March 29, 2020

Drug Adherence is key for TB elimination in India

Written by Nishant Halkarni and Rahul Doshi, Sensedose Technologies

Tuberculosis remains a disease of immense public health importance as it continues to inflict a large quantum of socioeconomic cost on the society. TB has been curable for decades now and great strides have been made in innovations for newer diagnostic and drug delivery mechanisms. All we need today is a surge in our actions to reduce the TB burden dramatically. To achieve our goals all stakeholders, need to work in synergy and all available resources need to work in cohesion for TB control.

When we started working in public health, the first thing we observed was how stigmatized the disease is. We were shocked to see that in some cultures TB is associated with witchcraft. It is also considered a curse on a family, as the illness often affects multiple generations. We have seen so much discrimination against patients on a daily basis, often by those close to them. The fear of discrimination means people with TB symptoms delay seeking help, making it much more likely that they will become seriously ill and infect others.

This perpetuates the myth that it is the TB treatment itself that causes deaths, as treatment is much less effective if left until the illness is in its advanced stages. Stigma around TB can also make people reluctant to stick with their course of treatment. The tuberculosis medication regimen is long, and unforgiving; it lasts for months, sometimes years, and the fear of being found out inflicts more psychological pain than the side effects of medications. This leads to irregular adherence to regimens, thus increasing the chances of the patient to develop resistance.

Two years ago, we met a young person suffering from MDR-TB, pursuing his engineering career while working part time. Once diagnosed with TB his main concern was his family – has he exposed his loved ones to this disease? He and his mother were heartbroken at the amount of medication he would have to consume to fight this battle. He was prescribed 11 different types of medication, to be consumed in different quantities daily. The sheer thought of looking at months’ worth of medication made him feel like he was fighting a losing battle. He lost his job, his friends and most of his close relatives. He was one of the very first MDR patients who began using our device. It is a matter of pride for us that he completed his medication regimen with 95% adherence, passed his engineering exam, and works at a civil engineering firm now.

Most women patients we meet suffer from self-stigma, low self-esteem, shame, disgust, and guilt. This can result in withdrawal from normal social interactions, shunning personal relationships, even avoiding leaving the house or adopting risky behavioural patterns. We onboarded a patient in September 2019, who had just gotten married earlier in the year and was now getting a divorce because she had TB. Another patient had to hide her medication from her in-law’s because she feared she would be kicked out of the house if they found out she had TB. Our highly modular and non-conspicuous looking TMEAD medication dispenser helped her adhere to her medication regimen in this case.

After we identified adherence as the key area where we would like to work, we started working closely on field with a diverse group of patients, and other key National Tuberculosis Elimination Program (NTEP) staff. We iterated on design and operation aspects of the intervention multiple times and finally have come up with TMEAD, a device consisting of an application, web dashboard and a medication dispenser which is smartly designed to blend into patient’s environment and does not stand out. It reminds the patient to take his medication and has helped boost adherence to 92% helping 20+ patients to fully recover.

We believe in using modular, extremely scalable, and affordable technologies, to ease the life of a tuberculosis patient. Sensedose technologies has been committed to helping end the disease with the power of innovation and collaboration, but most importantly by being empathetic to the needs of our patients and healthcare workers. We have spent several months, in the shoes of patients and healthcare workers to optimize our intervention.

With India Health Fund (IHF), stepping in and helping us to scale, we can expand our reach across district borders. The credibility that comes from association with IHF has helped open doors to agencies we never thought we could work with. The IHF team has been very supportive to the need of a start-up and has guided us through various regulatory barriers. It’s important for young start-ups to have mentors, especially if you are working in the healthcare space, and we are lucky to have found such support with IHF.

On World TB Day, we are humbled by the progress we have made over the last year and motivated to work even harder in the coming years. Reaching out to every TB patient in the country over the next two years is a quantum leap for us, but we are confident it’s a target we will strive hard to achieve. We would also take this opportunity to express our commitment to aid the government of India to achieve TB elimination by 2025 as envisioned by our Honourable Prime Minister.

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