Research Article Summary: Enhancing Tuberculosis Treatment Support via Digital Adherence Technologies

Objective

• Purpose: Assess user engagement with the Companion app within the TB Treatment Support Tools (TB-TST) intervention, and explore message themes to identify needs, challenges, and strategies for improved tuberculosis (TB) treatment support.

Study Design & Methods

• Type: Retrospective descriptive qualitative study using thematic analysis
• Setting: Four large public hospitals in Argentina (Nov 2020 – May 2023)
• Participants:
  • 277 patients with newly diagnosed, drug-susceptible TB; ages ≥16; smartphone access required
  • 6 treatment supporters (TSs): 3 physicians, 3 social workers
• Data: 6805 messages (2926 patients, 3879 TSs) via secure messaging in the Companion app, thematically coded
• Analysis: Descriptive statistics (usage patterns), iterative thematic qualitative analysis (content and interaction styles)

Key Findings & Themes

1. Living with TB (and COVID-19 Impact)

• Patients sought advice on:
  • Resuming daily activities and social interactions post-diagnosis
  • Managing family isolation and transmission risk
• COVID-19 pandemic raised concerns about vaccine compatibility, treatment continuity, and safety

2. Symptom Guidance

• Most common messages: Questions on managing symptoms and side effects (gastrointestinal, pain, cough, etc.)
• TSs provided:
  • Normalization/reassurance on common side effects
  • Guidance on urgent health concerns, usually referring to emergency services if needed
  • Requests for photos to assess visible symptoms

3. Emotional & Mental Health Support

• Emotional distress prevalent among patients (anxiety, isolation, panic attacks)
• TSs offered:
  • Practical coping strategies
  • Referrals to mental health professionals
• Emotional support was a significant aspect of SM use

4. Healthcare Coordination

• Patients requested help with:
  • Scheduling/rescheduling appointments
  • Navigating healthcare system challenges
• TSs acted as advocates/administrators to facilitate continuity of care

5. Treatment and Intervention Adherence

• TSs sent reminders for:
  • Medication intake reports
  • Milestone congratulations
• Personalized communication (using names, empathy) encouraged better engagement and adherence
• Barriers: Forgetfulness, technical issues, lack of time, connectivity, or resources

6. Technical Issues

• Frequent problems with:
  • Application glitches, logins, uploading photos, device/camera permissions, data syncing
  • Phone credit, connectivity or device changes
• TSs provided troubleshooting guidance and coordinated phone credit distribution

Patient Profile (Baseline Characteristics)

• Gender: 52% female, 47.7% male, 0.4% non-binary
• Age: 62.8% between 16–34 yrs
• Education: Nearly half had completed secondary or higher education
• Employment/Income: 51.6% employed; majority at or below poverty line
• Nationality: 76.9% Argentine

Recommendations

Key Strengths to Maintain & Enhance

• Personalized, empathetic communication
• Building trustful patient-TS relationships
• User-friendly interface for adherence reporting
• Personalized and timely reminder/message system
• Expanded mental health support and resources
• Efficient healthcare navigation and administrative support
• Ongoing technical/problem-solving support
• Clear guidance on medication side effects

Areas for Improvement & Future Enhancements

• Empathetic communication training for TSs
• Improved onboarding and welcome guidance
• Clearer emergency protocols in-app
• Enhanced technical stability and simplified interfaces
• More reporting options to fit various patient needs
• Alternative solutions for patients with limited connectivity
• Integrated mental health services and peer support
• More educational content to combat TB stigma and misinformation
• Systematic issue tracking for unresolved problems
• Investigate AI-powered support for 24/7 rapid and tailored responses
• Evaluate cost, scalability, and sustainability
• Incorporate patient success stories to encourage adherence

Discussion: Implications

• Personal communication: Personal, timely, and empathetic TS engagement fosters adherence and satisfaction.
• Mental health needs: Demand for integrated psychological support is high among TB patients, especially during crises.
• Technical robustness: Application reliability and connectivity are critical for intervention success.
• User diversity: Support for varying digital literacy levels is necessary to prevent disparities in engagement.

Limitations

• Limited to those with smartphone access/drug-susceptible TB in Argentina.
• Did not measure impact of TS response time or directly analyze digital literacy disruptions.
• Translation from Spanish may have lost nuance, despite mitigation measures.

Conclusion

• Personalized, empathetic, and reliable mHealth solutions can enhance TB treatment adherence and patient experience.
• Future DATs should prioritize technological reliability, intuitive design, adaptability, and support for diverse patient needs—including emotional well-being and digital literacy gaps.

Contributing Authors

Javier Roberti, Priscilla Carmiol-Rodríguez, Enrique Chan-Liang, Omar Alfonso Aguilar-Vidrio, Agnes A. Suyanto, Jennifer Sprecher, Fernando Rubinstein, Sarah Iribarren

Reference

Roberti J, Carmiol-Rodríguez P, et al. (2025). Enhancing tuberculosis treatment support: A thematic analysis of interactive messages in a digital adherence technology trial to identify needs, challenges, and strategies for improvement. PLoS One, 20(7): e0326492. https://doi.org/10.1371/journal.pone.0326492

Type: Research Article Summary
Goal: Quickly understand core findings, methods, and recommendations of the study.