Mobile solutions to treating MDR-TB

Leveraging innovation to increase adherence support to drug-resistant Tuberculosis patients in Eswatini: Video-enabled Directly Observed Therapy

‍

Emergency medical relief organization Doctors Without Borders/Médecins SansFrontières (MSF) has been treating tuberculosis (TB) patients for over 30 years. TB is a deadly infectious disease often thought of as a disease of the past. But the spread of drug-resistant forms makes it very much an issue of the present. Almost half a million people develop multidrug-resistant strains of the disease every year.

Monitoring treatment to ensure adherence is vital for people with multidrug-resistant TB. In fact, inconsistent treatment can cause further mutations, which in turn may lead to extensively drug-resistant – or worse, completely drug-resistant – strains of TB. This can leave patients with few or no effective medication for treatment. While monitoring is critical, frequent in-person visits to a health centre or in the patient’s home can be a major disruption to their lives, including the inability to retain employment.

Capitalizing on an ever-increasing technology literacy, MSF has introduced asynchronous Video Observed Therapy (VOT) to support treatment adherence among patients with drug-resistant TB. The tool is designed to help patients take their medication as prescribed, without a regular visit to a healthcare provider. Using a dedicated mobile application, patients record each administration of medication and share the videos with their healthcare provider. Results can be reviewed by the healthcare provider through a web-based dashboard, whereby adherence status can be assessed and immediate feedback can be given as required.

Not only is this an efficient and cost-effective solution for patients who have access to a smartphone, it also provides assurance to healthcare providers that patients are supported and successful in treatment. Patients are able to complete their daily tasks in a private and convenient manner. Results to date have shown excellent adherence of about 50 patients.

More broadly, through video and an interactive mobile application, this project aims to accommodate the needs of remote rural communities and decrease the burden, both economic as well as logistic, on chronic patients. By providing remote healthcare services of this nature, MSF is contributing to a patient-centred approach of healthcare support, widening access to care for communities at risk of exclusion. Madiro’s grant will contribute to the MSF pilot program to be scaled nationally in Eswatini by 2024.