{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T13:50:46Z","timestamp":1791381046834,"version":"4.3.3"},"reference-count":33,"publisher":"BMJ","issue":"6","license":[{"start":{"date-parts":[[2025,6,6]],"date-time":"2025-06-06T00:00:00Z","timestamp":1749168000000},"content-version":"unspecified","delay-in-days":5,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Glob Health"],"accepted":{"date-parts":[[2025,5,14]]},"published-print":{"date-parts":[[2025,6]]},"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Treatment compliance is considered significant for curing tuberculosis (TB). Digital adherence technologies (DATs) have been recommended for improving treatment compliance and outcomes of patients with TB. Whereas the effectiveness of DATs on TB treatment remains indefinite, we estimated whether a mobile application has an effect on treatment adherence and outcomes among patients with TB in an urban area in China.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We conducted a multicentre, two-arm, open-label, equivalent, stratified block randomisation trial from 7 districts involving 4670 eligible new patients with TB in Shanghai, China. Patients in the intervention group were instructed to get access to the app through WeChat. In the control group, patients were treated with standard of care. The primary outcome of this study was a composite outcome, which included death, treatment failure, loss to follow-up and relapse. The secondary outcomes were mainly described as overall poor treatment adherence and monthly poor treatment adherence. A generalised estimating equation is used to estimate the correlation between the two groups\u2019 outcomes after adjusting for concomitant variables.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Between 1 March 2021 and 31 December 2022, 741 patients (371 in the intervention group and 370 in the control group) were included in the intention-to-treat population, 430 (58%) were male and the median age was 33 years (IQR 27\u201349). 80 (22%) patients in the intervention group and 104 (28%) patients in the control group had a primary composite outcome event. The adjusted risk difference for the intervention versus control was \u22127.04\u2009percentage points (95% CI \u221213.25 to \u22121.14, p=0.025); secondary outcome included overall poor treatment adherence with an adjusted risk difference \u221216.39\u2009percentage points (95%\u2009CI \u221222.13 to \u22129.62, p&lt;0.001).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>The mobile health application improved TB treatment adherence and outcomes significantly, especially for loss to follow-up. Future research should be focused on implementation problems in various settings and the improvement of patient-centred management strategies.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Trial registration number<\/jats:title>\n                    <jats:p>ChiCTR2000037575.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjgh-2024-018022","type":"journal-article","created":{"date-parts":[[2025,6,6]],"date-time":"2025-06-06T04:25:14Z","timestamp":1749183914000},"page":"e018022","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":9,"title":["Effectiveness of a mobile health application on treatment outcomes among patients with tuberculosis in Shanghai, China: a multicentre randomised controlled trial"],"prefix":"10.1136","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0009-0001-2399-3514","authenticated-orcid":false,"given":"Nan","family":"Qin","sequence":"first","affiliation":[{"name":"Shanghai Municipal Center for Disease Control and Prevention, Shanghai, China"},{"name":"Shanghai Academy of Preventive Medicine, Shanghai, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jing","family":"Chen","sequence":"additional","affiliation":[{"name":"Shanghai Municipal Center for Disease Control and Prevention, Shanghai, China"},{"name":"Shanghai Academy of Preventive Medicine, Shanghai, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lili","family":"Chen","sequence":"additional","affiliation":[{"name":"Shanghai Pudong New Area Center for Disease Control and Prevention, Shanghai, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Weihong","family":"Hu","sequence":"additional","affiliation":[{"name":"Shanghai Baoshan District Center for Disease Control and Prevention, Shanghai, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yan","family":"Feng","sequence":"additional","affiliation":[{"name":"Shanghai Jiading District Center for Disease Control and Prevention, Shanghai, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chunhua","family":"Xu","sequence":"additional","affiliation":[{"name":"Shanghai Fengxian District Center for Disease Control and Prevention, Shanghai, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Huaiqing","family":"Zhang","sequence":"additional","affiliation":[{"name":"Shanghai Jing'an District Center for Disease Control and Prevention, Shanghai, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yun","family":"Hou","sequence":"additional","affiliation":[{"name":"Shanghai Yangpu District Center for Disease Control and Prevention, Shanghai, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lihong","family":"Tang","sequence":"additional","affiliation":[{"name":"Shanghai Minhang District Center for Disease Control and Prevention, Shanghai, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xin","family":"Shen","sequence":"additional","affiliation":[{"name":"Shanghai Municipal Center for Disease Control and Prevention, Shanghai, China"},{"name":"Shanghai Academy of Preventive Medicine, Shanghai, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zheyuan","family":"Wu","sequence":"additional","affiliation":[{"name":"Shanghai Municipal Center for Disease Control and Prevention, Shanghai, China"},{"name":"Shanghai Academy of Preventive Medicine, Shanghai, China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2025,6,6]]},"reference":[{"key":"2025072914475377000_10.6.e018022.1","unstructured":"Global tuberculosis report 2023. 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Handbook for the use of digital technologies to support tuberculosis medication adherence. 2017."},{"key":"2025072914475377000_10.6.e018022.10","doi-asserted-by":"crossref","first-page":"197","DOI":"10.1146\/annurev-pharmtox-041921-074800","article-title":"Emerging Therapeutics, Technologies, and Drug Development Strategies to Address Patient Nonadherence and Improve Tuberculosis Treatment","volume":"62","author":"Garcia-Cremades","year":"2022","journal-title":"Annu Rev Pharmacol Toxicol"},{"key":"2025072914475377000_10.6.e018022.11","doi-asserted-by":"crossref","DOI":"10.1136\/bmjgh-2018-001018","article-title":"Digital adherence technologies for the management of tuberculosis therapy: mapping the landscape and research priorities","volume":"3","author":"Subbaraman","year":"2018","journal-title":"BMJ Glob Health"},{"key":"2025072914475377000_10.6.e018022.12","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pmed.1002595","article-title":"Adherence interventions and outcomes of tuberculosis treatment: A systematic review and meta-analysis of trials and observational studies","volume":"15","author":"Alipanah","year":"2018","journal-title":"PLoS Med"},{"key":"2025072914475377000_10.6.e018022.13","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pmed.1001876","article-title":"Effectiveness of Electronic Reminders to Improve Medication Adherence in Tuberculosis Patients: A Cluster-Randomised Trial","volume":"12","author":"Liu","year":"2015","journal-title":"PLoS Med"},{"key":"2025072914475377000_10.6.e018022.14","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pmed.1003628","article-title":"Digital adherence technology for tuberculosis treatment supervision: A stepped-wedge cluster-randomized trial in Uganda","volume":"18","author":"Cattamanchi","year":"2021","journal-title":"PLoS Med"},{"key":"2025072914475377000_10.6.e018022.15","doi-asserted-by":"crossref","DOI":"10.1183\/13993003.00493-2020","article-title":"Video-observed therapy and medication adherence for tuberculosis patients: randomised controlled trial in Moldova","volume":"56","author":"Ravenscroft","year":"2020","journal-title":"Eur Respir J"},{"key":"2025072914475377000_10.6.e018022.16","doi-asserted-by":"crossref","first-page":"913","DOI":"10.1016\/S0140-6736(23)02270-5","article-title":"Effectiveness of a comprehensive package based on electronic medication monitors at improving treatment outcomes among tuberculosis patients in Tibet: a multicentre randomised controlled trial","volume":"403","author":"Wei","year":"2024","journal-title":"The Lancet"},{"key":"2025072914475377000_10.6.e018022.17","doi-asserted-by":"crossref","first-page":"e693","DOI":"10.1016\/S2214-109X(23)00068-2","article-title":"Digital adherence technologies to improve tuberculosis treatment outcomes in China: a cluster-randomised superiority trial","volume":"11","author":"Liu","year":"2023","journal-title":"Lancet Glob Health"},{"key":"2025072914475377000_10.6.e018022.18","doi-asserted-by":"crossref","DOI":"10.3389\/fpubh.2023.923319","article-title":"Effect of mobile health reminders on tuberculosis treatment outcomes in Shanghai, China: A prospective cohort study","volume":"11","author":"Wu","year":"2023","journal-title":"Front Public Health"},{"key":"2025072914475377000_10.6.e018022.19","unstructured":"Organization WH . Definitions and reporting framework for tuberculosis\u20142013 revision. 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