Background The success rate of tuberculosis (TB) treatment in Malaysia remains below the recommended World Health Organization target of 90% despite the implementation of directly observed therapy, short-course, a physical drug monitoring system, since 1994. With increasing numbers of patients with TB in Malaysia defaulting on treatment, exploring another method to improve TB treatment adherence is vital. The use of gamification and real-time elements via video-observed therapies in mobile apps is one such method expected to induce motivation toward TB treatment adherence. Objective This study aimed to document the process of designing, developing, and validating the gamification, motivation, and real-time elements in the Gamified Real-time Video Observed Therapies (GRVOTS) mobile app. Methods The modified nominal group technique via a panel of 11 experts was used to validate the presence of the gamification and motivation elements inside the app, which were assessed based on the percentage of agreement among the experts. Results The GRVOTS mobile app, which can be used by patients, supervisors, and administrators, was successfully developed. For validation purposes, the gamification and motivation features of the app were validated as they achieved a total mean percentage of agreement of 97.95% (SD 2.51%), which was significantly higher than the minimum agreement score of 70% (P<.001). Further, each component of gamification, motivation, and technology was also rated at 70% or more. Among the gamification elements, fun received the lowest scores, possibly because the nature of serious games does not prioritize the fun element and because the perception of fun varies by personality. The least popular element in motivation was relatedness, as stigma and discrimination hinder interaction features, such as leaderboards and chats, in the mobile app. Conclusions It has been validated that the GRVOTS mobile app contains gamification and motivation elements, which are intended to encourage medication adherence to TB treatment.

BACKGROUND The number of Tuberculosis (TB) patient increases everyday and according to a model projection by (Ismail N. et al.,2013), the observed and projected TB cases in Malaysia, will reach up to 300,000 cases in 2030. In Malaysia, Direct Observed Therapy Short Course (DOTS) has been implemented since 1994 however the treatment success rate still remains at, below the recommended WHO target of 90%. With the increasing trend of TB Defaulter in Malaysia despite DOTS implementation, exploring another method to improve TB treatment adherence is vital. Therefore, the use gamification- reality elements via Video Observed Therapy (VOTS) in the mobile apps is expected to induce motivation toward TB treatment adherence. OBJECTIVE This study aims to document the process of designing, developing, and validating the gamification-motivation-reality element in the GRVOTS mobile apps. METHODS According to the literature review, gamification elements can motivate TB patients. The modified nominal group technique (NGT) via expert panel of 14 people were used to validate the presence of gamification-motivation element inside the apps. The participants of the serial NGT session were divided into three main groups, including the IT expert team, the TB administrator team, and the on-site healthcare worker. They were asked to assess the gamification-motivation element in the apps based on the percentage value of agreement, where a value of more than 70% is interpreted as acceptable and confirming to the element's existence. RESULTS The GRVOTS mobile apps, that can be used by three different users — patients, supervisors, and administrators — was successfully developed. For the validation study purpose, this apps have also been verified as the gamification-motivation features inside it have been rated over 70% through the agreement results via the NGT study. For the gamification element, the fun received the lowest values maybe due to many factors including perception of fun vary by different personalities as well as the nature of serious game which do not prioritize the fun element. As for the motivation factors, the least voted element is relatedness which usually associated with feature of leader boards or chat which is not favoured in this apps as majority our tuberculosis patients refuse to disclose their condition and communicate with other patient due to the stigma associated with the tuberculosis itself. CONCLUSIONS It has been validated that the GRVOTS mobile apps contain a gamification-motivation element, which is intended to encourage medication adherence for DOTS amongst the TB patients

Background: Viral Hepatitis HIV Co-infection is an important and preventable cause of chronic liver disease, and having them lead to many consequences, especially for those living in wrenched conditions. Thus it is a significant health issue in the communities. This study aimed to determine the prevalence of Viral Hepatitis-HIV Co-Infection and determine the associated variables with this Co-Infection. Methods: A cross-sectional study was done using HIV Case Registry ( Anti Retroviral -(ARV) line listing). We included 1274 patients who were seen under the HIV Clinic services, which were screened for Hepatitis B Virus (HBV) and Hepatitis C Virus ( HCV) upon registered to the clinic. Factors associated with the HBV-HIV and HCV-HIV were determined using bivariate, and multivariate logistic regression analysis using SPSS and odds ratio was used as the measures of association. A P-value of less than 0.05 was considered statistically significant for all the tests. Results: From the 1274 number of HIV patients, the prevalence of HBV-HIV is 5.6% (71 cases), while the prevalence with HCV co-infection was 14.8% (189 cases). As for the frequency of multiple HIV-Coinfection, out of 238 HIV cases with Co-Infection, the majority of 167 cases (70.17%) were HCV-HIV Co-Infected followed by 49 cases (20.5%) were HBV-HIV Co-Infected. In comparison, another 22 cases ( 9.24%) were Co-Infected with HBV-HCV-HIV. In the final model of HBV-HIV Co-Infection, only male gender, CD4 count category less than 199 cells/mm3 and primary care type of facilities were associated with the disease whereas, in the HCV-HIV Coinfection, only male gender, Malay race, Intravenous Drug User (IVDU) modes of transmission, and source of the case from high-risk screening program were associated with the disease. Conclusions: Co-Infection with HCV-HIV is more prevalent from HBV-HIV in our study population. A more targeted intervention of HBV revaccination and more frequent screening of HCV post HCV treatment as reinfection is anticipated in high-risk behaviour patient are some of the intervention programs that can be suggested.

Review question / Objective: What is the level of health literacy towards breast cancer screening among the general population? Rationale: Breast cancer is one of the most prevalent cancers that happens in the female population globally. According to World Health Organisation, it is estimated about 2.3 million women diagnosed with breast cancer in the year 2020 globally. From the figure, about 685 000 attributed to death. Unfortunately, there is a certain p o p u l a t i o n t h a t d i ff e r s i n t h e sociodemographic such as minority group, or low socioeconomic status may not be INPLASY 1