Apollo & The Union, to integrate TB treatment at Private hospitals with Government’s Nikshay

The pilot program by Apollo & The Union, to integrate TB treatment at Private hospitals with Government’s Nikshay, gives encouraging results!

Hyderabad, March 31st, 2016: Apollo Hospitals and The Union – an international voluntary scientific organisation working against TB, HIV, asthma, tobacco and lung disease, announced the encouraging outcomes from a pilot project to integrate TB treatment rendered in the private healthcare sector with the National TB Control Program through a unique web-based software application, initiated a year ago. This innovative application which links the private health facility with Government of India’s TB notification portal Nikshay, upports TB patients for treatment adherence through messages, interactive voice calls and counselling services and thereby ensures better outcomes. The Union in collaboration with the Lilly MDR-TB partnership is implementing a project to systematically involve private health care providers in delivering effective and quality TB services in India.

The results from the collaborative project were announced by Ms. Sangita Reddy, Jt. Managing Director, Apollo Hospitals Group; Dr. Sarabjit Chadha, Deputy Regional Director, The Union – South East Asia; Ms Sunita Prasad, Programme Manager, Lilly MDR-TB Partnership and Dr. Suneetha Narreddy, Consultant Infectious Diseases, Apollo Health City, at a Press conference on Thursday at Apollo Hospitals.

As part of the pilot study during June 2015 – March 2016, 200 TB patients have been registered and all 200 patients have been successfully notified to Nikshay. These included 146 extra-pulmonary (73%) and 54 pulmonary (27%), 10 patients have Multi-Drug Resistant TB (MDR-TB). 116 (58%) are male. Of the 200 patients 32 have successfully completed treatment while the remaining are still on treatment.

Impact Of Patient Support Package- Reminders Through SMS/IVRS
Of the 200 patients, 165 (82%) agreed for receiving SMS and IVRC (Interactive Voice Response Calls). Analysis of ~3600 IVR calls shows that 95% have taken all doses and 5% missed one or more dose. All Patients who missed doses were counseled telephonically.

Feedback From Patients On IVRS/SMS
Feedback was taken from the 165 patients on SMS/IVRS. 95% remembered having received daily SMS in the last 7 days. 90% remembered that they have received and responded to at least 1 IVR calls in the last 7 days.

Nearly 90% of the patients found the SMS to be very helpful in reminding about drug intake and desired to continue receiving them. Over 90% patients did not find any problem in responding to the IVR calls and found them to be useful. 80% wanted to continue with twice a week IVR calls while 20% wanted a reduced frequency (1 call per week).

Cost
The total cost of daily SMS and twice a week IVR calls for a period of 6 months (normal duration of TB treatment) is only Rs 120/- (less than US $2).

Conclusion:
· Results from the pilot indicate that web based software with the patient support package developed is successfully notifying TB patients into Nikshay in real time.

· 95% of the patients who are receiving treatment adherence support (SMS and IVR calls) are adhering to treatment. Most of the patients (90%) find the SMS and IVR reminders useful and would like to continue receiving them.

· The pilot shows that this is an efficient and cost effective model to facilitate notification and treatment adherence of TB patients in the private sector.

The software is open source and can be easily customized to integrate with the hospitals Management Information System (MIS). There are encouraging results from Apollo Hospital, thus this notification adherence system is being scaled in other hospitals.

About TB
Tuberculosis is gaining epidemic proportions causing nearly 1.5 million deaths each year, mostly in developing countries. According to statistics available, India alone accounts for a fourth of the new cases of TB detected globally every year, India has 2.2 million new cases of the 8.6 million worldwide. This airborne disease kills about 1000 Indians every day and is therefore considered as India’s biggest health crisis. One of the reasons aggravating the rise in incidence is lack of integration of TB program with the private healthcare sector which handles 50% of TB patients in India, besides let up on constant vigilance, effective surveillance and monitoring. Often patients reporting at private clinics or hospitals after initial relief from the disease are off the treatment radar, resulting in non-compliance of treatment, while that being the crucial period for vigorously follow up and monitoring. Such patients also end up spreading the disease in the community and amplifying the resistance.

The World Health Organization (WHO) through its Stop TB Strategy has been engaging relevant health-care providers through public-private and public-public mix approaches in tuberculosis care and control. Well known global organization working in this arena – The Union, in collaboration with the Lilly MDR-TB partnership is implementing a project to systematically involve private health care providers in delivering effective and quality TB services in India.

As part of this initiative Apollo Hospitals is working on improving tuberculosis notification, adherence to treatment and bettering outcomes, in partnership with The Union and has launched a website – http: //www.ahtts.in/. The software linked with the Nikshay project, helps in reminding patients through regular SMS to take medicines, in addition, the integrated voice response tool monitors the treatment adherence.

To address these challenges The Union in partnership with Apollo Hospital Hyderabad, with support from Lilly MDR TB partnership, has developed this web-based software application to facilitate notification to the National TB Programme and provide treatment adherence support to TB patients treated in the private sector. The software links the private health facility with GoI’s TB notification portal Nikshay and simultaneously supports TB patients for treatment adherence through messages, interactive voice calls and counselling services.

TB patients diagnosed and initiated on treatment at the hospital are registered into the software which automatically notifies to Nikshay. This software also provides treatment adherence support to patients through daily reminder SMS (short message service) and twice a week IVRC (interactive voice response calls) which records patients’ response on treatment regularity. The sms and IVRC are available in patient’s preferred language. In addition to the daily reminder for taking medication there are reminders for follow up visits. Patients who miss doses or do not respond to IVRCor do not come for follow up visits are followed up by a trained counsellor.