X Out TB
Country of Operation
- Innovations in International Health of the Massachusetts Institute of TechnologyNot-for-profit
- Interactive Research and Development (IRD)Not-for-profit
- Indus Hospital, KarachiNot-for-profit
Target income level
- Bottom 20%
- Lower-middle income (20-40%)
- Middle-income (40-60%)
- Higher middle-income (60-80%)
- High-income (80-100%)
SummaryX out TB seeks to reduce the necessity of daily health worker monitoring of TB patients by using urinalysis tests strips and cell phones to remotely confirm adherence to medication.
Treatment for tuberculosis is long, complicated, and can cause uncomfortable side-effects. As a result, roughly 40% of patients worldwide do not complete the full course of treatment. Such non-compliance is in part responsible for the nearly two million annual TB deaths and the rapidly emerging problem of drug-resistant bacteria. The current standard for encouraging medication compliance of Directly Observed Therapy (DOTS) requires health workers or other designated individuals to watch patients take their medication, a challenge in places with minimal human resources for health. This new strategy uses high-tech urine test strips and mobile phone SMS texts to remotely monitor patient adherence and rewards them with mobile minutes.
Key program components
Participating patients are required to urinate daily on test strips that detect whether or not they have taken their medication. Patients are given a monthly supply of test strips which are dispensed automatically each day by a dispenser provided to the patient to take home. If the test is positive (the patient did take his/her drugs), the strip will reveal a unique code that the patient can type into their cell phone and send as a text message to a central database, monitored by health care workers and doctors. Positive compliance will be rewarded with a transfer of a small monetary credit on their cell-phone at the end of the week.
The strips, developed by the X out TB team, contain four printed numbers and embedded chemicals that change color to reveal a special code of numbers a new color when they react with the urine of patients who have taken TB medication.
X out TB was born out of the MIT IDEAS competition, which encourages student groups to come up with new technologies to solve international development problems. In 2007, the competition focused on solving issues of TB noncompliance.
Barclay E. Text messages could hasten tuberculosis drug compliance The Lancet. doi:10.1016/S0140-6736(08)61938-8 http://www.thelancet.com/journals/lancet/article/PIIS0140673608619388/fulltext
Pending Impact Evaluation from 3ie: http://www.3ieimpact.org/en/evidence/impact-evaluations/details/194/