eDOTS Revolutionizing Tuberculosis Treatment
Description
Operation ASHAs eDOTS initiative is enhancing tuberculosis (TB) control by implementing biometric attendance terminals at its treatment centers. Because patients who default on their medicines are likely to develop multi-drug resistant TB (MDR), patient adherence to standard tuberculosis medicines is essential. In response to the rising epidemic, the WHO implemented the DOTS program, which requires patients to travel to TB clinics and take their medicines under the observation of a health worker. eDOTS works similarly to the DOTS program, but requires patients to register their attendance on a fingerprint reader when they take their medicines. At the end of each day, the attendance record from every terminal is sent to our database via text message. On the occasion that a patient misses his or her dose, a notifying text message is sent from the terminal to the responsible health worker and supervisor. Once the SMS is sent, the health worker has 48 hours to deliver TB medicines and acquire the fingerprint of the defaulting patient as proof of the visit. EDOTS focuses health consultation on the patients who need it most, while providing indisputable verification that a patient was physically present for the treatment.
What we deliver
eDOTS delivers the most reliable method of tracking tuberculosis treatment to slum areas. TB has been a difficult disease to fight in these areas because of population density and a low level of health education. TBs symptoms subside after the first two months of treatment, and patients often fail to complete the full 6-7 month regimen. In response to this behavior, eDOTS digitally tracks patient adherence, and ensures that patients are physically present to take their medicines. Although this system can be applied to any demographic, it will be the most effective in areas with minimal resources to direct towards tuberculosis control. While the system does not take the place of provider-to-patient interactions, eDOTS can act as a supervision tool when a health worker is not present.
Whom we deliver
Tuberculosis patients receive the majority of the benefits from the eDOTS innovation. 70-90 patients interact with the terminal 1-3 times per week. Since OpASHA focuses on disadvantaged communities, these patients generally have minimal health education and resources. Operation ASHAs health workers are the primary users of eDOTS. They will interact with the system on a daily basis. Since many of these individuals are illiterate, these terminals are designed with minimal text and utilize color coding. Program managers and database managers utilize the back-end of the system. When the daily records are submitted to the online server, database managers are responsible for analyzing and reporting the overall program performance from the information. Program managers are responsible for ensuring that their health workers follow up with defaulting patients and assessing other counselor performance indicators.
Why is the project unique?
Operation ASHAs eDOTS initiative is the first to apply biometric attendance monitoring to tuberculosis treatment. No other TB control system can provide verifiable evidence to back up their TB statistics. The innovations transparency and accountability are two of its strongest aspects. While other TB programs have digitized their systems, these programs rarely cater to impoverished areas, relying on the internet or 3G networks to relay information. eDOTS is the first TB control system to leverage SMS to coordinate records. Other health institutions have implemented biometric programs, but most have created systems exclusive to their own operations. Their biometric terminals often use customized hardware and run on copyright-protected software that can only be used with their system. eDOTS on the other hand, is unique because of its focus on replicability by using only commercially available components and open-source code.
Roadmap
Currently, 26 eDOTS terminals are operational. The next step in the project will be expanding into the remaining 140 Operation ASHA centers. The beginning of this expansion will begin October 3, 2011, where 11 new terminals will be installed in Rajasthan. As eDOTS expands, post-implementation data will be compared to pre-implementation data to assess the effectiveness of the program. Development is currently underway to add audio to Version 2.1 of the eDOTS software. When users hover the mouse over an icon, the system will state the icons name in the local language. This will make eDOTS easier to use by illiterate health workers. Since there are few icons in the system, less than 20 recordings will be needed to translate the device into a new local language. Similarly, we are increasing the ease-of use in illiterate areas by adding symbols to the interface. Patients will be identified by a symbol, which will correlate with the symbol on his or her medicine box. When a patient logs a visit at a terminal, the symbol will appear next to the patients’ name, and the health worker can retrieve the appropriate box. Looking further, we are also planning on moving the eDOTS software to the Android operating system so that it can be used on smart phones and tablets. This will make the system more mobile, easier to use, and will decrease the amount of components used. The current system, which has three components that are attached with USB cords and two power cords, will be consolidated into two components with a single power cord. Many health workers who have never used a laptop have commented that the notebooks track pad is not intuitive to use. Touch screen technology will be much more accessible for health workers, and will provide them with the fundamental skills to use mobile technology. Moving the software to the android platform will significantly reduce the cost of an eDOTS terminal.
Contact
Sandeep Ahuja
Operation ASHA
G-26, First floor, Kalkaji
New Delhi, India
110019
URL/Website – http://opasha.org
