World TB Day
About the Union The mission of International Union Against Tuberculosis and Lung Disease (The Union) is to bring innovation, expertise, solutions and support to address health challenges in low and middle-income populations. Headquartered in Paris, The Union is the only international voluntary scientific organisation with partners providing a neutral platform to fight TB, HIV, asthma, tobacco and lung disease. Established in 1920, The Union today is both a non-profit institute with five scientific departments and several offices worldwide; and a federation of close to 3,000 organisations and individuals. Its scientific departments focus on tackling major health challenges including: Tuberculosis, HIV, Lung health (including Child Lung Health), Non-communicable diseases, and Tobacco Control. Technical assistance, research, education and advocacy form the core of The Union’s activities and support to more than 170 countries and programmes across the world. The Union is most widely known for developing the DOTS (Directly Observed Treatment, Short Course) strategy for treating and controlling tuberculosis. Internationally recommended and adopted by the World Health Organization, The Union model has been used to treat 37 million people around the world. For more information, please see www.theunion.org. About The Union South-East Asia Based in New Delhi, The Union South-East Asia Office (USEA) works in India and other countries across the region, drawing on a network of consultants and strong partnerships with governments, civil society, corporations and international agencies. Established in 2003 as The Union’s first regional office, today it brings global experience and expertise to its work as well as efficiency and energy to The Union’s services across the region. USEA has a dedicated staff with technical expertise which reflects the Union’s emphasis on tuberculosis, HIV, lung health, tobacco control, non-communicable diseases and research. Since 2009, USEA has managed Project Axshya, a Global Fund supported project designed to enhance access to TB services by vulnerable and marginalised populations in 300 districts across 21 states of India. Other key projects include tobacco control efforts in India, Nepal and Bangladesh through the Bloomberg Initiative to reduce tobacco use; and the Eli-Lilly supported project to expand sustainable TB control in India. USEA also coordinates trainings to build capacity in the management of TB and MDR-TB, operational research, programme management and other skills. About The Union – Apollo Partnership Project Engaging all relevant health-care providers in tuberculosis care and control through public-private and public-public mix approaches is an essential component of the World Health Organization’s (WHO’s) Stop TB Strategy. The Union in collaboration with the Lilly MDR-TB partnership is implementing a project to systematically involve private health care providers in delivering effective and quality TB services in India. Nearly 50% of TB patients in India are treated in the private sector with most of them neither being notified nor followed up for treatment adherence with a high risk of unfavourable outcomes and amplification of resistance. To address these challenges The Union in partnership with Apollo Hospital Hyderabad has developed a web-based software application to facilitate notification to the National TB Programme and provide treatment adherence support to TB patients treated in the private sector. The software links the private health facility with GoI’s TB notification portal Nikshay and simultaneously supports TB patients for treatment adherence through messages, interactive voice calls and counselling services. TB patients diagnosed and initiated on treatment at the hospital are registered into the software which automatically notifies to Nikshay. This software also provides treatment adherence support to patients through daily reminder SMS (short message service) and twice a week IVRC (interactive voice response calls) which records patients’ response on treatment regularity. The sms and IVRC are available in patient’s preferred language. In addition to the daily reminder for taking medication there are reminders for follow up visits. Patients who miss doses or do not respond to IVRC or do not come for follow up visits are followed up by a trained counsellor. Results of the pilot study During June 2015 – March 2016, 200 TB patients have been registered in the pilot project. These include 146 extra-pulmonary (73%) and 54 pulmonary (27%), 10 patients have multi-drug resistant TB (MDR-TB). 116 (58%) are male. Of the 200 patients registered 32 have successfully completed treatment while the remaining are still on treatment. Notification All 200 patients have been successfully notified to Nikshay. Impact of patient support package- Reminders through SMS/IVRS Of the 200 patients, 165 (82%) agreed for receiving SMS and IVRC. Analysis of ~3600 IVR calls shows that 95% have taken all doses and 5% missed one or more dose. All Patients who missed doses were counseled telephonically. Feedback from patients on IVRS/SMS Feedback was taken from the 165 patients on SMS/IVRS. 95% remembered having received daily sms in the last 7 days. 90% remembered that they have received and responded to at least 1 IVR calls in the last 7 days. Nearly 90% of the patients found the sms to be very helpful in reminding about drug intake and desired to continue continue receiving them. Over 90% patients did not find any problem in responding to the IVR calls and found them to be useful. 80% wanted to continue with twice a week IVR calls while 20% wanted a reduced frequency (1 call per week). Cost The total cost of daily sms and twice a week IVR calls for a period of 6 months (normal duration of TB treatment) is only Rs 120/- (less than US $2). Conclusion: Results from the pilot indicate that web based software with the patient support package developed is successfully notifying TB patients into Nikshay in real time. 95% of the patients who are receiving treatment adherence support (sms and IVR calls) are adhering to treatment. Most of the patients (90%) find the sms and IVR reminders useful and would like to continue receiving them. The pilot shows that this is an efficient and cost effective model to facilitate notification and treatment adherence of TB patients in the private sector. The software is open source and can be easily customized to integrate with the hospitals Management Information System (MIS). There are encouraging results from Apollo Hospital, thus this notification adherence system is being scaled in other hospitals.