Opportunities for Mobile App-Based Adherence Support for Child Tuberculosis in South Africa

Rachel Morse, Hanlie Myburgh, David Reubi, Ava Archey, Leletu Busakwe, Anthony Garcia-Prats, Anneke Hesseling, Stephanie Jacobs, Sharon Mbaba, Kyla Meyerson, James Seddon, Marieke van der Zalm, Dillon Wademan and Graeme Hoddinott, 2020, JMIR mHealth and uHealth, doi: 10.2196/19154

Tuberculosis (TB) is the number one infectious cause of death globally. Young children, generally under the age of five years, are at highest risk of progressing from TB infection to TB disease and of developing the most severe forms of TB. Most current TB 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 TB 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 have been developed for children that aim to promote adherence to TB treatment. In this paper we draw on our experiences of researching in clinical pediatric TB studies in South Africa. We present hypothetical scenarios of children’s adherence to TB medication to suggest priorities for how a mobile–based app that incorporates behavioral and educational strategies could address some of the adherence support gaps faced by children diagnosed with TB. We argue that a mobile–based app has the potential to lessen some of the negative experiences that children associate with taking TB treatment and to facilitate a more positive treatment adherence experience for children and their caregivers.