One Startup is Using Phone Calls and Other Inexpensive Means To Save TB Patients (microsoft.com)

Tuberculosis (TB) is one of most common causes of death globally. In 2016 alone, more than 10.4 million people fell sick to TB and 1.7 million TB-related deaths were reported. The WHO says India, in particular, and developing markets, in general, lead the count for the occurrence of TB in the world even as the local authorities provide free and effective medications to anyone who is ill. From a report: "One of the biggest barriers to recovery from TB is medication adherence," explains Microsoft Researcher Bill Thies, who is also the Chairman and Co-founder of Everwell Health Solutions, a Bangalore-based healthcare start-up. "Patients have to take daily drugs for a full six months, or else they do not fully recover, and are at risk of developing drug resistance. While medication adherence might sound like a simple problem, it turns out to be an enormously complex and heavily studied multi-disciplinary problem. If patients start feeling better after a few weeks, how can we convince them to take toxic drugs for another five months -- especially if patients have little or no understanding of germs and antibiotic resistance?"

The popular recommended practice to ensure medication adherence is Directly Observed Treatment or DOTS, which involves the patients going to a healthcare centre where they ingest the medication in front of a health worker. As it was implemented at the start of their work, patients needed to visit the centre three times per week for the first two months and once a week for the remaining four months. The system involves an unnecessary burden on the patients, who are typically from low-income groups -- every visit means travel expense and loss of work. There are ways to ensure that a patient has taken medication on time -- we have things like smart pills, and you can send texts to people to remind them about the pills -- but in places like India, these solutions are beyond the reach of people. So in 2013, Thies and his colleagues, along with Microsoft Research Program Manager and TEM collaborator, started a project called 99DOTS to explore if any low-cost tech solution could be employed. They did find one, and it involves making a "missed call" to people. Here's the fascinating story of what happened next.

Comments

Patients made calls to verify

[_Sharp'r_]

For those who read the summary and not TFA, the solution ultimately involves putting a toll-free phone number where you have to open each pill to read it and having the patients call that number for free to confirm they took their pill, otherwise someone follows-up with them. Cheaper than having the patients have to come somewhere to get their pills on a schedule from someone who records they took it.

Re:Patients made calls to verify

[sonamchauhan]

"If the patient is not convinced of the seriousness of the illness, and that taking the medication is absolutely necessary . . . no elaborate scheme of pill taking monitoring will help."

Not really. People procrastinate, change their mind, flip-flop, reverse decisions and revert again, on a second-by-second basis.

There is a public health benefit to monitoring compliance with TB medication.

And think of it from the individual's perspective. For whatever reason, you've already done the hard yards -- you made the time, located the drugs, opened the blister packing, texted the secret phone number. So now popping the pill is a trivial job - the hard work's already done.

Re:Patients made calls to verify

[Kjella]

If the patient is not convinced of the seriousness of the illness, and that taking the medication is absolutely necessary . . . no elaborate scheme of pill taking monitoring will help.

True, but most of those problems relate to taking a new drug. These people have been ill, taken the drugs and started feeling better like they beat it. They've just gotten a bit sloppy and lazy, not developed some deeper aversion against the drug. Just like they should have eaten healthier, exercised more, taken their vitamins, flossed properly and so on but never got around to it. This is just a small reminder that finishing your cure is kinda important so they don't relapse - at least that's what you should say is in it for them. That there's also a public benefit in reducing the spread of antibiotic resistant diseases is important to us, but maybe not so much to them. Easier to say you're doing it for your own health...

Re:Patients made calls to verify

[tomhath]

Trying to get people to take the full regimen of drugs is good, and this idea seems like a reasonable approach.

But what's missing from the article is how much impact it actually had. They didn't mention what percent of patients follow through by calling every day, how many start back up on the meds after they get the nag text message, etc. When the success rate isn't given you have to wonder why.

Medication Adherence

[mentil]

This is a solved problem. Just add a little Morphine into their pills, and they'll be SURE to finish every single one. In fact, they'll be begging for more!
Seriously though, the pills can come in daily blister packs (like contraceptive pills), and the Morphine dosage can gradually reduce so they'll no longer be addicted by the end.

Re:Medication Adherence

[dcw3]

At first, I thought you were trying to be funny...sigh. This is a serious problem, and by the way, morphine doesn't work the same on everyone...it's a DNA thing. One I had to go through with my ex-wife for nearly a year because she got several months into the first round of treatment, and hated the medication. When you screw up, you have to move to a different med, and start all over.

To Save TB patients

[hcs_$reboot]

At first I read Tera Bytes... and I thought these phones are not iPhones...

TB or not TB

[RogueWarrior65]

Consumption be done about it? Of cough, of cough.
It's not the cough that carries you off. It's the coffin they carry you off in.