Last week, as the global health community recognized World TB Day, we were combing through CHMI’s 1,200 program profiles for innovative ways to improve privately delivered TB care. With our colleagues at the University of Toronto, we will soon launch a brief summarizing our findings. This blog post draws upon some of this preliminary research and analysis.
While the mortality rate associated with TB has, excluding HIV-positive cases, decreased 41%, an estimated 8.7 million new cases of infections occur each year. Adherence to TB treatment is both difficult and critical—the disease carries a high mortality rate if not treated, and breaks in the recommended regimen can lead to drug resistance.
Governments are invested in TB treatment—why involve the private sector?
While many patients eventually seek care for TB from government facilities, the private sector is often the first point of care for patients in the 22 countries with the highest TB burden. In India, where nearly 2 million people develop TB annually, a study found that 86% of patients first consulted private practitioners after experiencing symptoms, and two-thirds of patients that continued treatments stayed in the private sector. For TB patients, private providers—including physicians, nurses, traditional healers, and pharmacists—offer advantages including greater flexibility, value, convenience, and privacy. As noted in the WHO’s Public Private Mix Toolkit, TB strategies that engage private providers can increase case detection, reduce diagnostic delays, and lower the cost of care, in part because private providers are often closer to patients’ homes or workplaces.
Where are innovators developing TB solutions?
CHMI’s data set includes 58 programs that work on TB in 33 countries. While many TB-focused programs profiled by CHMI operate in innovation hotspots, such as East Africa and South Asia, these locations do not exactly correlate with global TB incidence, as the map at top illustrates (from World Bank data on the Incidence of tuberculosis is the estimated number of new pulmonary, smear positive, and extra-pulmonary tuberculosis cases). CHMI profiles only a handful of programs delivering TB care in Southern Africa, a region with a high TB incidence in part due to the increased vulnerability of people co-infected with HIV.
Of all the innovative approaches used by the TB programs CHMI profiles, information technology is the most common. Below, we share a few innovative practices of programs that are leveraging information technology to counter the TB threat.
Using information technology to tackle TB
Combating TB effectively requires early diagnosis, access and adherence to high-quality, standardized treatment, and the availability of well-trained health workers to provide services, including treatment supervision and patient support.
In a previous blog post, my colleague Trevor Lewis wrote about programs that are franchising and linking together private provider practices, training providers to improve performance, and implementing regulatory reforms. In this post, I focus on information technology, as it is one key way to increase geographic access to screening, speed up diagnosis, and encourage patients to adhere to their medicine regimens.
Among the TB programs CHMI profiles, information technology is used by one-third as a core part of their model. Half of the programs using information technology also focus on other innovative approaches to improving TB care, through provider training, or franchising. The next section goes through specific ways in which information technology is being meaningfully used to combat TB.
Data collection, patient tracking, and monitoring with information communication technology
Technology, especially mobile devices, can enhance health workers’ ability to ensure that TB cases are diagnosed, reported, and managed effectively. In India, uNotify provides administrators of TB programs with four different types of technologies, from text messages to fingerprint scanners to intelligent pill dispensers in order to ensure adherence to TB drug regimens. uNotify devices send information to a centralized server that monitors program activity and alerts administrators when a patient misses a dosing.
Ensuring treatment adherence with mobile technologies
Many programs use mobile technologies to improve patient adherence to TB medication. In South Africa, On Cue Compliance uses specially designed pill bottles that are fastened with a SIM card and transmitter. When the pill bottle is opened, the transmitter relays a text message to a designated healthcare worker. If patients do not open pill bottles on time, they receive a text message reminding them to take their medication. According to this program’s reported results in the CHMI database, 90% of patients complied with their medication regimen, compared to a compliance rate of 22-60% without the system.
Using mobile technology to improve the supply chain of medications and reduce stock-outs
Ensuring effective drug management and reliable drug supply is essential for high-quality TB treatment. Stock-outs of TB medicines cause interrupted or delayed treatment, which can increase drug resistance and prolong illness. CHMI-profiled programs such as TexTB, in the Philippines, and the Uganda Health Information Network have used technologies to monitor and manage stocks of TB medications. In Uganda, officials in five districts monitor drug and supply levels at health centers via PDAs. Independent assessments have that shown the system is 24% more efficient than paper-based data management.
Providing diagnostic tools for health workers
For secondary care, which requires health workers with strong diagnostic skills and knowledge, technology is often used to enhance the abilities of health workers. The MOTECH Suit—featuring Dimagi CommCare mobile phone-based tools for community health workers—provides health workers with text messages, electronic forms, job aids, medical protocols, alerts, and other features to identify and respond to symptoms for high-burden health issues like TB. World Health Partners uses text messages included in the MOTECH Suite to enable rural medical providers and consumers alike in Bihar, India to better manage their TB. D-tree International is developing a TB module to help health workers in Tanzania identify TB among HIV-infected clients; the module will suggest diagnostic tests to perform even when clients miss a visit.
Which of these practices is showing evidence in peer-reviewed or gray literature? We’ll share this information in future CHMI publications. For now, we wanted to highlight the innovative ways in which technology is being used to combat TB, given that the use of information technology is the most utilized health market innovation among TB programs profiled in the CHMI database. As discussed, these programs are engaged in a range of activities, from improving diagnosis and patient tracking, to boosting adherence, to strengthening the supply chain for TB drugs. We look forward to following these and many more innovations to come and will share our findings in future posts and analytical products.
This blog post was based on a brief summarizing innovative practices in TB from the CHMI data set. Produced in collaboration with Kathryn Mossman and Onil Bhattacharyya at the University of Toronto, the brief will be published on CHMI in early summer.