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India bears the burden of TB more than any other country with an estimated 3.1 Million victims. In addition to the large patient population is the problem of mutant variants of the bacteria that are drug resistant. The World Health Organization (WHO) reports in 2013 that 3.7% of all newly reported cases are Multi-drug resistant TB (MDR-TB), and 9% of MDR-TB is Extremely Drug Resistant (XDR-TB). In India the MDR-TB burden is estimated at 66,000 people, representing 5% of all new TB cases detected. Treatment for MDR-TB takes at least 24 months as compared to 6 months for regular TB, and the cost is 20 times more expensive.
A major cause for MDR-TB and XDR-TB is non-adherence to medication during the prescribed six to nine month treatment regimen. The bacteria build up immunity to first line of drugs such as Rifampicin and Isoniazid due to interrupted or irregular treatment.
There are several problems that lead to non-compliance from the prescribed treatment regimen. Below is a list of reasons that will help you understand why a patient may fail to take medication despite being aware of the disease.
1. Behavioral problems
a. Patient does not perceive tangible benefits of taking medication
b. Patient stops taking medication if they do not experience difficulty/pain (symptom
c. Forgetfulness of the human mind
d. Use of Alcohol and Tobacco
2. Cost of treatment and travel, absence from work
3. Lack of Awareness about the disease and treatment procedures
4. Lack of Access to affordable healthcare providers
5. Ineffective communication between patient and healthcare provider
6. Differences in languages in India
We believe that technology innovations will be able to help patients adhere to the treatment regimen better through reminder systems, patient tracing, awareness generation and reporting mechanisms. The health providers / doctors will be able to oversee a large population of patients with an automated monitoring system, and will find it easier to follow up with defaulters.
We have substantial evidence that reminder systems, late patient tracers (following up on defaulters), financial and material incentives, and education and counseling are interventions that help achieve higher levels of treatment adherence, and thereby better cure rates and health outcomes.
Our solution is a multi layer technical solution to deal with the current challenges around TB treatment tracking. The solution includes a server application to register patient with patient history. Server application is integrated with SMS gateway which remind patients to consume their pills on time in regional languages. To ensure the treatment compliance the server application is also connected to pill boxes, which are handed over to non compliant patients. The pill boxes are equipped with SIM cards, LED indicators and buzzers and most importantly weight sensors to measure the remaining weight of the pills. The server application reminds the patient remotely about treatment timings through buzzers and LED indicators. If the pill box is not operated by the user, server application starts sending SMS messages and automated calls to the patient and also alerts care giver to followup with the patient. Weight sensor tracks the regularity of the treatment through complex algorithms on the server. We are rolling out the Android mobile application in February 2016. Initial pilots are over showing significant improvement in treatment compliance within TB patients. The project is funded through Grand Challenges in TB Control program 2013 supported by USAID and BMGF.