Conversational mHealth Platform Designed to Support Tuberculosis Treatment Adherence in Low-Income South African Patients: Pilot Cohort Study

Background: Tuberculosis is a leading cause of death in South Africa, with poor adherence undermining treatment success. Findings from recent research on the impact of mHealth (mobile health) interventions on tuberculosis treatment outcomes show promise, yet many interventions remain untested in African contexts. Rising smartphone ownership in South Africa enables more complex mHealth interventions, offering an opportunity to deploy behavioral tools within high-burden, resource-constrained settings. Objective: This pilot study evaluates the feasibility and effectiveness, among low-income patients at a South African clinic, of a WhatsApp (Meta)-based conversational mHealth platform designed to tackle specific behavioral barriers to adherence. Aims include the following: (1) evaluating coverage by studying the proportion of patients within the target group who own smartphones, (2) describing patterns of engagement with the platform and the role of mobile data scarcity as a barrier to use, and (3) producing evidence on the impact that a behavioral mHealth intervention can have on tuberculosis treatment success. Methods: Patients newly diagnosed with drug-susceptible pulmonary tuberculosis between August 2022 and October 2023 completed a screening survey. Those owning compatible mobile phones were invited to enroll. The platform provided reminders alongside behavioral support features. Coverage was studied by estimating smartphone ownership among screened patients and comparing characteristics between enrolled patients (n=42) and those receiving standard care (n=102) using standardized differences. Engagement was analyzed using local polynomial regressions for usage trends and logistic regressions to estimate the impact of mobile data top-ups. The marginal effect of enrollment on the probability of successfully completing tuberculosis treatment was studied using a test and logistic regressions with and without covariates. Results: A total of 34% (49/146) of screened participants owned a phone that could use WhatsApp. There were differences in characteristics by enrollment status. Further, 50% of patients engaged with the platform each day until the end of treatment. Overcoming an initial inability to send unprompted messages to inactive patients was associated with an immediate 13-percentage-point increase in aggregate engagement the following month. Mobile data scarcity hindered use—receiving mobile data top-ups within the previous week was associated with a 3.37-percentage-point increase (95% CI 0.0007 to 0.0666) in platform engagement. The estimated marginal effect of enrollment was a 17.6-percentage-point (95% CI 0.003 to 0.348) increase in treatment completion, becoming attenuated after adjusting for patient characteristics (12.8 percentage points, 95% CI −0.048 to 0.304). Conclusions: While phone ownership and mobile data constraints represent barriers to feasibility, findings suggest that smartphone-based mHealth interventions may aid successful treatment completion—alleviating health system burdens by automating care for less vulnerable patients. Engagement with the platform throughout tuberculosis treatment was high and stable, and enrolled users experienced a higher success rate. A randomized controlled trial is required for impact evaluation.
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Virtual Patients Will Train Future Mental Health Clinicians

Researchers from the University of Pennsylvania and New York University have received a $4 million grant from the Wellcome Trust to develop an AI-driven platform to train mental health clinicians using simulations of real patients. 

Within the next two years, the partners will work on the development of the STELLAR platform, which stands for Steering-Vector Enhanced LLM Agents for Realistic Digital Twins in Mental Health. The platform will create digital twins of patients that trainees can use to practice conducting clinical interviews and evaluating psychiatric symptoms. 

“STELLAR brings together behavioral data, clinical expertise, and AI to ask a very practical question,” said Sharath Chandra Guntuku, PhD, associate professor of computer and information science at Penn Engineering. “Can we build training tools that better prepare clinicians for how varied and complex patients are?”

Preparing future mental health clinicians for clinical interviews can be challenging as patients will often report overlapping symptoms that shift over time and subjective experiences that can be expressed differently by each individual. STELLAR will give trainees an ethical option for trainees to simulate interviewing patients with a broad range of symptoms, backgrounds, and clinical scenarios.

“In psychiatry, the details of symptom experience matter: how someone describes distress, how symptoms overlap, how severity changes over time, and how context shapes the clinical interaction,” said Raquel E. Gur, MD, PhD, professor of psychiatry, neurology, and radiology at Penn’s Perelman School of Medicine.

Patient simulations will be created drawing from clinical data from the Philadelphia Neurodevelopmental Cohort, a repository including psychiatric assessments and clinical interviews from thousands of young people created by Penn Medicine and the Children’s Hospital of Philadelphia. Rather than copying individual patients, the simulations will create composites based on real-world data for clinicians to practice realistic conversations in the context of a clinical interview. 

This will allow trainers to precisely control the symptoms students encounter, their intensity, and how they interact with each other. For instance, a trainee may practice interviewing a patient with mild anxiety and another whose anxiety overlaps with depression or psychosis to learn how to distinguish the differences in presentation between both.

Because many mental health symptoms manifest beyond formal clinical settings, the platform will also be trained using data from social media platforms, where people discuss mental health symptoms in everyday language.

“Patient simulations will only be useful for clinician training if they are grounded in real clinical speech and evaluated as clinical interactions, not just plausible AI dialogue,” said Neville Ryant, PhD, researcher at Penn’s Linguistic Data Consortium. “[Our] role is to bring speech and language science into the core of the project: adapting speech-recognition tools to clinical interviews, creating high-quality transcripts and annotations, and helping evaluate both what the simulations say and how they say it. That includes assessing the language generated by the models, the naturalness of synthetic voices, how well those voices reflect target speech patterns, and the behavior of the avatar during real trainee interactions.”

To ensure the conversations are realistic, respectful, and useful to trainees, the team will involve people with lived experience of mental health conditions as well as family members and caregivers to provide their perspective into the evaluation process. Their feedback will help researchers assess the accuracy of simulations, avoid stereotyping patients, and prepare trainees for complex and nuanced clinical conversations with real patients. 

“The promise of this approach is that we can move beyond stylized and potentially biased simulations,” said João Sedoc, PhD, assistant professor of technology, operations and statistics at NYU’s Stern School of Business. “If we can create digital patients that simulate controllable plausible symptom expression and responsibly evaluate, we can augment current clinician training practices with the kinds of conversations that are essential to better mental health care.”

The post Virtual Patients Will Train Future Mental Health Clinicians appeared first on Inside Precision Medicine.

STAT+: White House reviewing top contenders to lead FDA

WASHINGTON — The top contenders to lead the Food and Drug Administration have been sent to the White House for a final review and decision, according to a person familiar with the process.

The finalists include Heidi Overton, a White House adviser; Jeffrey Vacirca, an oncologist and health system executive; and Stephen Ferrara, a health affairs official at the Defense Department.

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STAT+: Mass General Brigham, nurses called to talk at State House amid biggest nursing strike in Mass.

BOSTON — Governor Maura Healey has summoned the state’s largest health system and its striking nurses to the State House on Wednesday in an attempt to broker a new contract, according to the Massachusetts Nurses Association.

The calling of the late-afternoon meeting came hours after a boisterous start to Massachusetts’ biggest-ever nurses strike, and the first at Brigham and Women’s Hospital. Mayor Michelle Wu also helped arrange the meeting, the union said.

Thousands of Brigham nurses and supporters poured onto Francis Street near the hospital starting at 7 a.m., shaking cowbells, banging on plastic buckets and cheering at a deafening chorus of supportive honks from passing cars. The nurses, sporting “Union Strong” and “Brigham Nurses United” shirts, waved signs calling out management. “Value Nurses Like You Value Your Bonu$e$,” one sign read.

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Opinion: The AI licensure debate is missing the point of licensure

A cardiologist reviews an echocardiogram flagged by an algorithm she did not choose, trained on data she has never seen, deployed by a health system that did not ask for her input. The algorithm recommends a diagnosis. She disagrees. She overrides it. The patient does well.

No one will remember this moment. But if she had acquiesced and the patient suffered harm, she would be the one in the deposition, with her license on the line. Not the engineer who built the algorithm. Not the vendor who sold it. Not the health system that deployed it.

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