Ever since the onset of a COVID-19 pandemic, the world has had little time to think and worry about anything else. During this time one of the most vital issues the healthcare sector has had to put on hold was Tuberculosis (TB). In India, the first two waves have severely disrupted the progress in TB diagnosis and treatment and witnessed a 25% relative decrease in annual diagnosis of TB cases (during 2019 and 2020). For the first time in a decade the number of death due TB have increased. COVID-19 has derailed the progress made towards eliminating this killer disease by 2025 in India. Hence double efforts and coordination is required to meet the target set by National tuberculosis elimination program (NTEP).
How could digital technology aid in healthcare?
Digital technologies include the Internet, virtual care, platforms, remote monitoring, smart wearables, artificial intelligence, big data analytics, blockchain, tools enabling data exchange and storage and tools enabling remote data capture and the exchange of data etc. These technologies have enabled sharing of pertinent information across the health ecosystem creating a gamut of care. It also has the potential to augment health outcomes by improving medical diagnosis, data-based treatment decisions, digital therapeutics, clinical trials, self-management of care and person-centred care as well as creating more evidence-based knowledge, skills, and competence for professionals to support health care.
Digital health and tuberculosis
Digital health will be critical in helping us reach our global targets to end the TB epidemic by 2035. Digital health is a collective term for eHealth (electronic) and mHealth (mobile) technologies. Ending the global TB epidemic will require a drastic reduction in TB incidence and mortality from the current levels. Achievement of this goal will require action within three pillars as defined by WHO. Digital health interventions can contribute to all these three pillars.
1. INTEGRATED, PATIENT-CENTRED CARE AND PREVENTION
- Early diagnosis of TB, drug-susceptibility testing, and systematic screening of contacts and high-risk groups.
- Treatment of all patients with tuberculosis including drug-resistant tuberculosis, and patient support.
- Collaborative tuberculosis/HIV activities, and management of co-morbidities.
- Preventive treatment of persons at high risk, and vaccination against tuberculosis.
Digital health is contributing to this pillar by use of automated tests results, 99DOTS a low-cost mobile application for monitoring and improving medication adherence, by e-learning by staff, SMS communication etc.
2. BOLD POLICIES AND SUPPORTIVE SYSTEMS
Maximizing the benefits of health and development policies and systems, by employing a broader segment of stakeholder across government, communities, and the private sector
This is being achieved by creating platform called Nikshay 2.0, creating unique patient identifiers, e-learning for the patients, creating toll free helpline for TB patients.
3. INTENSIFIED RESEARCH AND INNOVATION
Pursuing new scientific knowledge and innovations can dramatically change TB prevention and care. This could be achieved by using mobile phones as resources for data collection, add-on hardware to smartphones to permit clinical measurement etc.
In the fight against TB, MedGenome has put all hands-on deck, wherein it offers array of tests for TB including molecular tests like GeneXpet/CBNAAT test which has revolutionized diagnosis of TB. MedGenome has also partnered with Karnataka government to perform this test on daily basis. SPIT-SEQ which is in-house developed Next Generation Sequencing (NGS) based test is a game changer in providing drug resistance testing for 18 drugs within 2 weeks of diagnosis of TB. This is especially useful because multi-drug resistant tuberculosis is major deterrent in eliminating TB in India. At Medgenome, right from booking an order for a test, till report generation is integrated in a Laboratory information system (LIMS) where report generation is automated to avoid delays and errors.
NI-KSHAY-(Ni=End, Kshay=TB) is the web enabled patient management system for TB control under the NTEP. It is developed and maintained by the Central TB Division (CTD), Ministry of Health and Family Welfare, Government of India, in collaboration with the National Informatics Centre (NIC), and the World Health Organization Country office for India. Nikshay is used by health functionaries at various levels across the country both in the public and private sector, to register TB cases, order various types of tests from Labs across the country, record treatment details, monitor treatment adherence and to transfer cases between care providers. It also functions as the National TB Surveillance System and facilitates reporting of various surveillance data to the Government of India. NIKSHAY is example how digitalization can be effective tool to control TB.
A recent study reported that United States, China and India are the major hubs of research on digital health for TB. Thus, there is rising optimism that available technological innovations can solve many of the programmatic and logistical barriers that have hindered TB control efforts, however to end the epidemic greater investment, better science, and more political will is still required.
Views expressed by Dr. Gunisha Pasricha, Principal Scientist & Infectious Disease Expert, MedGenome labs
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