Reliability and Validity of Mobile Teledermatology in Human Immunodeficiency Virus–Positive Patients in Botswana: A Pilot Study | Allergy and Clinical Immunology | JAMA Dermatology | JAMA Network
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Original Investigation
June 2014

Reliability and Validity of Mobile Teledermatology in Human Immunodeficiency Virus–Positive Patients in Botswana: A Pilot Study

Author Affiliations
  • 1Department of Dermatology, University of Pennsylvania, Philadelphia
  • 2Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia
  • 3Division of Dermatology, Department of Medicine, University of California–San Diego, San Diego
  • 4Department of Oral Medicine, University of Pennsylvania School of Dental Medicine, Philadelphia
JAMA Dermatol. 2014;150(6):601-607. doi:10.1001/jamadermatol.2013.7321

Importance  Mobile teledermatology may increase access to care.

Objective  To determine whether mobile teledermatology in human immunodeficiency virus (HIV)–positive patients in Gaborone, Botswana, was reliable and produced valid assessments compared with face-to-face dermatologic consultations.

Design, Setting, and Participants  Cross-sectional study conducted in outpatient clinics and public inpatient settings in Botswana for 76 HIV-positive patients 18 years and older with a skin or mucosal condition that had not been evaluated by a dermatologist.

Main Outcomes and Measures  We calculated the κ coefficient for diagnosis, diagnostic category, and management for test-retest and interrater reliability. We also determined sensitivity and specificity for each diagnosis.

Results  The κ coefficient for test-retest reliability ranged from 0.47 (95% CI, 0.35 to 0.59) to 0.78 (0.67 to 0.88) for the primary diagnosis, 0.29 (0.18 to 0.42) to 0.73 (0.61 to 0.84) for diagnostic category, and 0.17 (−0.01 to 0.36) to 0.54 (0.38 to 0.70) for management. The κ coefficient for interrater reliability ranged from 0.41 (95% CI, 0.31 to 0.52) to 0.51 (0.41 to 0.61) for the primary diagnosis, 0.22 (0.14 to 0.31) to 0.43 (0.34 to 0.53) for diagnostic category, and 0.08 (0.02 to 0.15) to 0.12 (0.01 to 0.23) for management. Sensitivity and specificity for the top 10 diagnoses varied from 0 to 0.88 and 0.84 to 1.00, respectively.

Conclusions and Relevance  Our results suggest that while the use of mobile teledermatology technology in HIV-positive patients in Botswana has significant potential for improving access to care, additional work is needed to improve the reliability and validity of this technology on a larger scale in this population.