The Bigger problem- India is the highest TB burden
country with World health Organisation (WHO) statistics for 2010 giving an
estimated incidence figure of 2.3 million cases of TB for India out of a global
incidence of 9.4 million cases. The WHO statistics also show that India is 17th
out of the 22 high burden countries in terms of TB incidence rate. The
estimated TB prevalence figure for 2010 is given as 3.1 million. It is
estimated that about 40% of the Indian population is infected with TB bacteria,
the vast majority of whom have latent rather than active TB.
Compliance issues in Treatment- To treat TB, the
WHO recommends the so-called DOTS (Directly Observed Treatment Short-course)
strategy, where patients take medication under supervision from health staff.
Daily supervision of treatment is too demanding for most of our patients and
instead implements self-administered therapy with patient education and support
to ensure adherence. In many countries affected by conflict, access to health
structures is limited for the population. Conflict interrupts travel and makes
people fearful of leaving their shelters to seek assistance. It can also lead
to the collapse of existing health systems.In India in 2010 292,972 people
needed TB re-treatment because of initial treatment relapse, failure or
default.
In Focus- Operation ASHA
Operation ASHA is a registered non-profit that has
taken TB treatment to the doorsteps of 5.37 million individuals living in
disadvantaged areas. It operates in over 2,053 villages and slums in six states
spread across India and Cambodia. The effort is self-sustainable and is using
technology to reach out to millions everyday.
Establishing Centres- Operation ASHA establishes tuberculosis
(TB) treatment centers within existing community locals (for example,
strategically placed shops, homes, temples, or health clinics). Under the World
Health Organization’s Directly Observed Therapy (DOTS), patients must take
their medicines under the supervision of a health care worker. The model is
designed to help patients procure their medicines conveniently without wasting
time, spending money on transport, and losing wages. This also drastically
reduces the effort, time and money that patients have to invest in taking their
medication, which is key to ensuring that patients complete the entire course
of treatment.
Training- Operation ASHA trains community members
(often former patients) to become tuberculosis health workers who are responsible
for identifying new patients, ensuring adherence to the drug regimen, and
carrying out regular educational campaigns. Operation ASHA works closely with
the Government of India, who provides them with free medicines and diagnostic
services. After a center has been established for two years, the government
provides a grant for every patient cured, making OpASHA’s centers financially
self-sustaining.
Building Compliance through technology- Ensuring
patient compliance is important because of the threat of multi-drug resistant
tuberculosis (MDR-TB), which has become one of the world’s largest public
health issues. Resistant strains of the disease can take up to two years to
treat (in comparison to the standard 6 month regimen). Second line medicines
have more severe side effects and can also cost 50-200 times more. Such
unrealistically high costs are essentially a death warrant to those below the
poverty line. To combat the rising MDR-TB epidemic, OpASHA launched
eCompliance, a biometric initiative in collaboration with Microsoft Research,
which uses fingerprint scanners to track patient visits.
The system consists of three parts:
- a netbook computer,
- a USB fingerprint reader (from Digital Persona),
- and a GSM modem that uploads the visitation logs (via SMS) to a central location.
Patients scan
their finger every time they take medication, and these logs are visualized in
the central office to monitor medication delivery. Missed doses trigger an SMS
notification to managers, who ensure timely supervision or counseling to the
patients and health workers involved. The health worker is then required to do
a follow-up visit within 48 hours to deliver the medicines and supplementary
health education.
These home visits are also confirmed by biometrics. Currently
the terminal is used daily in over 40 treatment centers, spanning Delhi,
Mumbai, and Jaitpur; Operation ASHA is aggressively expanding the deployment to
over 225 centers around the world. To date, the technology has enrolled about
2,700 patients and logged over 50,000 supervised doses. The biometric records
are used to automatically generate reports to the government and other
stakeholders.
With the help of eCompliance, Operation ASHA has
reduced its default to 1.5%, which is much lower than other institutions. The
cost of treating a patient for the entire therapy of is US $50.
References/Credits:
TB statistics of India- TB India 2011 Revised
National TB Control Programme Annual Status Report, New Delhi, 2011
www.tbcindia.nic.in/documents.html#
Doctor without borders-
http://www.doctorswithoutborders.org/news/issue.cfm?id=2404
Operation ASHA- http://www.opasha.org/