Activities I n January 2013, the National Tuberculosis Control Program, with the support of the USAID TB CARE II project, introduced an mHealth application for the management of DR-TB patients under community based treatment. The web-based smartphone application, which supports the provision of home- based DOT in cPMDT districts, includes the following features: n Contains contact details of the patient and DOT provider, at-a-glance patient information, treatment start date, DOT provider information and patient status n Patient information stored on a server n Adverse Drug Reactions can be monitored daily n Regular DOT visits monitored through geo-tagging feature In January 2013, the TB mHealth application was introduced as a pilot in Gazipur district, followed by Narayanganj and Chittagong districts in March 2013. After a successful piloting phase, Bangladesh’s National Tuberculosis Program, with technical assistance from the TB CARE II project developed a scale up plan to cover all cPMDT implementing districts. Each MDR TB DOT provider received a smartphone and training on using the mHealth application. During each household visit, the application allows the DOT provider to access each patient’s tailored treatment regimen including drugs and dosing requirements. During each DOT session, the smartphone module guides the provider to record the patient’s treatment history, including any side effects, and perform contact tracing among family members. The application includes a geo- tagging feature, which allows program supervisors to verify when and where each DOT session was recorded. All information from this application is stored in a central database for central monitoring, including the coordinate location of patients’ geo- tagged residence. Impact of mHealth on Retention and Management of MDR TB Patients Living in the Community Dr. Neeraj Kak; A.N.M Al Imran; and DR. Refiloe Matji; University Research Co., LLC Background B angladesh has been classified as a High Burden Country by the WHO for its severe burden of Tuberculosis (TB) and Multi-Drug Resistant TB (MDR TB). To address this problem, the USAID-funded TB CARE II Project introduced a new strategy to improve access to and quality of MDR-TB services in Bangladesh called Community based Programmatic Management of Drug Resistance TB (cPMDT). Providing effective care at the community level requires strong systems to ensure appropriate clinical follow-up and patient adherence to the full 18-20 months of treatment.Considering this critical need, the project designed and implemented an mHealth application to monitor patient care and treatment adherence. Objectives T he TB CARE II project designed and implemented an mHealth application to support the provision of home-based Directly Observed Treatment, Short- Course (DOTS) in the cPMDT area. The mHealth application was designed to strengthen support systems for DR-TB patient management at both intensive and continuation phases, improvetreatment adherence, facilitateAdverse Drug Reaction (ADR) management, and improve treatment outcomes. About the Project The United States Agency for International Development (USAID) awarded the five-year TB CARE II Project to University Research Company to assist Bangladesh’s National Tuberculosis Program (NTP) to strengthen national capacity for diagnosis and management of TB and MDR TB. From 2011 to 2015, the project provided technical assistance to the NTP to strengthen detection, expand access to treatment, and enhance community-level case finding and management of TB. Results n 394 DOT providers were using the mHealth application to manage 435 patients in February 2015 n From the start of the mHealth program through February 2015, a total of 758 DR TB patients from 34 districts have been followed using the mHealth application as part of the cPMDT program n The mHealth application improved project capacity for real time monitoring of DOT providers, promoting treatment adherence, reducing missed DOT, and facilitating side-effect management and follow-up. n Patients who received daily DOT visits increased from 80% at baseline to 98% n Since introduction of the smartphone application in 2013, drug compliance increased by approximately 30% n Patient compliance with required follow up smear and culture tests consistently remained at 100%. n Contact tracing during household visits through the application contributed to approximately 5% of active case finding of new TB and MDR TB patients. Contact tracing contributed to achieving a high cure rate of 84% and maintaining very low number of default cases throughout the project period. An MDR-TB DOT provider uses the mHealth app while on a visit to a patient’s home Challenges n The application is dependent on the strength of mobile networks. The mobile network coverage was poor at the beginning stage in some remote areas n Some DOT providers are not familiar with smartphone technology n Despite increases in retention rates, irregularity of medication was reported in the absence of DOT providers and when the patient travels away n Patients living in heard to reach areas fail to visit health facilities on due dates for follow up tests n Follow up for Adverse Drug Reactions should be improved n Lack of community-based patient counselors is a barrier to patient treatment compliance and understanding. Discussion M obile phone applications have significant potential to facilitate case management of community based MDR TB patients, particularly in rural areas in Bangladesh. The application allowed project staff and government supervisors to review updated patient records and take action for missed DOTS, side effects, and follow up issues. Further, the mHealth application has proven to reduce the burden of human resources required for supervision.Through active monitoring at the central level and with field level cooperation, mHealth can play an important role to ensure patient adherence to DOT and effective monitoring to reduce burden of TB in Bangladesh. Cured Died Failure Transfer out Discontinued Figure 1. Treatment outcomes for patients in Chittagong District, based on patient data from the first two quarters of 2013 7.2% 90.4% 1.2% 1.2% 0% Screen shot of the smartphone TB application
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Activities
In January 2013, the National Tuberculosis Control Program, with the support of the USAID TB CARE II project, introduced an mHealth application for the
management of DR-TB patients under community based treatment. The web-based smartphone application, which supports the provision of home-based DOT in cPMDT districts, includes the following features:
n Contains contact details of the patient and DOT provider, at-a-glance patient information, treatment start date, DOT provider information and patient status
n Patient information stored on a server
n Adverse Drug Reactions can be monitored daily
n Regular DOT visits monitored through geo-tagging feature
In January 2013, the TB mHealth application was introduced as a pilot in Gazipur district, followed by Narayanganj and Chittagong districts in March 2013. After a successful piloting phase, Bangladesh’s National Tuberculosis Program, with technical assistance from the TB CARE II project developed a scale up plan to cover all cPMDT implementing districts.
Each MDR TB DOT provider received a smartphone and training on using the mHealth application. During each household visit, the application allows the DOT provider to access each patient’s tailored treatment regimen including drugs and dosing requirements. During each DOT session, the smartphone module guides the provider to record the patient’s treatment history, including any side effects, and perform contact tracing among family members. The application includes a geo-tagging feature, which allows program supervisors to verify when and where each DOT session was recorded. All information from this application is stored in a central database for central monitoring, including the coordinate location of patients’ geo-tagged residence.
Impact of mHealth on Retention and Management of MDR TB Patients Living in the Community
Dr. Neeraj Kak; A.N.M Al Imran; and DR. Refiloe Matji; University Research Co., LLC
Background
Bangladesh has been classified as a High Burden Country by the WHO for its severe burden of Tuberculosis (TB) and Multi-Drug Resistant TB (MDR TB).To address this problem, the USAID-funded TB CARE II Project introduced
a new strategy to improve access to and quality of MDR-TB services in Bangladesh called Community based Programmatic Management of Drug Resistance TB (cPMDT). Providing effective care at the community level requires strong systems to ensure appropriate clinical follow-up and patient adherence to the full 18-20 months of treatment.Considering this critical need, the project designed and implemented an mHealth application to monitor patient care and treatment adherence.
Objectives
The TB CARE II project designed and implemented an mHealth application to support the provision of home-based Directly Observed Treatment, Short-Course (DOTS) in the cPMDT area. The mHealth application was designed to
strengthen support systems for DR-TB patient management at both intensive and continuation phases, improvetreatment adherence, facilitateAdverse Drug Reaction (ADR) management, and improve treatment outcomes.
About the Project The United States Agency for International Development (USAID) awarded the five-year TB CARE II
Project to University Research Company to assist Bangladesh’s National Tuberculosis Program (NTP)
to strengthen national capacity for diagnosis and management of TB and MDR TB. From 2011 to
2015, the project provided technical assistance to the NTP to strengthen detection, expand access to
treatment, and enhance community-level case finding and management of TB.
Resultsn 394 DOT providers were using the mHealth application to manage 435 patients
in February 2015
n From the start of the mHealth program through February 2015, a total of 758 DR TB patients from 34 districts have been followed using the mHealth application as part of the cPMDT program
n The mHealth application improved project capacity for real time monitoring of DOT providers, promoting treatment adherence, reducing missed DOT, and facilitating side-effect management and follow-up.
n Patients who received daily DOT visits increased from 80% at baseline to 98%
n Since introduction of the smartphone application in 2013, drug compliance increased by approximately 30%
n Patient compliance with required follow up smear and culture tests consistently remained at 100%.
n Contact tracing during household visits through the application contributed to approximately 5% of active case finding of new TB and MDR TB patients. Contact tracing contributed to achieving a high cure rate of 84% and maintaining very low number of default cases throughout the project period.
An MDR-TB DOT provider uses the mHealth app while on a visit to a patient’s home
Challengesn The application is dependent on the strength of mobile networks. The mobile
network coverage was poor at the beginning stage in some remote areas
n Some DOT providers are not familiar with smartphone technology
n Despite increases in retention rates, irregularity of medication was reported in the absence of DOT providers and when the patient travels away
n Patients living in heard to reach areas fail to visit health facilities on due dates for follow up tests
n Follow up for Adverse Drug Reactions should be improved
n Lack of community-based patient counselors is a barrier to patient treatment compliance and understanding.
Discussion
Mobile phone applications have significant potential to facilitate case management of community based MDR TB patients, particularly in rural areas in Bangladesh. The application allowed project staff and government
supervisors to review updated patient records and take action for missed DOTS, side effects, and follow up issues. Further, the mHealth application has proven to reduce the burden of human resources required for supervision.Through active monitoring at the central level and with field level cooperation, mHealth can play an important role to ensure patient adherence to DOT and effective monitoring to reduce burden of TB in Bangladesh.
Cured
Died
Failure
Transfer out
Discontinued
Figure 1. Treatment outcomes for patients in Chittagong District, based on patient data from the first two quarters of 2013
7.2%
90.4%
1.2%1.2%
0%
Screen shot of the smartphone TB
application
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