Leveraging mHealth for tackling TB in India

Urvashi Prasad, CNS Correspondent, India
India accounts for a large part of the world’s TB burden. As highlighted by Dr Suneetha Narreddy, Infectious Diseases Expert, Apollo Hospitals,  Hyderabad, during a webinar organised by CNS, there are approximately 2.6 million cases of TB annually in India. Unfortunately, nearly 1 million cases are missed every year on account of poor notification, especially from the private sector where 50% of patients are treated, as well as the absence of standardised diagnostic and treatment practices.

Mobile health (mHealth) has the potential to play an important role in improving the quality and efficiency of TB diagnosis and treatment. However, evidence in this area, is limited. During the webinar, Dr Archana Trivedi, Senior Technical Advisor, International Union Against TB and Lung Disease (The Union), presented findings from an mHealth project that was implemented in the predominantly tribal district of Khunti in Jharkhand between April 2012 and February 2015.

As part of this initiative, a mobile health (mHealth) technology based application was developed to help rural health care providers (RHCPs) identify and refer presumptive TB patients to the nearest centre for diagnosis and treatment, by using this special mobile application on their smart phones.

Results from the project revealed that the number of referrals increased significantly as a result of this intervention. Practitioners who used the application referred nine times more presumptive TB cases as compared to those who did not. Moreover, the time taken for initiating diagnosis and treatment was reduced by 8-9 times. Further, the application made it possible to inform providers about referrals in real-time which contributed to the engagement of a large number of providers who had previously not been tapped by the Revised National TB Control Programme (RNTCP). Additionally, the mobile platform was leveraged for dissemination of educational material for increasing awareness among presumptive TB patients and the community about disease symptoms as well as the need for starting treatment promptly. An important operational learning was that while time and resources had to be invested for training the providers, they became proficient soon after the training was completed and the pay off in terms of improving various output and outcome indicators was substantial.

mHealth applications can also be deployed for improving treatment adherence by combining them with incentive mechanisms. The data generated through such applications can be used for encouraging health workers, for instance, to follow-up with patients who have missed doses or have stopped coming to DOTS centres for treatment.

Given the high and increasing penetration of mobile phones in India, mHealth applications have the potential to play an important role in battling the country’s TB challenge. However, it is important that a solid evidence base, pertaining to the effectiveness and acceptability of mHealth interventions for TB, is built. Equally crucial is to scale up and replicate those mHealth projects, that have demonstrated success.

Urvashi Prasad, Citizen News Service - CNS
September 12, 2017