A team from Columbia University’s Earth Institute adapted Operation ASHA’s 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 in 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 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. 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.
eCompliance may be just the assistant that overworked doctors and health workers in disadvantaged areas across the world need to easily, efficiently, and successfully care for all of their at-risk patients.
Operation ASHA’s model & eCompliance system have proven their quality in India & Cambodia. In July 2012 the technology was replicated by Columbia University in the rural settings of Uganda. The innovative, low cost and efficient system has worked remarkably well and proved successful. It has helped in preventing & treating Tuberculosis in urban slums, villages & tribal areas by bringing the treatment to the doorsteps of the underprivileged at no cost.
In November 2013, one organization named “Clínica de Familia” implemented eCompliance software in the eastern Dominican Republic.
“Clínica de Familia” is a non-governmental organization, is aimed at improving the quality of life of the poorest and most vulnerable populations in the eastern Dominican Republic by providing high quality health, education, and psychological support services to those most in need, including adults and children with HIV, sex workers, and adolescents.
At Clínica de Familia, the finger printing software is being used with patients who are co-infected with HIV and TB, and are receiving both TB treatment and antiretroviral therapy at the health center. Each time a patient with TB visits the center to receive their scheduled dose, s/he scans a finger using the reader, which is connected to a netbook with the eCompliance software. At the end of each day, staff people receive an attendance log and are able to quickly follow-up via telephone and/or home visits with any patients who have missed a dose.
As of May 2013, Clínica de Familia has registered five co-infected patients into the eCompliance software, and has had extremely encouraging results. Now the clinic can easily & quickly track missed doses of the patients and do the appropriate follow-up. Of the five registered patients, two have already completed their TB treatment successfully.
OpASHA in the News