m-Health helping in TB control

Babs Verblackt, CNS Special Correspondent
Photo credit: Babs Verblackt/CNS
Getting diagnosed, getting treatment and adherence to treatment are all well known challenges in TB care and control. In this age of information technology, mobile phone devices around the world are being used to help address these challenges. From SMS alerts for patients to fully integrated systems, the possibilities for incorporating m-Health in TB treatment, care and control seem endless, as several presentations at the 45th Union World Conference on Lung Health in Barcelona showed.

From Ukraine to Nigeria and from South Africa to Cambodia, mobile phone devices are increasingly being used to serve TB patients, healthcare workers and communities. Whether taking the first small steps or heading for bold new moves, those involved are confident that mobile technology has an important role to play in the fight against TB.

Linkage to treatment
Lynsey Isherwood
Photo credit: Babs V/CNS
South Africa is using this technology to get more people with multi-drug resistant TB (MDR-TB) into treatment. "Using surrogate data from our GeneXpert results, approximately 30-40% of those diagnosed with MDR-TB get linkage to proper care. However going forward, m-Health solutions will provide one way of measuring time to treatment access," said Lynsey Isherwood, National m-Health Programme Manager at the National Priority Programmes Unit of the National Health Laboratory Service in Johannesburg.

"We want to address this issue with mobile health initiatives at all levels. From rudimentary SMS to advanced monitoring apps on all mobile platforms. The primary aim is to link newly diagnosed MDR-TB patients to the first pill swallowed within five days of diagnosis," Isherwood told Citizen News Service (CNS).

Simple interventions
She told CNS about the use of SMS bi-directional printers in health care facilities as an example of a 'simple intervention'. As soon as the TB status of a patient is flagged in laboratories, it prints out in the clinic, so that healthcare workers are immediately aware that the patient has been diagnosed. "And if the result gets lost somehow, a nurse can scan the barcode of the requisition to receive the results again within seconds."

South Africa is working on implementing m-Health along the whole pathway, connecting doctors, nurses, TB coordinators and field workers. They will all get notified on results and steps in treatment at the same time. A pilot project testing a treatment initiation app will start next month in Guateng province, in partnership with the Guateng Department of Health and the Center of Disease Control. Another national m-Health project on a monitoring and evaluation tool, funded by the Global Fund and in partnership with the National Department of Health, Johns Hopkins University and Jhpiego, will start in early 2015.

With mobile devices being widely used in the country, the projects have the potential to be integrated into care for HIV, diabetes and other diseases. "Once you have m-Health in place, it is definitely not limited to one disease," Isherwood stressed. The use of mobile devices in health care is expected to change and save lives. South Africa aims to raise the number of people who get proper treatment after being diagnosed with MDR-TB from the current 30% to 75% by March 2016.

Patient empowerment
m-Health can be used for patient empowerment too. "It is a patient's right to ask questions. The better informed they are, the more questions they can ask. We plan to provide better health education, hopefully with an interactive SMS system for patients and apps for health care workers," Isherwood said. 

Concerns on patients' rights and ownership of data, are well covered in South Africa. "The government drafted a paper, which outlines in detail issues like patient confidentiality and data storage," Isherwood explained. "When implementing programmes one should of course always be careful on the legal side of it all. Everyone should take their responsibility in these issues; that is the only way to go."

Icing on the cake
Shelly Batra, Op.ASHA
Photo credit: Babs V/CNS
"Technology is like icing on the cake," says Shelly Batra, co-founder and president of Operation ASHA, a NGO in TB treatment and prevention. "It should add to programmes with a solid base. It can not just be dumped on people."

Operation ASHA aims to use m-Health in finding missing cases in TB detection. Worldwide 3.3 million TB patients go undetected, undiagnosed and untreated for many reasons. People living in hard to reach areas, hiding in homes, isolated by fear and stigma of the disease, being unable to afford transportation costs to the clinic, not being educated on TB—all make it difficult for them to access diagnosis and treatment, Batra said.

No more passivity
Early this year an app to increase case detection in Cambodia was introduced. After receiving training, local community members visit families door to door, using a simple tablet to ask basic questions on TB symptoms and educate the community. If any symptom is present, the app directs them to the next steps to be taken.

"At the click of a button the possibilities of each next step are shown," Batra said, adding that after just a few months of implementation the results are already promising. "Not only did the app improve diagnosis, providers also spent more time on and paid better attention to each person screened, with a higher quality of screening. There is no more passivity. We are going and meet the patients, bring them back in the TB system."

it is clear that m-Health is concurring the world to get ready to hold the future of TB care in your hands, literally.

Babs Verblackt, Citizen News Service - CNS
1 November 2014
(The author is reporting for Citizen News Service (CNS) from the 45th Union World Conference on Lung Health in Barcelona, Spain, with support from the Global Alliance of TB Drug Development (TB Alliance). Email: babs@citizen-news.org)

No comments:

Post a Comment