Digitalisation Leverages Notification and Treatment Adherence of Tuberculosis Patients in Private Sector: Pilot study from India

Background:

In 2014 there was noticeable increase (6.3 million) in global TB notifications of which 29% increase was from India, 12% of this was from private sector. Nearly 50% of TB patients in India are treated in private sector which neither notifies nor follows up on treatment adherence. To address this challenge, web-based software was developed that facilitates notification and provides treatment adherence support to TB patients in private sector. It is being piloted at Apollo Hospital Hyderabad.

Methods:

The software links private health facility with national TB notification portal Nikshay and simultaneously supports TB patients for treatment adherence by sending daily reminders SMS (short message service) for taking medication, follow up visits and bi-weekly IVRC (interactive voice response calls) which records patients’ response on treatment regularity. Patients who miss doses or do not respond to IVRC or do not come for follow up visits are followed by counsellor.

Results:

200 TB patients have been notified during June 2015 - March 2016 of which 58% were male and 73% were extra-pulmonary. 10 have multi-drug resistant TB. 32 have completed treatment while the rest are on treatment. 165 (82%) agreed for receiving reminders. Analysis of ~3600 IVRCs shows that 95% have taken all doses and 5% missed one or more dose.

Feedback was taken from 165 patients. 95% remembered having received daily SMS, 90% remembered to respond to at least 1 IVRC in last 7 days. 90% found SMS to be very helpful in reminding drug intake and desired to continue receiving. 80% wanted to continue with twice a week IVRC while 20% wanted reduced frequency (1 call per week). Total cost of SMS and IVRC for 6 months is Rs.120/- (less than US $2).

Conclusion:

Web based software with patient support package is successfully notifying into Nikshay in real time. This is cost effective model to facilitate notification and treatment adherence in private sector. This is open source and can be easily customized to integrate with the hospital’s Management Information System (MIS).