{
  "abstract": "Tuberculosis (TB) treatment requires strict adherence over the long course of treatment. To support adherence, we developed the TB Treatment Support Tools (TB-TST), which combines a urine-based lateral flow assay (LFA) with a mobile application for patient education, support, and communication with treatment supporters. In a pragmatic randomized controlled trial participants uploaded images of the LFA. A blue-purple color change indicates detection of an isoniazid metabolite consistent with recent medication ingestion. This study assessed real-world interpretability and usability of the TB-TST LFA by analyzing the quality and characteristics of user-submitted images. We conducted structured qualitative coding (visual content analysis) of 1,655 submitted test images to identify recurring issues affecting interpretation. Eligible participants were aged 16 or older, newly diagnosed with TB, and had access to a mobile phone. An iteratively developed codebook identified three primary issue categories: 1) color variations in the test or control strip, 2) photo quality issues, and 3) test cartridge/test-strip artifacts. Most (72%) images were consistent with a clear positive (blue-purple) color change or clear negative. Variations that were not clear positives included no color change (white), yellow/orange, and green/teal hues. Blurriness was the most common image quality issue. The most common test artifact was visual evidence consistent with dye bleed/possible cross-strip contamination between the control and the test strips. Despite challenges in image submission and test appearance, relatively few images were difficult to interpret, supporting the feasibility of user-submitted LFA images for monitoring recent isoniazid ingestion. Opportunities to improve performance and usability include enhanced user guidance for image capture, refinement to cartridge design to reduce artifacts, clearer interpretation protocols for atypical color outcomes, and automated image-based reading. Integrating qualitative image analysis with engineering design principles can inform user-centered improvements to home-based LFAs connected to digital adherence technologies.",
  "abstract_shown": true,
  "affiliations": [
    "Engineering Department, Bioengineering Section, Pontificia Universidad Católica del Perú, Lima, Peru",
    "University of Washington, Department of Biobehavioral Nursing and Health Informatics, Seattle, Washington, United States of America",
    "University of Washington, Department of Bioengineering, Seattle, Washington, United States of America",
    "Instituto de Efectividad Clinica y Sanitaria (IECS), Buenos Aires, Argentina"
  ],
  "article_type": "Research Article",
  "arxiv": null,
  "author_total": 10,
  "authors": [
    {
      "affs": [
        0
      ],
      "name": "Kiara Lee"
    },
    {
      "affs": [
        1
      ],
      "name": "Enrique Chen Liang"
    },
    {
      "affs": [
        2
      ],
      "name": "Alejandra Tolentino"
    },
    {
      "affs": [
        3
      ],
      "name": "AuDuyen Trinh"
    },
    {
      "name": "Daniel Leon"
    },
    {
      "name": "Kyle Goodwin"
    },
    {
      "name": "Jennifer Sprecher"
    },
    {
      "name": "Fernando Rubinstein"
    },
    {
      "name": "Barry Lutz"
    },
    {
      "name": "Sarah Iribarren"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/bkv76h86nd62q.bib",
  "cited_by": 0,
  "doi": "10.1371/journal.pgph.0007182",
  "fulltext_url": "https://journals.plos.org/globalpublichealth/article?id=10.1371/journal.pgph.0007182",
  "id": "bkv76h86nd62q",
  "issns": [
    "2767-3375"
  ],
  "landing_url": "https://journals.plos.org/globalpublichealth/article?id=10.1371/journal.pgph.0007182",
  "language": null,
  "licence": "CC-BY-4.0",
  "licence_label": "CC BY 4.0",
  "licence_source": "journal",
  "licence_url": "https://creativecommons.org/licenses/by/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "plos",
      "/Biology and life sciences/Anatomy/Body fluids/Urine"
    ],
    [
      "plos",
      "/Biology and life sciences/Biochemistry/Metabolism/Metabolites"
    ],
    [
      "plos",
      "/Biology and life sciences/Physiology/Body fluids/Urine"
    ],
    [
      "plos",
      "/Medicine and health sciences/Anatomy/Body fluids/Urine"
    ],
    [
      "plos",
      "/Medicine and health sciences/Diagnostic medicine/Virus testing"
    ],
    [
      "plos",
      "/Medicine and health sciences/Medical conditions/Infectious diseases/Bacterial diseases/Tuberculosis"
    ],
    [
      "plos",
      "/Medicine and health sciences/Medical conditions/Tropical diseases/Tuberculosis"
    ],
    [
      "plos",
      "/Medicine and health sciences/Pharmaceutics/Drug therapy"
    ],
    [
      "plos",
      "/Medicine and health sciences/Pharmacology/Drugs/Isoniazid"
    ],
    [
      "plos",
      "/Medicine and health sciences/Pharmacology/Pharmacokinetics/Drug metabolism"
    ],
    [
      "plos",
      "/Research and analysis methods/Imaging techniques/Image analysis"
    ]
  ],
  "openalex": null,
  "pdf_url": "https://journals.plos.org/globalpublichealth/article/file?id=10.1371/journal.pgph.0007182&type=printable",
  "pmcid": null,
  "pmid": null,
  "published": "2026-10-05",
  "publisher": "Public Library of Science",
  "ris": "https://research.draconitic.com/paper/bkv76h86nd62q.ris",
  "sources": [
    {
      "first_seen": "2026-10-30T12:17:37Z",
      "native_id": "10.1371/journal.pgph.0007182",
      "source": "plos",
      "url": "https://journals.plos.org/globalpublichealth/article?id=10.1371/journal.pgph.0007182"
    }
  ],
  "subjects": [
    {
      "field": "medicine",
      "origin": "plos:pharmacology",
      "subfield": "pharmacology-toxicology"
    },
    {
      "field": "medicine",
      "origin": "plos:anatomy",
      "subfield": "physiology"
    }
  ],
  "title": "Evaluating a biochemical TB medication adherence test: Insights from image-based reporting through a patient companion app",
  "title_text": "Evaluating a biochemical TB medication adherence test: Insights from image-based reporting through a patient companion app",
  "type": "peer-reviewed",
  "updated_at": "2026-10-30T12:17:37Z",
  "url": "https://research.draconitic.com/paper/bkv76h86nd62q",
  "venue": "PLOS Global Public Health",
  "versions": []
}