“The White Plague” or “Phthisis” may be occasionally encountered in manuscripts or historical books depicting the disease Tuberculosis (TB) that once plagued humanity as early as the ancient Greek period. Mycobacterium tuberculosis, the causative agent of TB, was first discovered in the 19th century by Dr Robert Koch, which triumphed further discoveries in the development of diagnostic tools and disease management. Presently, TB remains the bane of countries of tropical climates and the global cause of strain on modern healthcare systems. To put into perspective, TB is an infectious disease caused by Mycobacterium tuberculosis, which is spread through inhaling airborne respiratory droplets, causing multisystem manifestations in the lungs (primary), kidneys, gut, or brain. Statistics from the World Health Organisation (WHO) revealed that 1.13 million people worldwide lost their lives to TB in 2022. In Malaysia, TB cases are progressively on the rise and remain a public health dilemma.
Currently, in most countries, TB patients are managed conventionally via an intervention called Directly Observed Therapy Shortcourse, aka DOTs. This intervention involves a standardised six- to eight-month TB treatment monitored by a healthcare worker to ensure that each dose is taken. However, the inflexibility and logistical issues arising from this intervention method have resulted in poor treatment compliance, translating to high treatment default rates. With the advent of technology, the incorporation of Video Observed Therapy (VOT) into video-enabled electronic devices is explored to increase the efficiency of treatment monitoring.
Henceforth, this article proudly introduces Prof Ts. Dr. Vimala Balakrishnan and her team’s accomplishment in their research endeavour -- “MyTBCompanion: An Integrated Video Observed Therapy Application for TB Management in Malaysia.” This innovative application aims to enhance treatment compliance and represents a significant step toward our nation’s goal of eliminating TB by 2035.
Development of MyTBCompanion
The development of MyTBCompanion is a joint effort between the Faculty of Computer Science and Information Technology and the Department of Respiratory Medicine, Faculty of Medicine, Universiti Malaya, as well as international partners from the United Kingdom and Indonesia, in the development of a multilingual mobile application that integrates both VOT and other functions to cater for Malaysia’s diverse population.
From the fruitful discussion with Prof. Dr. Vimala, we have identified two primary limitations that contribute to high default rates under the implementation of DOTS, namely, the inaccessibility and logistical difficulties for patients, especially those from rural communities, and the lack of time flexibility for patients with pre-existing commitments such as livelihoods and childcare responsibilities, among others.
To overcome geographical barriers, the VOT adopted in MyTBCompanion offers a seamless and convenient method for healthcare professionals to monitor the treatment management progress of TB virtually. To aid healthcare professionals in optimising TB patient management, the mobile application features a myriad of integrated modules, such as a platform for reporting treatment side effects, a treatment progress tracker, and teleconsultation bookings, all of which represent a synergistic application of technology in the field of healthcare.
Adoption of VOT in MyTB Companion app. Patients need to upload their videos for healthcare professionals to monitor their treatment management progress.
The healthcare professionals can accept or reject the video uploaded by the patients and leave comments.
Discoveries and Insights into Field Tests
Usability testing of MyTBCompanion was conducted among selected TB patients recruited by the Malaysian Association for the Prevention of Tuberculosis (MAPTB). The study recruited 29 participants from various regions, namely Kuala Lumpur, Klang Valley, and Pahang. Another twenty patients were recruited from Jakarta, Indonesia, through an international collaboration. Participants were selected based on the inclusion criteria:
(1) Active TB infection,
(2) TB treatment managed under DOTS or VOT program,
(3) Adults more than 18 years old and from the low-income group
In the execution of this study, pre-and post-test surveys were used to gather perceptions about current TB treatment monitoring methods and the usability of MyTBCompanion after the demonstration of the application. Twenty TB patients from Kuala Lumpur and Klang Valley were on WhatsApp-based VOT, while ten patients from less-developed regions of Pahang were on DOTS for their TB management. Interestingly, all the 20 patients from Jakarta expressed optimism towards the adoption of MyTBCompanion despite having no previous exposure to VOT.
Overall, the key outcomes of the field test revealed that patients who were initially on DOTS rated this method as a score of 5 out of 5 but responded with resistance (2 out of 5) towards adopting MyTBCompanion. Conversely, as most patients from Pahang were from the geriatric population, a higher preference for DOTS was reported as the elderly enjoy travelling outdoors and the opportunity to communicate with their healthcare providers. Nevertheless, the Pahang population recommended the application to others despite their preference for DOTS.
Preferences on using VOT in TB management reflected more favourable feedback among the urban population, and hence, higher acceptance of MyTBCompanion. The stark comparison between the preferences of the less-developed area of Pahang and the urban population was attributed to increased ownership and proficient use of mobile phones in urban areas.
Challenges Faced in the Development of MyTBCompanion
The development of MyTBCompanion encountered several challenges, particularly in patient involvement in the study, and technical and time constraints. A significant barrier to patient participation was observed in Pahang, where the lack of awareness about TB prompted the emphasis on proactive education strategies in the mitigation of TB in Malaysia. To raise public awareness of TB, the research team has delved into various strategies, which include the dissemination of printed and online information sheets to the Pahang recruits.
Additionally, while mobile phone ownership was not a barrier, ensuring inclusivity was a concern. Hence, a desktop version of MyTBCompanion was developed for those without mobile access. As this research was fully funded by the Research and Innovation for Development in ASEAN (RIDA) under the United Kingdom, the research team was tasked with a six-month project timeline for the development and field testing of MyTBCompanion. Combined with the adrenaline rush to complete within a short time frame, field testing required training modules for the NGO staff before the recruitment process, to which imposed extra strain as all training sessions were conducted virtually. Despite all the challenges, the research team triumphed in the successful development of the app that currently supports three languages, namely English Bahasa Melayu and Bahasa Indonesia, thus catering to implementation across diverse regions.
Into The Future
Ultimately, market surveys and usability studies have demonstrated a positive reception towards the adoption of MyTBCompanion in TB management. Moving forward, the research team endeavours the initiation of clinical trials, where MyTBCompanion is to be utilised by TB patients and DOTS healthcare providers, essential for assessing the app’s effectiveness in real-world clinical settings. Upon successful completion, Prof Vimala hopes that the commercialisation of MyTBCompanion will follow, making it available for widespread use in TB management. Currently, the research team is actively seeking grant support in its upcoming clinical trials and, ultimately, in ensuring the application’s successful integration into TB care systems.
Conclusion
Fundamentally, MyTBCompanion marks a transformative step forward in the evolution of TB management, thereby addressing critical gaps in the existing DOTS framework through the integration of digital solutions into MyTBCompanion. Ultimately, the development of MyTBCompanion has exemplified the invaluable partnership between multidisciplinary professionals in the quest to develop innovative solutions for combating global health threats. The success of MyTBCompanion sets a precedence for the broader application of digital health innovations in tackling complex diseases and, ultimately, better management of health conditions with improved quality of life of patients. This intersection of technology and medicine provides an optimistic view in redefining future approaches to global health, thereby driving progress toward more accessible, efficient, and patient-centered care.
Researchers featured:
Prof. Ts. Dr. Vimala Balakrishnan
Department of Information System
Faculty of Computer Science and Information Technology, UM
For inquiries, please contact:
T: +603-79676377
Author:
Ms Eng Pink Huey
Pink Huey is currently a fourth-year medical student at the Universiti Malaya. Outside clinical wards, her enthusiasm for writing and classical music drives her appreciation for the harmonious union of art and life. For a tinge of adrenaline, she enjoys hiking and chasing sunsets!
Copyedit:
Siti Farhana Bajunid Shakeeb Arsalaan Bajunid, Assistant Registrar, UM
Commenti