Using ICT to end TB

Francis Okoye, CNS Correspondent, Nigeria
Photo credit: Ashok Ramsarup
As the world advances, new idea and technologies are taking root in all fields, especially in the medical field. This brings us to the idea of using information and communication technologies to help control TB. The new technology being applied is called mobile health or mHealth, and in a webinar titled ‘Can mHealth help accelerate progress towards ending TB?’ hosted by CNS, experts explained how the new technology is being applied in India in the rural as well as urban areas. Mobile health technology is being used in different ways by TB programs in some high burden countries.

A recent study published in June 2017 shows that presumptive TB case referral by healthcare providers using mHealth technology went up manifold.

M HEALTH IN PRIVATE SECTOR

Dr Sunneetha Narreddy, senior infectious diseases expert at Apollo Hospitals, Hyderabad, India revealed that 50% of the 2.6 million TB cases in India seek treatment in the private sector, even though India’s public healthcare system provides free TB treatment. However, this sector suffers from lack of standard diagnosis and treatment practices, poor mechanism for treatment adherence and poor notification. All this results in incomplete and irregular treatment abetting multi drug resistant TB (MDR-TB), besides resulting in catastrophic costs to the patients.

TB was declared a notifiable disease in India in May 2012. However, of the 2500 private doctors who participated in a study done in Mysore, 80% stated they did not diagnose or treat TB, 70% were not aware that TB was notifiable, of those aware, 95% not know the mechanism for notification.

MHealth use in the private sector

To help solve some of these problems the International Union Against Tuberculosis and Lung Disease (The Union), with help from partners, started a strategy to engage corporate hospitals to update knowledge of physicians on diagnosis and management of TB and MDR-TB, improve TB notification, ensure adherence and favourable outcome, through the use of a web based software.

This mobile based web technology tracks and monitors TB patients, reminds them to take their medication, amongst other things. It was pilot tested with Apollo Hospitals India. Dr Narreddy gave a comprehensive view of this innovative application.

The hospital’s information system records when the patient is diagnosed and started on treatment, the case is notified, SMS reminders are sent to patients daily to take medication, IVR calls are also made to them. If the patient is not taking medication (or not responding) partially or fully, the social worker is then notified, who in turn contacts the patient.

Thus, this application registers, notifies, tracks and monitors TB patients. It has in built features that help the hospital administration to register patients. Initiate automatic calls, messages and IVRS for reminders, and views the medical reports/records of the patient.

All this can help the private sector to make TB case notifications convenient, remind and track patients for follow up visits, and monitor the outcomes. It also helps in data analysis for policy and planning.

MHealth use in the rural areas
 
Dr. Archana Trivedi
, from the Union’s South-East Asia Office, presented the results of a pilot that demonstrates the effectiveness of mHealth to increase real time referrals, early diagnosis and treatment initiation of TB patients in remote areas.

According to Dr. Trivedi, Rural Healthcare Providers (RHCPs) are mostly often first point of contact for curative services in remote areas with limited public healthcare services. In these areas, identifying and ensuring testing of presumptive TB patients is a constraint; front line workers often lack information about referred chest symptomatic cases; paper based referral mechanism is used; and validating referrals is resource intensive, time consuming & difficult.

The mobile application used for the study was piloted in three blocks of the tribal district (Khunti) covering a population of 45, 000. It tracked referrals and follow ups for diagnosis and treatment of TB efficiently and created real time central database. The application comprised two interoperable modules: (i)Module for the RHCPs and NGO supervisors includes referral forms for chest symptomatic, video with counselling messages and basic DOTS protocol support. Also, if the patient does not reach centre within 7 days for test, an SMS is sent to the patient, NGOs and RHCPs with patient information for follow up; and the
(ii) Module for lab technician records sputum examination result at the designated microscopy centre.

This first of its kind study done during June 2013 – Sept 2016 demonstrated that
  • mHealth increases referrals, early diagnosis & treatment initiation of TB patients.
  • Creates a real-time central database which helps in retrieval.
  • Facilitates compilation and analysis of data.
  • First of its kind app for RHCPs to facilitate identification, referral of presumptive TB patients and track them to ensure testing, link those diagnosed to treatment service
  • mHealth can be used in tribal areas where use of apps is considered to be low.

Francis Okoye, Citizen News Service - CNS
September 14, 2017

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