Technology can help improve TB management: Experts

Aarti Dhar, CNS Correspondent, India
[First published in the India Saga
Simple technology, such as basic mobile phones, can help in improving TB management, experts suggest. At least two pilots, conducted in India, have shown increased adherence to treatment regimen and improved the notification of the disease, particularly in the private sector.

India has 2.6 million TB cases annually and as many as 1 million patients are still missed by the public health system. More than half the TB patients receive treatment in the private sector——ranging from unqualified doctors to corporate hospitals. The absence of standardization of TB treatment in the private sector, with no mechanism for monitoring and follow-up, there is a high percentage of patients dropping out of treatment, which is one of factors leading to drug resistance.

TB was declared a notified disease in India in May 2012 and the government created a specialized web portal—Nikshay—where TB cases are to be mandatorily reported. However, Dr Suneetha Narreddy, Senior infectious diseases expert at Apollo Hospitals Hyderabad, said that a study conducted in Mysore involving 2,500 private practitioners showed that 80% did not diagnose or treat TB. Of those managing the disease, 70% were not aware that TB was notifiable while those aware did not know the mechanism of notifying the disease and took shelter under the provision of privacy of patients in not notifying the disease as it identified the patients.

Dr Narreddy, shared that they had launched a pilot project wherein they engaged with private practitioners to upgrade their knowledge on diagnosis, including notification, of TB and management of TB and drug resistant TB.

Apollo Hospital created a software, which was connected with Nikshay and the TB patients who came to the hospital for treatment. Details and data of all TB patients was fed into the software which automatically went to the Nikshay site. The hospital also sent out regular SMS to the patients, reminding them of the medication, and IVRS calls twice a week to ensure that they stuck to the regimen. If there were some drop outs, they were contacted by the social worker and counseled about the importance of adhering to the regimen.

During June 2015 and March 2017, 500 cases of TB were notified with Nikshay. These included 17 multi drug resistant TB (MDR-TB) cases. Of the total number of cases, 151 successfully completed treated, treatment is going on in 203 patients, while 80 have shifted to other hospitals in the outskirts (Apollo is a tertiary care facility). Unfortunately, 11 stopped treatment, 27 died and 22 are not traceable.

Dr Narreddy said 94% had taken all doses though 6% had missed one or more doses. A feedback from 350 patients suggested that 93% found SMS and IVRS calls useful while 9% wanted reduced frequency of calls and SMS.

Results of another pilot project conducted in three blocks of the tribal district Khunti in Jharkhand, covering a population of 45,000, suggested that diagnosis and treatment of TB was four times higher among those patients who used mobile application under the project, according to Dr Archana Trivedi, Senior Technical Advisor at the South East Asia Office of the International Union Against Tuberculosis and Lung Disease.

The mobile based application was provided to rural health care providers (RHCPs), NGOs and laboratory technicians to manage patient information and counseling.

The RHCP feed the patient details into the mobile as soon as they came for testing. Once testing was done, the results of the test were sent by the lab technician to the patient as well as the RHCP. If the patient did not turn up for treatment within 7 days after the test report was provided, the RHCP would contact the patient and counsel him/her to come for treatment as well as the importance of sticking to the regimen.

Aarti Dhar, Citizen News Service - CNS
September 11, 2017

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