Tuberculosis (TB) remains an urgent global health problem and a leading cause of death worldwide with most of the 1.5 million annual deaths being preventable. Much of the adverse outcomes are related to poor treatment adherence resulting in prolonged infectivity, morbidity and economic hardship, and the growing drug resistant TB. To improve adherence, directly observed therapy (DOT) has been a long standing recommended strategy. However, because DOT is labor intensive, transportation dependent, and often inconvenient to patients it continues to be challenging to implement universally and new supportive treatment supervision strategies are needed. Mobile health technologies, including apps, with increased sophistication capable of accommodating multiple tools (e.g., automated reminders, symptom tracking), among others, hold great promise to provide supportive treatment supervision, heighten patient involvement in their own care and improve monitoring, communication, and individual tailoring. To date, few TB related apps have directly targeted patients and none included functions to support patient engagement in self-management of their care . The proposed research will use rapid iterative methodology to convert and expand TextTB to include innovative adherence monitoring into a mobile optimized app, refine and enhance with end-users and stakeholders and assess feasibility, usability and initial efficacy in a setting with historically low treatment success rates where treatment delivery is commonly by self-administration. The training and research builds upon pre- and post-doctoral work where the candidate led a team of patients in active TB treatment and TB experts to develop TextTB, a text messaging-based intervention. This intervention aimed to support patients receiving TB treatment by self-administration and healthcare teams to more quickly respond to patients with non- or problematic adherence. Although successful as a pilot, needed improvements were identified, such as increasing automation of alerts, expanding educational messages, incorporating visualization of treatment course, and improving patient tailoring. Responsive design apps could address these issues. The candidate's long-term career goal is to become an independent researcher and lead in the development of cutting-edge interventions, suitable for the emerging economies of the world, that facilitate self-management of health and prevent disease. The career development plan integrates didactic coursework with practical mentored research experience to achieve the following training goals: 1) obtain advanced training in health informatics, 2) develop expertise in iterative development of patient-centered technologies, 3) achieve capacity to effectively conduct clinical trials to design and evaluate information technology to improve patient outcomes, and 4) obtain proficiency with scientific writing and grantsmanship. The candidate has developed a clear research trajectory for patient-oriented intervention research, which meets NINR's programmatic priorities to promote self-management, to promote health and prevent disease, and to advance nursing science to improve the health and well-being of the world's citizens.
Increasing adherence to tuberculosis treatment is a global public health priority and new supportive supervision strategies are needed. Mobile health technologies to provide supportive treatment supervision, such as innovative adherence monitoring along with a behavioral intervention to heighten patient involvement in their own care, improve monitoring, communication, and individual tailoring in this effort could have significant impact.
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