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 improving the percentage of notification of Tuberculosis, particularly in the private sector.
India has 2.6 million TB cases annually and as many as 1 million patients are still missed. However, lack of standardization of TB treatment in the country is a bigger challenge with the treatment being provided by unqualified people to corporate hospitals. More than half the patients receive treatment in the private sector where there is no mechanism for monitoring and follow-up with a high percentage of patients dropping out which results in drug resistance.
Tuberculosis was declared a notified disease in India in May 2012 and the Centre created a specialized web portal—Nikshay—where TB cases are to be mandatorily reported.
A study conducted by Apollo Hospital in Mysore involving 2,500 private practitioners showed that 80 per cent did not diagnose or treat TB. Of those managing the disease, 70 per cent 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.
According to Dr Suneetha Narreddy, an infectious diseases expert from Apollo Hospital said 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 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 SMS regularly 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 MDR Tuberculosis cases. Of the total number of cases, 151 successfully completed treated while treatment in 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 per cent had taken all doses though 6 per cent had missed one or more doses. A feedback from 350 patients suggested that 93 per cent found SMS and IVRS calls useful while 9 per cent wanted reduced frequency of calls and SMS.
Results of another pilot project conducted in Khuntia district in Jharkhand suggested that diagnosis and treatment was four times higher among those patients who used mobile application under the project, according to Dr Archana Trivedi, Senior technical Advisor, The Union South East Asia Office.
The project was conducted in three blocks of Khuntia district covering a population of 45,000. The applications were provided to Rural Health Care Providers, 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 seven 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.