Mobile app research, development could help TB patients manage their condition more effectively

Tuberculosis (TB) remains one of the top 10 causes of death worldwide and a significant economic burden to individuals and countries. According to the World Health Organization (WHO), digital solutions will be an essential component in the fight against TB to meet the 2030 Sustainable Development Goal to end the TB epidemic. New effective treatment supervision strategies are needed particularly in low-resource high TB burden settings and a potential solution is in the hands of nearly every patient – a mobile phone.

Professor Sarah Iribarren

Dr. Sarah Iribarren, UW assistant professor of nursing, is working to develop an app in collaboration with patients, TB experts, human centered design and engineering experts, and other faculty mentors and students to support individuals receiving treatment for active tuberculosis.  The app works on both smartphones and tablet, and communicates with a server that doctors and nurses can access to monitor the patient’s progress.

The goal of this research is to develop and refine a user-friendly app to provide supportive treatment supervision that includes innovative adherence monitoring along with a behavioral intervention, to heighten patient involvement in their own care, improve monitoring, communication, and individual tailoring. This formative work will inform a version that will be tailored for and pilot tested with patients with active TB in a high burden region in Argentina where treatment is delivered by self-administration.  According to the World Health Organization country report, Argentina continues to have rates of treatment success well below target rates (47%), and there are high rates of treatment abandonment. Unfortunately, similar to other countries in the world, the rate of drug-resistant TB is on the rise due to a number of factors, one of which includes incomplete treatment.

Screen shot of mobile app in development

Connected mobile apps capable of automated reminders, messaging, and gathering information on patient preferences, symptoms, and outcomes hold great promise to provide personalized monitoring, communication, and educational materials and heighten patient involvement in their own care.

Current technologies allow for rapid modification based on end user needs, implementation of native iOS and Android apps for users with inconsistent internet access, and integration of the patients’ experiences with electronic health records using programming standards such as SMART on FHIR. To date, few apps have focused on TB patients as users, supported patient engagement in self-management of their care, and offered direct adherence monitoring.

“Strategies to provide support and treatment monitoring in a convenient and meaningful way for patients is needed for both chronic and infectious diseases,” Iribarren said. “Mobile digital technologies are being leveraged to deliver real-time health related behavior-change interventions, yet better understanding of their impact is needed for wider adoption and clear recommendations.”

Professor William Lober

“Understanding end-user needs and priorities is essential to optimize these tools,” she said. “This research will add to this body of knowledge.”

Iribarren recently received a National Institute of Nursing Research (NINR) K23 Patient Oriented Career Development Grant to support her work. Dr. William Lober, UW professor of nursing and Dr. George Demiris, Penn University professor of nursing and are her primary mentors, along with Dr. Rebecca Schnall, Columbia University associate professor of nursing.  Dr. Lober’s team, who have developed and deployed applications and other systems in global settings, lead the app programming. Dr. Barry Lutz, UW associate professor of bioengineering, serves as technical consultant for the drug metabolite testing component. Long standing collaborators in Argentina include Dr. Cristina Chirico, director of regional tuberculosis and Dr. Fernando Rubinstein, University of Buenos Aires associate professor of public health who are both TB and health care system experts.

The grant provides funding to advance Iribarren’s areas of research in health informatics, iterative development of patient-centered technology-based interventions and clinical trial development and execution. And, in the near term, Iribarren’s work has the potential to greatly improve the experience of TB treatment for Argentinians.