Though more than 3,500 people worldwide died of tuberculosis (TB) today, you won't see it reported in headlines of any major American newspaper. Neither will you see that March 24 is World TB Day simply because for many Americans it is a disease that doesn't hit home, but this could quickly change. Drug-resistant strains of TB, the most deadly and costly form of the illness, had a brief moment in the spotlight in 2007 when an American lawyer made headlines after making several international trips while infected with multidrug-resistant TB (MDR-TB), a strain of TB resistant to the two most potent TB antibiotics.
Drug resistant TB, like drug susceptible TB, is spread through the respiratory system simply by breathing the infectious particle coughed by a sick patient. It was a worrisome situation for the hundreds of people who were exposed to the drug-resistant strains while travelling on the same airplanes as the MDR-TB patient. Just last month, the CDC was searching for more than 4,500 people in the LA area that had been exposed to the disease.
In 2011, there were nearly 11,000 reported cases of TB in the U.S., and 1.
3 percent of these cases were multidrug resistant. Despite this, tuberculosis and tuberculosis resistance is not considered a major issue in the United States. Drug-resistant TB cases are on the rise: the World Health Organization predicts that by 2015, there could be as many as 2 million drug resistant cases around the world.
Drug resistance occurs when patients are not compliant with their drug regimen. But patients are often not to blame for TB drug resistance. Drug resistance regularly occurs by the failures of resource strained health care systems to ensure treatment completion.
Drug susceptible TB requires a six-month minimum treatment time, during which the patient must take a daily cocktail of drugs with several unpleasant side effects. Following only a few months of the treatment, usually as early as two months, the symptoms of tuberculosis tend to wane off -- but the side effects of the drugs remain. This leads patients to discontinue treatment early in the absence of a strong health care support system to ensure their follow-up.
While there are drugs on the horizon that promise a shorter treatment time, they are still currently not available for use. Drug resistance cannot wait and requires an immediate response. This problem is particularly poignant in resource-limited settings where TB is most prevalent.
In the developing world, most of the medical record systems are still in paper-based formats. Human error and omissions in the paper records provide ample opportunity to lose patients to follow-up, especially during treatment times of six months as required for TB patients. So how do we fix this?
Operation ASHA, an NGO based in New Delhi, India has developed one solution called eCompliance, an electronic, biometric tool to ensure that health workers can accurately follow-up with all TB patients. It is comprised of a software system on a simple notebook computer combined with a fingerprint scanner, all for a low cost of less than U.S.
$250 per clinic. eCompliance works by using the patient's fingerprints to record daily visits each time the patient comes to the clinic for a dose of medication. When the health worker observes a dose, they scan the patient's finger and the visit is automatically entered into a simple compliance log that allows healthcare workers to not only view each patient's history, but also to easily access a list of patients that have missed a daily dose.
Health workers do not have to waste time thumbing through individual records of each patient. Instead, they easily find their patients, administer therapy, and provide the educational support that is need. The system has already been proven to work effectively and efficiently in dense New Delhi slums.
Operation ASHA has 26 clinics utilizing the system and less than three percent of patients are lost to follow-up. But is this successful system transferable when the distance between the healthcare worker and the patient's home is more than one kilometer? A team from Columbia University's Earth Institute decided to test this exact question by taking the system to the opposite extreme of the India model.
We adapted the Operation ASHA strategy for a rural African setting in Uganda. In that context, patients no longer go to the clinic while on TB treatment, but rather a community health worker goes to the patient's home with an eCompliance system to observe the patient taking the drugs and record the drug intake. Our team implemented three systems (notebook fingerprint scanner) in the Millennium Villages Project in Ruhiira, in the rural southwest of Uganda and trained three community health workers (CHWs) on the process of eCompliance.
Some changes in the system were necessary to adapt to local constraints. For example, unlike urban India where the systems were clinic-based, the CHWs have to ensure the system's battery is always fully charged since electricity access is often not readily available and road quality or lack thereof means travel can be long and difficult. Yet, even with these added challenges, the system has proven to be successful.
Now the CHWs are able to easily and accurately identify when a patient has missed a dose and have a conversation with them to ensure that they do complete treatment, instead of missed doses going unnoticed and resulting in loss to follow-up. That is not to say that a patient never misses a meeting for observation, it is impossible to avoid all obstacles in a six-month plus period; events such as funerals or patient travel occasionally lead to a missed record. The results in Ruhiira are a staggering improvement.
The cluster of villages has a population of about 50,000. In 2011, the most recent year with full data, there were 52 TB cases diagnosed and placed on treatment and eight patients died. The eCompliance compliance system was implemented in July 2012; since then, 31 patients have been enrolled in the system, none of those patients have been lost to follow-up, and none have died.
Perhaps more importantly, the community and the patients are excited about the system. When the project was first implemented, the mother of one patient said she could not thank the eCompliance team enough for taking care of her son. She insisted that they take a few valuable pineapples as a gesture of her appreciation.
Another health worker reported that community members told him how much they appreciated both him and the system. Now they can rely on him to always check on the health and treatment status of patients. In areas of the cluster where the system doesn't yet reach, patients are asking when they will get the new technology.
These results are remarkable, and mean better TB patient care not only for the Ruhiira village cluster, but also for TB follow up rates worldwide. If systems like eCompliance work in areas as different as dense urban Indian slums and sprawled rural Ugandan villages, we may be able to halt the increased incidence of drug resistant cases. Stopping the incidence of drug resistance in India or Uganda may seem like an issue that is not relevant to those of us in the United States.
But today it is more true than ever that TB anywhere means TB everywhere. The American lawyer likely picked up MDR-TB while doing development work. But the transfer of TB can be even more indirect.
As globalization grows, and the number of people travelling increases, it is more important than ever to stop TB drug resistance and stop the spread of this deadly epidemic. Moreover, the benefit of eCompliance is not limited to tuberculosis alone. There are other medical issues where the largest challenge to success is ensuring patient follow-up, particularly in resource-scarce settings.
Other opportunities include ensuring delivery of consistent antenatal care to pregnant women, recording childhood vaccinations, and aiding prevention of HIV transmission from mother to child. eCompliance may be just the assistant that overworked doctors and health workers in disadvantaged areas need to easily, efficiently, and successfully care for all of their at-risk patients, including in the United States. With a solution available, why are we continuing to ignore the problem?
Dr. Shelly Batra, co-founder and President of Operation ASHA, helped contribute to this article.
{"site":{"site_id":3457,"site_type":11,"site_domain":"yfisher.com","domain_mode":1,"original_domain":"yfisher.com","language_code":"hmn","is_init_domain":0,"is_shop":true,"is_ssl":1,"lang_prefix":"/","animate_name":"none"},"page":{"page_id":69402,"page_type":"ai_article_detail","page_code":423,"page_url":"/ai-article/harnessing-new-technologies-to-tackle-an-old-disease.html","page_source":"","allowAnimat":0,"content_id":472,"content_type":5,"detail_thumb":"","detail_title":"Harnessing New Technologies to Tackle an Old Disease","detail_id":26171,"moq":1},"translateList":{"A new item has been added to your Shopping Cart":"Cov khoom tshiab tau ntxiv rau koj lub tawb nqa khoom","account":"chaws ceev nyiaj","Account Name":"Npe Npe","Account Number":"Tus lej nyiaj","Account is not exists":"Tus account tsis muaj","account security":"Tus Account Security","Active Commission":"Haujlwm Saib Xyuas Haujlwm","Add a review on the product":"Ntxiv cov tshuaj xyuas ntawm cov khoom","Add to":"Ntxiv rau","Add to Cart":"Ntxiv rau lub tawb","address book":"Phau Ntawv Chaw Nyob","affiliate links":"kev sib txuas kev sib txuas","all":"tag nrho","All Orders":"Txhua daim ntawv xaj","Already commented":"Twb tau tawm tswv yim","Are you sure to cancel this withdrawal?":"Koj puas paub tseeb tias rho tawm no tshem tawm?","Are you sure to delete the selected items?":"Koj puas paub tseeb tias rho tawm cov khoom xaiv?","Are you sure you want to delete it?":"Koj puas paub tseeb tias koj xav rho tawm nws?","Awaiting Payment":"tos them nyiaj","Awaiting Shipment":"tos cov zaub mov xa tuaj","Back":"Nram ntej","Bank Transfer":"Lub txhab nyiaj hloov chaw","bank address":"chaw nyob nyob nruab nrab","basic information":"Cov Lus Qhia Yooj Yim","Buy":"Yuav","Buy Now":"yuav tam sim no","bank name":"Lub Npe Lub Npe","city":"nroog","Copy successful":"Luam ua tiav","Copy failed":"Luam tsis tiav","Can Extract":"Tuaj yeem rho tawm","Currency Type":"Txiaj Hom","Cancel":"tshem","Cancel the success":"Ncua Txoj Kev Zoo","Cancelled":"Tshem tawm","Choose a country":"Xaiv lub tebchaws","Choose Coupon":"Xaiv daim coupon","Choose items":"Xaiv cov khoom","Clear":"Meej","Clear Search":"SOUR SEAM","Comment Successful!":"Tawm tswv yim ua tiav!","Comment Failed!":"Tawm tswv yim tsis ua tiav!","Commission Details":"Cov Lus Qhia Txog Cov Lus Qhia","Commission":"Nyiaj","Commission Status":"Commission li cas","commodity payment":"Kev Them Nyiaj Them","completed":"completed","Completed":"ua tiav","Condition not met":"Mob tsis tau ntsib","Confirm":"Pom zoo","Confirm password is inconsistent with new password":"Paub meej tias lo lus zais yog tsis sib haum nrog tus password tshiab","Congratulations":"Kev qhuas","Congratulations! You are got a coupon.":"Pab kev zoo siab! Koj tau txais ib daim coupon.","Congratulations! You are got all coupons.":"Pab kev zoo siab! Koj tau txais tag nrho cov coupons.","Continue":"mus txua ntxiv","Continue Shopping":"Kav tsij txuas ntxiv mus","Copy the code and use it directly in the shopping cart.":"Luam cov cai thiab siv ncaj qha rau hauv lub tawb nqa khoom.","Country":"lub teb chaws","Coupon code":"Daim coupon code","Coupon List":"Daim Ntawv Teev Npe","Date":"Hnub tim","days after receiving":"hnub tom qab tau txais","Design customization":"Tsim Kho Customization","Do not use any discount":"Tsis txhob siv ib qho luv nqi","Earliest":"Ntxov","Export successful":"Kev xa tawm","Export failed":"Export tsis tau","email":"tus email","email format does not match":"email hom tsis phim","Estimated Delivery Time":"Kwv yees tus me nyuam","Effective Order Count":"Siv tau zoo suav","Effective Sale Amount":"Muag Khoom Siv Tau","Expense":"Siv nyiaj","expired":"sij hawm","export a report?":"Export ib daim ntawv tshaj tawm?","Failed to upload files.":"Failed to upload files.","FAQ":"FAQ","Find Parts":"Nrhiav qhov chaw","for order over":"rau kev txiav txim tshaj","Free":"Dawb","Free Quote & Information Request":"Pub Dawb Tso & Thov Cov Ntaub Ntawv","Free Shipping":"Dawb shipping","Get":"Tau","Get coupons":"Tau Txais Coupons","Get discount":"Tau txais luv nqi","Get it":"Tau txais nws","Get it after logging in and use it in the shopping cart.":"Tau txais nws tom qab nkag mus rau hauv thiab siv nws hauv lub tawb nqa khoom.","Go to Page":"Mus rau nplooj","Highest Price":"Tus nqi siab tshaj plaws","home":"lub tsev","Hot Sale":"Kub Muag","Income":"Nyiaj tau","Incorrect form format":"Daim foos tsis raug","inquiry":"kev noog","join guide":"Koom Tes Qhia","Last 30 days":"Kawg 30 hnub","Last 7 days":"Kawg 7 hnub","Links report":"Txuas Daim Ntawv Tshaj Qhia","Loading":"Qho chaw thau khoom","Lowest Price":"Tus nqi qis tshaj","Match Product":"Phim Khoom","Merchant Free Shipping":"Tus tub lag luam dawb shipping","message":"zaj lus","Most Popular":"Feem ntau nrov","my account":"kuv tus account","my coupons":"Kuv daim coupon","my inquiry":"kuv kev nug","my orders":"kuv xaj","my reviews":"kuv cov kev txheeb xyuas","my wishlist":"kuv xav tau","name":"lub npe","New Arrival":"Tuaj Txog Tshiab","Newest":"Tshiab","No Quotation":"Tsis muaj nqe lus","No time limit":"Tsis muaj sijhawm txwv","Not deleted":"Tsis tshem tawm","not valid yet":"tsis siv tau","Off":"Tawm","Offers and Discounts":"Muab thiab luv nqi","ok":"ua li cas","Only DOC,DOCX,PDF,PNG,JPEG and JPG files can be uploaded":"Tsuas yog Doc, DOCX, PDF, PNG, JPEG thiab JPG cov ntaub ntawv tuaj yeem tso tawm","optional":"yam ua tau","order notes":"Kev Txiav Txim Siab","Order over":"Txiav txim dua","order id":"Txim ID","order status":"Kev txiav txim siab","order amount":"Tus Nqi","Orders Report":"Cov lus txib tshaj tawm","Other":"Lwm","Password contains at least numbers and letters length should be 6-20":"Lo lus zais muaj tsawg kawg zauv thiab ntawv ntev yuav tsum 6-20","Password is invalid":"Lo lus zais tsis raug","Password length should be 6-20":"password ntev yuav tsum 6-20","Paypal":"Paypal","paypal payment":"PayPal Them","Pending":"Tseem tsis tau paub","Pending Commission":"Tseem tos cov neeg ua haujlwm","personal info":"Tus Kheej Cov Ntaub Ntawv","Please click ’click to continue’ to retry.":"Thov nyem \"Nyem txhawm rau txuas ntxiv mus\" kom rov ua haujlwm.","Please contact customer service for cash withdrawal":"Thov hu rau cov neeg siv kev pabcuam rau nyiaj rho nyiaj","Please enter a valid email address":"Thov sau tus email chaw nyob siv tau","Please enter the verification code":"Thov sau tus lej pov thawj","Please login in first":"Thov ID nkag mus ua ntej","Please select attribute":"Thov xaiv tus cwj pwm","Please select country/region":"Thov xaiv lub tebchaws / thaj av","Please select superior":"Thov xaiv zoo dua","Please select the number of ratings.":"Thov xaiv tus naj npawb ntawm kev ntsuas.","Please select your country":"Thov xaiv koj lub teb chaws","Please upload the invoice file":"Thov upload cov ntaub ntawv invoice","Processing":"Tab tom ua","Product Name":"Khoom npe","Please fill in the delivery address before selecting the payment method":"Thov sau rau qhov chaw nyob xa khoom ua ntej xaiv txoj kev them nyiaj","promotion center":"Chaw Ua Haujlwm","Promotion Link Click Amount":"Kev Txhawb Txuas Kab Xov Tooj Nyem Qhov Nyiaj","Promoted link clicks":"Txhawb Txuas Nyem","Promotion Order Count":"Kev Tshaj Tawm Kev Cia","Promotion Reports":"Cov Ntawv Qhia Txog","read more":"Nyeem ntxiv","Received commission":"Tau Txais Commission","Refund":"Kev them nyiaj rov qab","Refuse":"Tsis yuav","Region":"Cheeb tsam","Register Success":"Sau npe txoj kev vam meej","Remittance":"Kev xa nyiaj rau luag","Reviews":"Xyuas","reports":"qhia","Sale ends in":"Muag xaus rau hauv","Save in wishlist":"Txuag hauv kev xav","Search":"Kev tshawb nrhiav","swift code":"SWIFT code","Select how to share":"Xaiv Yuav Qhia Li Cas","Select premium items to increase your chances of making money":"Xaiv cov khoom hwm hwm kom ua kom koj muaj feem tau txais nyiaj","Share items to your channels.when other purchase a from your link, you can get commission.":"Qhia cov khoom rau koj cov channels.Thaum lwm yam yuav khoom ntawm koj link, koj tuaj yeem tau txais Commission.","Share Product":"Qhia tawm cov khoom","shipment successful":"Kev xa khoom tau ua tiav","Shipping":"kev xa mus","Shipping Address":"Chaw Nyob Xa Khoom","Size guide":"Phau Ntawv Loj Loj","Small Text":"Cov ntawv me","Small Title":"Cov npe me me","Sort By":"Txheeb los ntawm","Sales Amount":"Tus nqi muag","State/Province/Territory":"Xeev / Xeev / Thaj Chaw","Successfully delete":"Ua tiav kev rho tawm","Successfully save":"Ntse cawm","Thank you for trying":"Ua tsaug rau koj sim","The account has been deactivated, please contact customer service to activate":"Tus as khauj tau txiav tawm, thov hu rau cov neeg siv kev pabcuam rau kev ua haujlwm","the content can not be blank":"Cov ntsiab lus tsis tuaj yeem tsis yog","The coupon code has been copied and used in the shopping cart.":"Daim coupon code tau raug theej thiab siv nyob rau hauv lub tawb nqa khoom.","The file name cannot exceed 100 characters":"Cov ntaub ntawv npe tsis pub dhau 100 cim","The file size cannot exceed 2MB":"Cov ntaub ntawv loj tsis pub dhau 2MB","The number of withdrawals on the day has been capped":"Tus naj npawb ntawm kev rho tawm rau hnub tau raug txiav","The subscription is successful, thank you for your participation":"Cov npe yuav ua tiav, ua tsaug rau koj kev koom tes","The user center is out of service. Please contact customer service":"Tus neeg siv lub chaw yog tawm ntawm kev pabcuam. Thov hu rau cov neeg siv kev pabcuam","There is no amount to withdraw":"Tsis muaj tus nqi rho tawm","There is no data to export":"Tsis muaj cov ntaub ntawv xa tawm","This is Text":"Nov yog ntawv nyeem","This is title":"Qhov no yog npe","This transaction has failed.":"Qhov kev sib pauv no tau ua tsis tiav.","Time to shop":"Lub sij hawm mus kav khw","Tips":"Cov Lus Qhia","To be commented":"Kom tau hais tawm","Total":"Tag nrho","Tutorial":"Kev qhia ua","This Supplier/Shipping Company does not deliver to your selected Country/Region.":"Cov chaw muag khoom / xa khoom xa tawm tsis xa rau koj lub tebchaws xaiv / thaj chaw.","Update password success":"Hloov tshiab lo lus zais kom tiav","Upload Image":"Upload duab","Upload up to 6 pictures":"Upload li 6 daim duab","uploading":"thau","used":"siv","user center":"Tus Neeg Siv Chaw","Upload Invoice":"Upload Invoice","valid now":"Tam sim no","Validity period":"Lub sijhawm siv tau","View Cart & Checkout":"Saib Laub","views":"feem views","Valid for":"Siv tau","Welcome to the website":"Txais tos rau lub vev xaib","Western Union":"Sab hnub poob","When your buyers received and confirmed orders, you can get commission right now!":"Thaum koj tus neeg yuav khoom tau txais thiab paub tseeb tias cov xaj, koj tuaj yeem tau txais Commission tam sim no!","Withdrawal":"Kev rho tawm","Withdrawal success":"Rho tawm txoj kev vam meej","Withdrawal Method":"Kev rho tawm txoj kev","Write a Review":"Sau tus saib xyuas","Withdrawal Amount":"Thim Nqi","Yes":"Tau","Yesterday":"Nag hmo","You are clicking too fast":"Koj tau nyem nrawm heev","You are got a coupon.":"Koj tau txais ib daim coupon.","You can select a maximum of 90 days":"Koj tuaj yeem xaiv qhov ntau kawg ntawm 90 hnub","You can withdraw the commission to your Paypal account.":"Koj tuaj yeem thim cov commission rau koj tus lej PayPal.","You haven’t chosen an address yet":"Koj tsis tau xaiv qhov chaw nyob tsis tau","You haven’t selected a product yet":"Koj tsis tau xaiv cov khoom tseem","Your rating":"Koj qhov kev ntaus nqi","Your review":"Koj Rov Ntsuam Xyuas","Your shipping address error":"Koj qhov chaw nyob xa khoom yuam kev"}}