Challenges in Reversing the TB Epidemic
The Tuberculosis Epidemic
Tuberculosis is the Leading Infectious Disease Killer of Women Worldwide
Tuberculosis (TB) is curable, yet 1,800,000 people died of it in 2007, mostly in indigent communities. India bears the biggest burden with 300,000 deaths a year.
Intermittent Delivery is Causing Emerging Drug resistance
Interruptions in the 6-8 month treatment may lead to drug-resistance (MDR-TB), which is 100x more expensive to treat. An estimated 500,000 patients developed MDR-TB in 2007.
Barriers to Effective Delivery
There are many impediments to reversing the TB epidemic, chief among them poverty. However, these impediments are not insurmountable, as demonstrated by programs that systematically address economic and logistical issues. Our goal is to help such effective programs scale, while reducing costs and ensuring every dose is delivered. Since 2007 we have worked with programs and their communities to identify the challenges they face in scaling.
Burden of Supervising Staff
Under current protocol, patients visit a local “provider” who supplies and records ingestion of medication. Providers are often volunteers, and are numerous and spread out. Supervision requires traveling to each provider and studying paper records to identify irregular dosing.
Inability to Authenticate Dosage Records
It is difficult to ascertain the veracity of paper records.
Delayed Notification of Missed Doses
The burden of supervision and lack of authentication often lead to long delays before programs realize that doses were missed. This precludes taking immediate action to ensure adherence.
Significant time spent on tasks that may be easily automated: record management, report generation, pharmacy tracking, scheduling follow-ups, etc.
These problems lead to poor cure rates, and inefficiencies in settings that are highly resource limited to begin with.