Tuberculosis (TB) is an infectious disease caused by the bacillus Mycobacterium tuberculosis. Although the bacteria usually affect the lungs, they can also attack any part of the body such as the kidney, spine, and brain . Tuberculosis that affects the lungs is referred to as pulmonary TB whilst TB affecting other parts of the body is known as extra pulmonary TB. Pulmonary TB is spread by droplet infection when an infected sputum positive infected person sneezes or coughs. The symptoms of TB infection include a cough that lasts 3 weeks or longer, pain in the chest, coughing up blood or sputum (mucus from deep inside the lungs), weakness or fatigue, weight loss, loss of appetite, chills, fever and night sweats [2, 3]
According to the World Health Organisation (WHO) sputum smear microscopy is the widely used methods to diagnose Tuberculosis worldwide. However, this method only detects half the number of TB cases and does not detect drug resistance. On the other hand, the use of the rapid test Xpert which provides results within 2 hours has been on the increase since 2010. This test detects TB and Rifampicin resistance. Currently this test is being recommended by WHO as the initial diagnostic test for all people with signs and symptoms of TB . Tuberculosis is treatable and curable, with active drug susceptible TB treated with a standard 6-month course of 4 antimicrobial medicines. However, adherence is always an issue during treatment and patients require lots of support in terms of information and monitoring .
According to the Global TB Report 2018, TB is still one of the top ten causes of death and is now the leading cause from a single infectious agent, ahead of HIV and AIDS .In addition, an estimated 9.6 million people developed TB and 1.5 million died from the disease in 2014 [2.3].Tuberculosis is a leading killer of people living with HIV resulting in a third of all HIV-related deaths globally .People with HIV are 19 times more likely to develop active TB disease than people without .This is because the combination of HIV and TB is deadly, with each speeding the others progression. In 2018 approximately 251 000 people died of HIV associated TB and 862 000 new cases of TB among HIV positive people were recorded, with 72% of these living in Africa. In 2015 TB was ranked alongside HIV as a leading cause of death [1, 2, 3]. It is estimated that worldwide about 10 million people developed TB in 2017. The majority of these were men (5.8 million) followed by women [3.2] and the remaining 1 million were children. Africa had the largest burden of TB with 281 cases per 100 000 population compared with a global average of 133 cases per 100 000 population .
In Zimbabwe TB is among the top 10 diseases of public health importance and is a leading cause of death among adults. The country had an estimated TB incident rate of 278 per 100 000 population in 2015 . The treatment success rate of 80% in 2015 (2), is still below the global target of 87%. Main challenges faced by the country in TB control are the emergence of drug resistant TB (DR), high TB death rates, high defaulter rates and non-evaluation of treatment outcomes for TB patients [5, 6].
Several treatment adherence interventions for TB exist to support patients. These include the provision of education and counselling on the disease and treatment ; offering a package of treatment adherence intervention for patients on TB treatment in conjunction with the selection of a suitable treatment administration option; material support to patients (for example food, transport, living allowance, housing or financial bonus); psychological support to patients (for example counselling sessions or peer-group support); communication with patients (for example home visit, SMS or phone call); digital medication monitor (a device to measure time between openings of the pill box and/or send SMS or audio reminders) ; staff education (e.g. education, chart or visual reminder, educational tool and desktop aid for decision-making and reminder). In addition, effective treatment options for each patient may be offered and these include community or home-based treatment, over facility-based treatment or unsupervised treatment; treatment administered by trained lay providers or health-care workers and the use of digital health technology such as SMS or phone calls, medication monitors, and video observed treatment – as a replacement for in-person directly observed treatment – when conditions of technology and operation allow .
The World Health Organisation has noted that the potential of information and communication technologies (ICTs) to fight TB remains largely untapped. Many countries are still researching further on how to use eHealth and mHealth effectively in the fight against TB. A lot of work still needs to be done to maximise the impact of these methods for monitoring treatment in people with TB .
The use of mobile phones has increased worldwide over the past decade and this has created opportunities to use mobile phones as intervention tools in health care including in promoting prevention, treatment and adherence monitoring and evaluation [9, 10]. The effectiveness of such client centred applications needs to be known as it will improve client care. A systematic review of the effectiveness of such patient centred applications in TB Care is important to inform future programming for the national TB programme, bringing the focus on interventions that really influence improving TB outcomes. This will result in the effective use of resources by channelling them where there is the greatest impact in terms of reducing morbidity and mortality due to TB in Zimbabwe.
The research question seeks to explore the mobile based applications that are being used in TB care globally and the implications of their use. The systematic review aims to summarize the literature on mobile based applications used in TB care globally, with specific objectives to: Determine the types, the scope, the target users and the effectiveness of the mobile TB applications in TB Care globally.