Youth and TB: Harnessing Digital Solutions in Uganda

Tuberculosis, or TB for short, is a serious infectious disease that mainly affects the lungs but can also attack other parts of the body. It spreads through tiny droplets released into the air when a person with active TB coughs or sneezes. Despite being treatable, TB remains a major health issue globally, especially among young people.

In 2022, around 10.6 million people fell ill with TB around the world, with roughly 1.8 million of those being Adolescents and young adults aged 10 to 24. This age group faces unique challenges when it comes to sticking to treatment plans compared to adults and younger children. Often, they are lumped together with other age groups, which makes it hard to create effective Treatments tailored just for them.

#The Situation in Uganda

Uganda is one of the countries with the highest rates of TB. The current rate is about 198 cases for every 100,000 people. Adolescents and young adults aged 15 to 24 account for approximately 13% of TB cases in Uganda. The treatment success rates in different regions can vary widely, ranging from 50% to 85%. A study found that adolescents with TB were twice as likely to drop out of treatment compared to younger children receiving the same care. This is a big deal, especially when considering that many of these young people are also living with HIV, which complicates their treatment even more.

#The Rise of Digital Solutions

There's been a lot of talk about using digital technologies to help manage TB treatment better, and Uganda's National TB Leprosy Program is jumping on the bandwagon. They are looking to use tools like mobile phones to help patients stick to their treatment plans. One promising tool is called 99DOTS.

99DOTS is a system that uses simple mobile phones (not the fancy smartphones) to help patients remember to take their meds and report back when they do. It sends automatic reminders and allows patients to confirm they took their medicine by calling a specified number. Healthcare Workers have a handy app and dashboard to see how well their patients are doing.

After some trials in Uganda showed great results with adults, the program was made available for adolescents in 2021. The goal of the study was to find out what factors play a role in how adolescents decide to participate in the 99DOTS program.

#Who Took Part in the Study?

In total, 410 adolescents with TB were looked at in the study. The average age was 17 years, and most of them were girls. About 20% of these teenagers were also living with HIV, and about 60% had confirmed TB. A significant number had support from someone close to them to help them through the treatment.

During the study, it was found that 73% of the participants signed up for 99DOTS. The older teens (15 to 19 years) were more likely to join the program compared to younger ones (10 to 14 years). Girls were also more likely to join, especially those who had family members supporting them. However, those at higher-level health centers had lower rates of participation compared to those at smaller health centers.

#Looking Deeper: The Interviews

To understand why some adolescents chose to join 99DOTS while others didn’t, researchers interviewed 20 of them. Half of the participants were boys, and most were in the older age group. They also spoke with health workers involved in the program to get their insights.

#What Encouraged Them to Join?

1. Tech-Savvy Teens: Many adolescents were already comfortable with using mobile phones. This made it easier for them to pick up on how to use 99DOTS. The healthcare workers also felt more capable using the system, which made for better communication with the teens.

2. Support from Caregivers: Caregivers played a crucial role. They often provided access to mobile phones and offered encouragement to help adolescents navigate 99DOTS.

3. Desire to Get Better: Many teens expressed a strong motivation to recover from TB. Their determination helped drive them to take part in 99DOTS. One teen said that it encouraged them to remember their treatment was about their life.

4. Appealing Design: Participants found the packaging and design of the 99DOTS system to be attractive. It helped remind them to take their medication while also helping to reduce the fear of being judged by others because of their TB status.

#What Stopped Them from Joining?

1. Limited Literacy: Some younger adolescents faced challenges with reading and understanding the instructions. This made it tough for them to engage with 99DOTS.

2. Decision-Making Issues: Many adolescents didn’t feel they had a say in whether they could join the program because caregivers made the decision for them. One teen expressed regret that their mother didn’t think they could handle 99DOTS, so they didn’t join.

3. Phone Access Issues: Not every teen had their own mobile phone. Some relied on family members for phone access, which often led to missed opportunities to participate properly.

4. Fear of Stigma: Many teens worried about their TB status becoming known. They were concerned that the messages and calls from 99DOTS could be seen by others who didn’t know about their treatment.

5. Healthcare Workers' Workload: Some healthcare providers felt that using 99DOTS added extra work to their tasks, which created some resistance to adopting the system fully.

#What Can Be Done?

The study found several ways to improve the uptake of 99DOTS among adolescents. Firstly, increasing access to mobile phones would help tremendously. Better communication between healthcare providers, adolescents, and caregivers is also essential. The goal is to create shared decision-making opportunities to reduce the concerns around TB stigma.

#The Bigger Picture

The results showed that 99DOTS had a high uptake among adolescents with TB who joined the program. While this is promising, it also highlighted that young people still need more tailored support. The study emphasized the need for effective communication strategies that address stigma and encourage active participation from both adolescents and their caregivers.

By focusing on these areas, healthcare providers can help ensure that young people receive the treatment they need in a way that feels comfortable and supportive. In a world where technology plays such a significant role in our daily lives, finding ways to make it work for health can be a game changer.

#Conclusion

The journey to addressing TB, especially among adolescents, is complicated. Digital solutions like 99DOTS offer a glimpse of hope, but they also shine a light on the barriers young people face. By listening to their experiences and finding ways to work together with caregivers and healthcare workers, we can pave the way for a future where no adolescent feels alone in their fight against TB. After all, if we can send messages to remind someone to take their medication, we’re one step closer to eradicating this disease. And who wouldn’t want to cheer on young people taking charge of their health in a world ruled by smartphones?