eCompliance: Tuberculosis has a new enemy

eCompliance: Tuberculosis has a new enemy

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Last Update: March 30, 2012

Under the current state of the WHO DOTS program, there is no method to verify the reliability of an institution’s tuberculosis drug adherence. To remedy this, eDOTS uses biometric devices to monitor patients’ drug adherence on a daily basis by digitally logging a patient’s registration at an OpASHA clinic. At the end of each day, every clinic sends its attendance record through SMS to a central server, where the information is synchronized. When a patient fails to register at a DOTS center, a notification is sent to multiple levels of the organization, and a counselor delivers the medicines directly to the patient’s home with supplementary tuberculosis education. Through this system, defaulting patients can be quickly identified and educated about the dangers of drug-resistant tuberculosis

Type: citizen sector

The Problem

OpASHA is eradicating tuberculosis in urban slums. Tuberculosis (TB) was declared a Global Emergency by WHO in 1993. “TB has historically been one of the world’s biggest killers. Nearly one-third of over 11,000 (business leaders from across the world) expect tuberculosis to affect their business in the next five years”, states a recent report of the World Economic Forum. 13 million people suffer from TB worldwide of which 3.5 million are in India. Two Indians die of the disease every three minutes. TB also carries terrible social stigma and 100,000 infected women are abandoned by their families every year, to die of disease and starvation. 300,000 children are forced to leave school (Government of India). For fear of being ostracized, patients do not come forward for treatment and the disease, being highly contagious, spreads rapidly. TB bacteria is mutating and giving rise to Multi-drug resistant (MDR) and Extensively-drug resistance (XDR) forms, which are fatal. A sanatorium in Miami, USA has quarantined over 40 XDR patients. They are CONFINED so they do not infect others. There are many more in developing countries. The world is at the brink of an epidemic of MDR/XDR TB. TB is not only a medical problem. It has serious economic effects. It saps the strength of the patients. The underprivileged in India lose $300 million annually in wages. So those affected find it impossible to pay for medication. The Indian economy loses $3 billion annually (Government of India). Tuberculosis is not just a disease, it is a socio-economic issue, where patients lose jobs and face horrifying discrimination. OpASHA is one of the world’s leading NGOs in TB control. It uses parameters prescribed by the World Health Organization and Government of India to measure its performance. A few additional parameters have also been opted by OpASHA. A complete list follows. 1. Population served 2. Number of patients 3. Average distance of treatment center from the patient’s house 4. Detection rate per 100,000 persons 5. Cure rate 6. Default rate 7. Death rate 8. Cost of treatment of each patient 9. Financial leverage 10. Social Return on Investment

The Solution

Operation ASHA’s eDOTS program enhances the existing DOTS program with reliable and up-to-date biometric data. No other TB control system has proved that it can eliminate drug default, especially in poor areas. In addition, eCompliance only uses “off-the-shelf” components: a fingerprint reader, a notebook computer, and a simple cellphone, making it an easily replicable and cost effective method of fighting drug resistant TB. Each time a patient visits one of OpASHA’s centers, the patient is required to confirm the visit on the terminal’s fingerprint reader. At the end of the day, each terminal will send the attendance log to an online server, where the data is imported into OpASHA’s Electronic Medical Record. Each time a dose is missed, the device sends a text message notifying the counselor, program manager, and office server that a patient follow-up is required within 48 hours. Since the counselor must acquire the patient’s fingerprint during the follow-up, drug default can be reliably prevented. Because the system alerts OpASHA to defaulting patients, tuberculosis consultation is targeted and individualized to the patients who need it the most. Since the records and reports are automatically generated, the system eliminates the chance of human error in data collection (both accidental and purposeful). This digitization has also freed up the time of OpASHA’s counselors, who can reallocate that time to finding new patients and spreading TB awareness.

Example

The primary objective of eCompliance is to completely halt the incidence of drug-resistant tuberculosis. eDOTS uses biometric devices to monitor patients’ drug adherence on a daily basis by digitally logging a patient’s attendance at an OpASHA clinic. At the end of each day, every terminal will send its attendance record through SMS to a central server, where the information is synchronized. When a patient fails to register at a DOTS center, a notification is sent to multiple levels of the organization, and a counselor delivers the medicines directly to the patient’s home with supplementary TB education. As every missed dose is immediately followed with counseling, the adoption of eCompliance can produce near 100% adherence to medications.

Budget: $500,000 - $1 million

Marketplace

OpASHA works like an extension of the government’s Public Health Department in the slums. TB treatment, medications to address side effects, ORS, protein supplements, iron and calcium tablets for pregnant women, and contraceptives for child spacing are all provided to OpASHA by the Public Health Department. The District TB Administration provides office stationary and stock registers for inventory management. District health authorities provide funding for snacks and beverages to participants at Health Awareness Camps organized by OpASHA. These government partnerships mean that external donations are leveraged 5 times; i.e. for every dollar donated to OpASHA, the Government provides medicines, diagnostics and physician’s services worth . The government also provides a grant for each patient treated two years from starting a centre. In this way, each centre becomes self-sustaining within two years. OpASHA also works closely with businesses, NGOs and individual donors. It is also very active in civil society organizations including the National TB Partnership in India.

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