USING ICT TO CURE TB by FRANCIS OKOYE

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 ICT to cure TB.

MHealth apps

The new technology being applied is called M Health, and in a webinar titled ‘can M Health help accelerate progress towards ending TB?, hosted by citizens new service, for the media, experts explain how the new technology is being applied in India, to cure TB in the rural communities.

Mobile health (M Health) is being used in different ways by TB programmes in some high burden countries. A recent studies published in June 2017shows that presumptive TB case referral by healthcare providers using M Health went up manifold.
According to Ashok Ramasarup, one of the moderators of the webinar and international award winning journalist based in South Africa ‘TB services are not reaching every person with TB, with M Health every person gets treated and the target to end TB by 2030 can be achieved.
M HEALTH IN PRIVATE SECTOR
Dr. Sunneetha Narreddy, a U.S.A trained doctor and senior infectious disease expert at Apollo Hospitals, Hyderbad, India reveals that they are 2.6 million incidence of TB in India, with 1 million TB cases missed. 50% of the TB cases are treated by private sector. The private sectors experience the following:
1. Lack of standard diagnosis and treatment practice
2. Poor notification
3. No mechanism for treatment adherence
These results in incomplete and irregular treatment, promoting DR-TB, catastrophic experience and mortality.
According to Dr. Narredy, TB was declared a notifiable disease in May 2012. In, India, of the 2500 private sector health establishment checked, 80% stated they did not diagnosis with notification of TB, of those managing TB-70% not aware of TB being notifiable, of those aware, 95% not know the mechanism for notification, 30% of patients lost to follow up – no mechanism for treatment adherence.
To help solve some of this problems (the union and partners) started a strategy to engage corporate hospitals using innovative approach. Notification and treatment adherence to update knowledge of physicians on diagnosis and management of TB and DR-TB, notify TB patients, ensure adherence and favourable outcome, developed a web based software.
The web based software registers, tracks and monitor TB patients, gives them reminder for taking medication, follow up visits and tests. It was pilot tested with Apollo Hospital India.
How it works? Patient hospital information system record when patient is diagnosed and started on treatment. Notification system takes over; social workers look at the records, sms reminder sent to patients daily to take medication, IVR call to patient also. If patient is not taking medication, partially or fully, the social worker is then notified who in turn contact the patient.
The application is built to register, track and monitor. It notify diagnosis of TB patients in private sector. It has in built features that help admin and consultant register patients. Initiates automatic calls, message and IVRS for reminder, views various medical reports.
The use of the application from June 2015 – March 2017 showed that 500 TB patients were registered and notified. 117 pulmonary and 373 extra pulmonary. The uniqueness and benefits:
1. Make notification convenient
2. Remind and track patients to follow up visits
3. Monitor outcome in private sector
4. Data analysis for policy and planning
The company that helped create the software is www.kavinsoft.com/tbunion
HEALTH USE IN RURAL COMMUNITIES
A pilot study from tribal district in India titled “Does M Health aid to increase referrals, early diagnosis and treatment initiation of TB patients?. This was carried out by Dr. Archana Trevedi Snr Technical Adviser of International Union against Tuberculosis and Lung Disease. South-East Asia Office.
According to Dr. Trevedi, Rural Healthcare Providers (RHCPs) are mostly often first point of contact for curative services in remote areas with limited public healthcare services.
RHCPs envisage a community of health workers at village level, mobile, qualifications not health related. The mobile application used for study was developed in collaboration with Dimagi, and easily customized. It was piloted in three blocks of a tribal district (Khunti) population 45, 000. It tracks referrals and follow up for diagnosis and treatment of tuberculosis efficiently and creates real time central date base.
They have two interoperable module
1. Module for RHCPs and NGOs Supervisors, includes
– Referral form for chest symptomatic
– Video with counseling messages
– If patients does not reach center within 7 days for test, patient NGOs and RHCPs receives SMS with patient information for follow up
– Basic DOTS protocol support.

2. Module for lab techs
– Records sputum exam result at designated microscopy center
– 25 RHCPs are referred through mobile and 69 through non mobile
– 3 lab techs using the application
It is used to create interface between non qualified health care providers in private hospitals
The study done in June 2013 – Sept 2016 among 1302 presumptive TB patients using interactive arm and 717 using control arm. The result showed that M Health increases referrals, early diagnosis and treatment initiative of TB, create real time data base, facilitate compilation and analysis of data. The first of its kind, which shows that M health can be used when rural use of apps is applicable in rural communities.
The webinar co-moderator was Shobha Shukla, CNS Managing Editor