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Monitoring and Improving Rural Tuberculosis Treatment Bill Thies Microsoft Research India

Monitoring and Improving Rural Tuberculosis Treatment Bill Thies Microsoft Research India. In collaboration with Manish Bhardwaj 1,2 , Sara Cinnamon 2,3 , Goutam Reddy 2,3 , Emma Brunskill 1,2 , Somani Patnaik 1,2 , Seema Kacker 1,2 , Sourav Dey 1,2 and Ajit Dash 1,2

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Monitoring and Improving Rural Tuberculosis Treatment Bill Thies Microsoft Research India

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  1. Monitoring and Improving Rural Tuberculosis TreatmentBill ThiesMicrosoft Research India In collaboration with Manish Bhardwaj1,2, Sara Cinnamon2,3, Goutam Reddy2,3, Emma Brunskill1,2, Somani Patnaik1,2, Seema Kacker1,2, Sourav Dey1,2 and Ajit Dash1,2 1Massachusetts Institute of Technology 2Innovators In Health 3Abiogenix, Inc. April 28, 2009

  2. Drug Delivery: Last-Mile is Broken  Rural Patients DrugDevelopers Distributors Local Clinics • TB treatment: 4 drugs, 6-8 months • Worker supervises ingestion3 times/week (DOT) • Rural programs operate in the dark • Interaction: Are workers reaching patients? • Adherence: Are patients taking medication? • Health: Are patients getting better? Courtesy PIH Courtesy PIH Our Mission: Track Interaction, Adherence, Health

  3. The uBox: A Smart PillboxDeveloped by Abiogenix, MIT, and Innovators In Health • The uBox monitors • Delivery, by logging patient/worker visits • Adherence, by logging pills dispensed • uBox impact • Worker supervision and incentives • Timely and targeted intervention • Lowers adherence burden uKey (one per patient,one per worker) uBox(one per patient) Patients Workers Clinic

  4. The uPhone: Monitoring Patient Health Worker relays vital patient health indicators using cell phone Nurseanalyzes data,identifies problems Physician sends advice to patients, schedules field visits Patient lives in a remote area

  5. Is Technology Really the Answer? • Often ignores systemic and societal issues • But, delivery is overwhelmingly about diligence • Today: 2.4M doses/day, 187 countries, 77% reliability • Need: 7M doses/day, 100% reliability • FedEx: 7.5M shipments/day, 220 countries, 97.7% reliability • Our goal is to reduce the burden of diligence • Change the culture: 85% is not enough • Need to respond to every failed transaction • Identify superstar workers early and replicate techniques

  6. Iterative Design: UBoxBihar, Jan. 2008 • Class proficient in less than 3 hours • Incorporated feedback into 9th design revision

  7. Iterative Design: UPhoneBihar, Jan. 2008 • uPhone more challenging • Despite intensive training, many errors on menu-based interface

  8. Controlled StudyGujarat, July 2008 Patnaik, Brunskill, & Thies [ICTD’09] • Compared three interfaces for health data collection Append to current SMS:11. Patient’s Cough:No Cough - Press 1Rare Cough - Press 2Mild Cough - Press 3 Heavy Cough - Press 4Severe Cough - Press 5 (with blood)— printed cue card— • 13 literate health • workers & hospital • staff, Gujarat, India

  9. Controlled StudyGujarat, July 2008 Patnaik, Brunskill, & Thies [ICTD’09] • Compared three interfaces for health data collection Result caused partners to switch from forms to operator Append to current SMS:11. Patient’s Cough:No Cough - Press 1Rare Cough - Press 2Mild Cough - Press 3 Heavy Cough - Press 4Severe Cough - Press 5 (with blood)— printed cue card— • 13 literate health • workers & hospital • staff, Gujarat, India

  10. The Case for Live Operators • Operators are good solution for mobile data collection • Benefits: • Lowest error rate • Less education and training needed • Most flexible interface • Cost effective

  11. Establishing a Treatment ProgramBihar, Oct. 2008 • Found few established DOT providers in rural Bihar • With Innovators In Health and the Prajnopaya Foundation,training local health workers and staff • Next step: controlled trial, measure impact on health outcomes

  12. Open Problem • How to prove that a health worker visited a patient? • Criteria: • Low cost • Instant notification • Fool-proof • Possibilities: • ID tags? Not fool proof. • Finger-print reading? Not low-cost? • Speaker identification? TBD.

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