Fuad Anis, Herwanto Guntur Budi, Pertiwi Ariani Arista Putri, Wahyuningtias Siska Dian, Harsini Harsini, Maula Ahmad Watsiq, Putri Diyah Utami Kusumaning, Probandari Ari, Ahmad Riris Andono
Department of Biostatistics, Epidemiology and Population Health, Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Yogyakarta, Yogyakarta, 55284, Indonesia.
Center for Tropical Medicine, Faculty of Medicine, Public Health and Nursing; Universitas Gadjah Mada, Yogyakarta, Yogyakarta, 55284, Indonesia.
F1000Res. 2021 Sep 29;10:983. doi: 10.12688/f1000research.67212.1. eCollection 2021.
Drug resistance and multi drugs tuberculosis (DR/MDR-TB) are associated with patients' low adherence to undergoing complex treatment. Driven by the increasing use and penetration of a smartphone and the End of TB Strategy that seeks for digital health solution, Center for Tropical Medicine Universitas Gadjah Mada has developed TOMO, an Android-based app for improving medication adherence in MDR-TB. This paper aims to present the sequential steps to develop the app, its general architecture, and its functionalities. It is a design thinking process involving two MDR-TB referral centers, district health offices, primary health centers, and MDR-TB patients in Central Java and Yogyakarta, Indonesia. We adopted the Principles for Digital Development to develop and design the app. MDR-TB treatment guideline from the Indonesian Ministry of Health was used to develop functionalities of the app for improving adherence. TOMO app could be used by patients, primary health centers, clinical teams, and case managers. The app prototype features include adverse event records and reports, medication-taking reminders, and communication between the patient and the TB-MDR case manager. We have successfully tested the functionalities based on four use cases: patients with high adherence, patients with low adherence, patients with adverse events, and patients following treatment in the primary health center without any visit to the MDR-TB center. TOMO app has contributed to the limited body of literature on improving TB-MDR adherence with digital health intervention, especially using a health app. The app has been tested using four scenarios. We will follow up with usability testing before implementing the app in a real setting.
耐药性和耐多药结核病（DR/MDR-TB）与患者对接受复杂治疗的低依从性相关。受智能手机使用和普及程度不断提高以及寻求数字健康解决方案的《终结结核病战略》的推动，加查马达大学热带医学中心开发了TOMO，这是一款基于安卓系统的应用程序，用于提高耐多药结核病患者的用药依从性。本文旨在介绍开发该应用程序的后续步骤、总体架构及其功能。这是一个设计思维过程，涉及印度尼西亚中爪哇省和日惹的两个耐多药结核病转诊中心、地区卫生办公室、初级卫生中心以及耐多药结核病患者。我们采用数字发展原则来开发和设计该应用程序。印度尼西亚卫生部的耐多药结核病治疗指南被用于开发该应用程序的功能以提高依从性。TOMO应用程序可供患者、初级卫生中心、临床团队和病例管理人员使用。该应用程序原型的功能包括不良事件记录与报告、服药提醒以及患者与耐多药结核病病例管理人员之间的沟通。我们已基于四个用例成功测试了这些功能：高依从性患者、低依从性患者、有不良事件的患者以及在初级卫生中心接受治疗且未前往耐多药结核病中心就诊的患者。TOMO应用程序为关于通过数字健康干预（特别是使用健康应用程序）提高耐多药结核病依从性的有限文献做出了贡献。该应用程序已通过四种场景进行了测试。在实际环境中实施该应用程序之前，我们将跟进可用性测试。
