Digital identification for TB management
What is the innovation and how does it address a pressing problem?
Operation ASHA’s eCompliance tool ensures patients adhere to their 6 month long TB treatment.
TB is transmitted through coughing, sneezing and breathing. Over 8.7 million people are infected globally. A deadlier form of TB, known as Multi- Drug Resistant-TB (MDR-TB), has grown into a dangerous epidemic. MDR-TB develops when patients stop taking their medicines partway through treatment. Each TB patient infects approximately 10-15 new people ever year, and thus the incidence of MDR-TB is rising exponentially. This is doubly dangerous to the poor because of the high medicine costs and the long treatment duration. Systems to track adherence have faced challenges ranging from low levels of literacy among health workers to deliberate data manipulation.
Used by Community Health Workers (CHWs), eCompliance is a fingerprinting system that introduces transparency and accuracy into the drug adherence therapy. Using netbooks, a finger printer and a modem, meds are given only when fingerprints are registered. When a patient doesn’t come to the clinic for their medications, their name is automatically flagged for a CHW to visit. Bringing the equipment with them, CHWs visit the patient and collect their fingerprint upon delivery of medication. This reduces missed doses, prevents data manipulation, and digitizes attendance records for external monitoring and evaluation. The tool is designed for use by semi-literate health workers who can use it with minimal training.
What existing practices inspired the innovation and how does it represent something new?
Two existing practices inspired the creation of eCompliance: the Directly Observed Therapy, Short course (DOTS) recommended by the WHO for the treatment of TB, and the decentralised community-based model pioneered by Operation ASHA.
Dr. Shelly Batra founded Operation ASHA in 2005, together with a colleague, Sandeep Ahuja. Her aim was to improve case detection and provide accessible treatment by decentralising DOTS. They have established dense network of TB treatment centers in disadvantaged areas, and currently operate in India and Cambodia. DOTS requires a TB patient to visit a center 60 times over 6 months. Operation ASHA employs local community representatives who are familiar with local customs and dialects, and trains them in detecting TB patients. These workers facilitate lab testing and physician examinations of suspected TB patients. After this, infected patients are enrolled in the community-based DOTS program to facilitate ease in the DOTS regimen.
eCompliance supports the work of CHWs and ensure precision of treatment. It was developed and rolled out in collaboration with Microsoft Research using only “off the shelf” components. In India, where eCompliance was launched, fingerprints are commonly used as a way for the illiterate to verify their identity, for example in purchasing cows. Patients are thus comfortable with this approach.
Please describe the social impact to date, as well as potential impact in the future.
eCompliance has helped Operation ASHA to treat more than 4500 patients to date, representing 270,000 patient visits. Currently, 1512 are enrolled. TB treatment outcome is measured by default rate. eCompliance has helped Operation Asha to achieve a remarkably low default rate of around 3%, which is 2-20 times less than other providers. In addition, 89% of patients successfully complete treatment, exceeding World Health Organization standards. eCompliance has also facilitated a massive cost reduction in delivery of treatment: cost per patient is 19 times lower than the nearest other provider.
In addition to the direct impact, indirect beneficiaries include those who don’t catch TB due to better adherence by patients.
eCompliance has potential to address other public health problems. Immediate developments include upgrading eCompliance to raise vaccination rates in urban slums.
eCompliance is also spreading to other communities. The first 3rd party replication of the approach was implemented by researchers from Columbia University, who represent the Millenium Villages in Uganda. Results in Uganda have been outstanding, with death rate from TB down to 0% after eCompliance, as compared to previous figures of 16%, and keen interest is being shown by the governments of the Philippines, Swaziland, Dominica, and Brazil.