To succeed, mHealth tools must account for evolving patient-provider dynamics, system constraints, and unintended consequences.

We propose a framework to guide more adaptive, relational, and user-responsive mHealth design, moving beyond pilots to lasting impact.

But when its functional limitations became clear, users shifted back to familiar channels like Zalo. The result: high acceptability, but low sustained use. This paradox reveals how symbolic meaning, not just functionality, shapes digital health engagement.

Our qualitative study, part of the V-SMART trial in Vietnam, explored why usage of an MDR-TB app for adverse event reporting declined over time.

Initially, patients embraced the app for its social value, a symbol of good care and trusted connection with healthcare workers.

🔍 Bottom line: We need more sensitive tools upfront in TB screening to detect and treat TB earlier, prevent spread, and move closer to ending TB.

This suggests symptoms are not reliable for early TB detection. Yet most TB programs still rely on them to decide who gets tested. Our findings show this approach misses many cases, including people who can still transmit TB, fueling ongoing spread and making it harder to end TB.

In a community screening study in Ca Mau, Vietnam, nearly 65% of people with confirmed tuberculosis reported no symptoms before diagnosis, yet more than 2/3 of those reported "symptomatic" shortly after learning their diagnosis (median time: 7 days).

🔥 Conference Registration:
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Deadline for Registration: November 15, 2025

🔥 Call for Contributed Talks & Poster Presentations:
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Deadline: June 30, 2025

🔥Call for Invited Session Proposals: docs.google.com/forms/d/1428...

Deadline: June 30, 2025

Congratulations Alvaro! I am looking forward to continue collaborating with you on this exciting work.