Sangitaben Vinodbhai Patni, 30, was diagnosed with Multidrug Resistant Tuberculosis (MDR-TB) a year ago and prescribed an 11-tablet regimen. She had never taken tablets before, and as a resident of Kumbhaji ni Chali, a slum colony in Meghaninagar, she found the prospect of taking so many pills intimidating. Many of the pills were large and difficult to swallow, while others were bitter and caused her to gag. She was also unsure about when to take her pills.
“Sangitaben was a difficult patient,” says Gaurang Vaghela, the healthcare worker attached to her case at the Meghaninagar Urban Primary Health Centre (UPHC). “She would refuse to take her pills or take them in an irregular manner. We finally convinced her to follow the regimen by telling her that her children ran the risk of catching the infection from her if she did not take her pills and get cured.”
Designated TB Health Visitor (TBHV), 41-year-old Gaurangbhai is a frontline worker for the National Tuberculosis (TB) Elimination Programme and is charged with the welfare of 169 TB patients in the Meghaninagar ward. Of these, 24 have MDR-TB, which is a form of infection that is most difficult to treat. “Meghaninagar has a large population living in slums, where an infectious disease like TB can spread rapidly. Our job is to detect cases early and make sure they are cured,” he says.
While the World Health Organization (WHO) has set a global goal of eliminating tuberculosis (TB) by 2030, India has set a more aggressive goal of eliminating the disease by 2025. The government has introduced several technological innovations to help with the effort. One of these is a TMEAD (TB Monitoring Encouragement Adherence Drive), a device developed by Nashik-based SenseDose Technologies with funding from the Tata Trust’s India Health Fund.
Last year, SenseDose tied up with the Indian Institute of Public Health (IIPH) Gandhinagar, to conduct clinical trials for MDR-TB patients in the districts of Ahmedabad, Gujarat, and Thane, Maharashtra, with 200 patients each. “TMEAD is meant to address the problem of non-adherence in the treatment of Tuberculosis. In the Ahmedabad trials, which were completed in January, adherence to the medicine regime was much higher among patients who used the device as compared to the control group which did not. “If all goes well, we hope to deploy TMEAD throughout Gujarat and Maharashtra by year-end, and nationally in two years,” says Nishad Halkarni, co-promoter of Sensedose (along with Rahul Doshi).
The TMEAD device is essentially a smart pill dispenser with an alarm clock that is linked to the internet via an Android App. The alarm sounds when it is time for patients to take their medication. If the reminder is ignored and the patient fails to take the pills prescribed by the device, an alert is sent to the TBHV assigned to the patient.
The system has worked for Sangitaben, who says, “Whenever the TMEAD alarm goes off, my children start pestering me. They will not leave me until I have swallowed my pills.”
The TMEAD device has also made the TBHVs’ jobs much easier. Previously, patients had to visit health centres on a regular basis and wait in line for their medication. The TMEAD device stores 15 days’ worth of medication, allowing patients to visit the health centre only twice a month.
The TMEAD App, which is installed on the phones of all TBHVs in Ahmedabad, also provides them with a color-coded dashboard on their phones, where patients are classified as requiring high (red), medium (green), or low (green) attention, depending on their adherence. The app has been integrated with NIKSHAY, another web-enabled app developed by the National Informatic Centre, to track his TB patients’ adherence levels. “These technologies have increased the efficiency of our operations,” Gaurangbhai says. “We can concentrate our efforts where they are most needed.”
Sangitaben’s health has improved considerably over the past year. She had a racking cough when she first came to the centre and her weight was 52 kg. Now the cough has disappeared and her weight has increased to 62 kg. As a result, her prescribed daily medicine regimen has come down from 11 pills to a more manageable seven pills.