Effectiveness, Feasibility, And Usability Of Mobile Application To Improve Adherence To Tuberculosis Treatment

Background Tuberculosis (TB) is an infectious disease that is caused by a bacterium called Mycobacterium tuberculosis. Worldwide, TB is considered as one of the major public health threats, where it is among the top ten causes of death and a leading cause of death due to a single infectious agent. Even though the most form of TB infection are treatable, and death is preventable, World Health Organization (WHO) estimated that 10 million people were infected and fell ill due to TB infection in 2019 and causing death to 1.2 million people. In addition, TB infection was identified as the number one cause of death among people living with HIV, where it was estimated 208 000 deaths or approximately 40% among HIV positive individuals died due to TB infection.

TB infection and the death is preventable using a standard 6 months medication regime. However, long duration of anti-TB treatment posed significant challenges to TB patients. Non-adherence to anti-TB therapy is one of the major challenges in TB management. A recent study in South Africa estimated that treatment loss is mainly occurred at the point of treatment completion, with only 53% of overall TB cases are able to complete treatment. Failure to complete anti TB therapy can lead to poor treatment outcome, such as the increased risk of relapse, acquired drug resistant TB, treatment failure, progression of disease leading to complication, risk of death, and ongoing transmission of disease in the community.

Adherence to TB therapy is critical for the success of TB treatment. Adherence to TB therapy is multidimensional, which is comprised of five factors, namely socioeconomic factor, health system factor, condition-related factor, therapy-related factor, and patient-related factor.

Ending TB epidemic is one of the main target under the Sustainable Development Goals (SDG) which require a holistic approach that combines biomedical, public health, social, and economic intervention. Therefore, tackling the issues of non-adherence to TB therapy and follow-up requires a concerted effort from a wide range of social determinants of TB disease. Under the End TB strategy, it encompassed a comprehensive package of intervention, which consists of three pillars. The first pillar emphasized on the integrated, patient-centered care and prevention, which require the need to strengthen and expand the core functions of TB programs. It involves the need to embrace the new strategies and technologies to enhance patient care.

The expansion of mobile phone and internet access to various parts of the world has provide a good opportunity to incorporate the utilization of digital technology into public health practice. According to the global report by Global System for Mobile Communication Association (GSMA), almost half of world's population or 3.5 billion individuals are connected to the internet, where more than half of people in low middle-income country has been using mobile phone as the primary mean of internet access. Even though affordability, low level of digital literacy and skills, and perceived lack of relevance might serve as a barrier in the use of mobile phone, the gap in the usage of mobile phone has been decreased from 24% to 10% worldwide, which mainly contributed by increased affordability and internet access. Department of Statistics Malaysia (DOSM) reported that in 2019, 98% of Malaysian populations are using mobile phone. Among those who are using mobile phone, the smartphone users have been substantially increased from 89% in 2018 to 91% in 2019. High usage of mobile phone and internet connectivity among Malaysian population may provide an opportunity for an alternative strategy in enhancing the prevention and care of TB patients.