18 years living in Botswana with skin or mucosal conditions. For comparative purposes, all patients initially received a face-to-face clinical evaluation by a board-certified dermatologist. Next, clinical data collected remotely from patients using a mobile phone with a 5-megapixel camera were forwarded to a password-protected website for evaluation. Three dermatologists and one oral medicine specialist were asked to provide a diagnosis based on the mobile data and recommend a course for the management of the primary diagnosis. To assess test-retest reliability, the specialists again were asked to make their recommendations several months later but without seeing their original comments.
According to the researchers, the specialists agreed with their initial primary diagnosis 52% to 80% of the time, with the kappa coefficient for test-retest reliability ranging from 0.47 (95% CI, 0.35-0.59) to 0.78 (95% CI, 0.67-0.88). Self-agreement on the diagnostic category to which the primary diagnosis belonged ranged from 36.5% (kappa coefficient=0.29; 95% CI, 0.18-0.42) to 77% (kappa coefficient=0.73; 95% CI, 0.61-0.84), and self-agreement on how to manage the condition ranged from 55% (kappa coefficient=0.17; 95% CI, –0.01 to 0.36) to 69% (kappa coefficient=0.54; 95% CI, 0.38-0.7).
Agreement between the gold standard of face-to-face evaluations and mobile teledermatology on the primary diagnosis ranged from 47% (kappa coefficient=0.41; 95% CI, 0.31-0.52) to 57% (kappa coefficient=0.51; 95% CI, 0.41-0.61). Agreement between the two methods on the diagnostic category ranged from 29% (kappa coefficient=0.22; 95% CI, 0.14-0.31) to 50% (kappa coefficient=0.43; 95% CI, 0.34-0.53), and agreement on how to treat the primary diagnosis ranged from 32% (kappa coefficient=0.08; 95% CI, 0.02-0.15) to 51% (kappa coefficient=0.12; 95% CI, 0.01-0.23).
The results suggest that the test-retest reliability of mobile teledermatology was moderate-to-good for diagnosis, fair-to-good for diagnostic category and poor-to-moderate for management of the diagnosis. In comparison, interrater agreement on melanoma diagnosis has been reported in previous studies as ranging from fair to good.
“As evidenced by our pilot study, although the introduction of mobile teledermatology into a resource-limited population of HIV-positive patients in sub-Saharan Africa has significant theoretical potential for improving access to care, much work is needed to optimize and validate the use of this technology on a larger scale in this population,” the researchers wrote.
Disclosure: One of the researchers reports receiving grants from Abbott, Amgen, Novartis and Pfizer, and he is also a consultant for Abbott, Amgen, Celgene, Centocor, Novartis and Pfizer.