Opportunities for Mobile App-Based Adherence Support for Children With Tuberculosis in South Africa.

Rachel M Morse,Sharon Mbaba,Anneke C Hesseling,David Reubi,Kyla Meyerson,Ava E Archey,Anthony J Garcia-Prats,James A Seddon,Hanlie Myburgh,Dillon T Wademan,Graeme Hoddinott,Stephanie Jacobs,Leletu Busakwe,Marieke M Van Der Zalm

doi:10.2196/19154

Abstract

Tuberculosis is the number one infectious cause of death globally. Young children, generally those younger than 5 years, are at the highest risk of progressing from tuberculosis infection to tuberculosis disease and of developing the most severe forms of tuberculosis. Most current tuberculosis drug formulations have poor acceptability among children and require consistent adherence for prolonged periods of time. These challenges complicate children’s adherence to treatment and caregivers’ daily administration of the drugs. Rapid developments in mobile technologies and apps present opportunities for using widely available technology to support national tuberculosis programs and patient treatment adherence. Pilot studies have demonstrated that mobile apps are a feasible and acceptable means of enhancing children’s treatment adherence for other chronic conditions. Despite this, no mobile apps that aim to promote adherence to tuberculosis treatment have been developed for children. In this paper, we draw on our experiences carrying out research in clinical pediatric tuberculosis studies in South Africa. We present hypothetical scenarios of children’s adherence to tuberculosis medication to suggest priorities for behavioral and educational strategies that a mobile app could incorporate to address some of the adherence support gaps faced by children diagnosed with tuberculosis. We argue that a mobile app has the potential to lessen some of the negative experiences that children associate with taking tuberculosis treatment and to facilitate a more positive treatment adherence experience for children and their caregivers.

Highlights

Tuberculosis (TB) is the number one infectious cause of death globally [1]
A frequently asked questions (FAQs) section, designed by children and adolescents who have experienced TB disease and medical professionals who work with TB disease, could address knowledge gaps by including answers to common questions, such as “How can I protect my family and friends from getting TB?” “What kind of bodily changes can I expect while taking treatment?” “Can I go to school if I have TB?” and “What is the relationship between TB and HIV?” In the app’s community space, users can play games, either with each other or solo, to earn additional diamonds
Digital health technology is a burgeoning resource for supporting health systems and patients in the prevention, treatment, and care of a wide array of diseases. While such technologies hold promise for supporting the adherence of children diagnosed with TB disease in low- and middle-income countries (LMICs), where the burden is highest, no such technologies have been developed to date

Summary

Introduction

Tuberculosis (TB) is the number one infectious cause of death globally [1]. Implementation of effective TB control programs continues to place enormous pressure on the health systems of high TB-burden countries [1]. Many of the small-scale studies published far provide promising evidence supporting the potential of mobile apps to positively impact adherence and treatment outcomes among children and young people [3,4,5,13,15,16,19].

Results

Conclusion