Tuberculosis kills over a million people each year, mostly in developing countries, where poor public health systems hamper efforts to diagnose and treat it. But NGOs are now embracing new mobile health technologies that could help fight the disease more efficiently and cost-effectively.
As one of the world’s deadliest communicable diseases, TB presents a massive public health challenge. Due to the high costs of fighting it in places with weak institutions and infrastructure, the WHO reports a $2 billion annual funding shortfall for TB prevention, diagnosis, and treatment. And as the disease festers in densely populated cities and remote areas, new antibiotic-resistant strains are gaining strength. It’s not implausible that one of these strains could morph into a superbug that causes the next big global pandemic.
To be sure, extensive work by The Global Fund, the World Health Organization, the United States Agency for International Development (USAID), and other large organizations are making a big difference. Worldwide incidence of TB declined at a rate of 1.5% each year between 2000 and 2013, according to the WHO’s Global Tuberculosis Report in 2014.
Yet further progress will require expensive efforts in low-resource settings where administering drugs and monitoring compliance can be a logistical nightmare. Most normal cases of TB require patients to take six months of antibiotics on a daily basis. Adherence to this regimen will usually cure the patient, but missing doses or failing to complete the regimen exposes the patient to treatment failure. It also allows TB bacteria in their bodies to develop into multi-drug-resistant tuberculosis (MDR-TB), which is substantially more difficult and costly to treat.
To work around this challenge, many budget-strapped NGOs have turned to mobile tech for health worker education, field management, data collection, patient tracking, and improved diagnostics. Here are three NGOs using hardware and software platforms to lower costs and improve outcomes in TB prevention.
1. FHI360 is an international non-profit that works on a wide range of issues, including TB. Its USAID-funded Control and Prevention of Tuberculosis (CAP-TB) program targets MDR-TB in Myanmar, China, and Thailand. One of its strategies involves enlisting community volunteers to support TB patients through their treatment, and to manage this work, CAP-TB developed an innovative smartphone app called DOTsync.
DOTsync provides a simple tool for community health workers to log the administration of antibiotics, monitor side effects among patients, check on infection control in homes, and manage other aspects of their work. Before CAP-TB developed the app, workers typically used paper forms that were easily lost or damaged. The new system links to a cloud database for frequent backups, monitoring, and analysis.
DOTsync was built using open-source software provided by Dimagi, a social enterprise that builds tech platforms for underserved communities around the world. Currently deployed in Myanmar as a joint effort with the Myanmar Medical Association, it is also being considered by public health agencies in Thailand, according to Dr. Anh Innes, who directs the CAP-TB program.
2. Operation ASHA, which runs large-scale TB prevention programs in India and Cambodia, also uses mobile tech to manage its field force. Founded in 2006, the organization initially noticed high levels of absenteeism among community health workers in India. Workers would sometimes report having visited patients and administered drugs even when they hadn’t, which drained organizational resources and falsified important public health data.
To counter this problem, Operation ASHA developed eCompliance, which uses biometric verification to ensure both patients and health workers are doing the right thing. The core feature of the system is a scanner that logs site visits only when both the patient and the field worker concurrently submit their fingerprints. The system proved so effective that it was later adopted by NGOs in other countries, including Uganda, Kenya, and the Dominican Republic.
eCompliance has a range of other features that help manage TB prevention efforts, including cloud-based electronic medical records, contact tracing applications, and an automated lab result alert system. Sandeep Ahuja, Operation ASHA’s CEO, says he’s currently working on more features and negotiating operating licenses with NGOs, multilateral institutions, and government public health agencies.
3. InSTEDD, a Silicon Valley NGO that builds open-source tech tools for the development sector, believes mobile tech can improve TB diagnostics. Since many TB patients live in under-resourced areas with few clinics, diagnostic tests frequently need to be carted off to remote towns or cities, with results sometimes taking weeks or months to process. Logistical hurdles like this can be deadly if they inhibit immediate treatment or cause lab results to be compromised or lost.
InSTEDD sees “connected diagnostics,” which automatically transmit results over the Internet to centralized databases for real-time monitoring, as a solution to this problem. In partnership with the Foundation for Innovative New Diagnostics (FIND) and Cepheid, InSTEDD ran a pilot test of connected diagnostics technology for TB in South Africa. Their system has potential applications for TB and other diseases everywhere.
FHI360, Operation ASHA, and InSTEDD are part of a growing group of NGOs leveraging mobile tech in the fight against TB and other diseases. The potential for global public health is tremendous.
Will Greene is Director of New Markets for mClinica, a health data and analytics firm for Asia’s emerging markets.