Dramatic results from TB REACH project make case for mHealth scale up

14 June 2012 - Karachi, Pakistan - Mobile phones and financial incentives helped a network of private clinics serving poor communities in Karachi find twice as many people with tuberculosis (TB) in 2011 compared to the previous year.

This is the key finding of a study published today in Lancet Infectious Diseases, which reports on the impact of a project run by Karachi's Indus Hospital and funded by the Stop TB Partnership's TB REACH initiative.

The clinics provided community members with electronic scorecards on mobile phones which they used to identify people who should get a TB test. The community members received cash incentives for each person with TB that they helped to find. In addition, posters, television advertisements and flyers encouraged people with a persistent cough to visit their local clinic for TB testing.

As a result of these activities, the project identified 3140 people with TB among nearly one million people in the Korangi and Bin Qasim neighbourhoods of Karachi. This made the Indus Hospital the second largest provider of TB care in the country in 2011. In a neighbouring control area comprising the Landhi and Shah Faisal districts, which together have a similar population, the number of people referred for treatment decreased by 9%.

The study follows a paper, Pushing the Frontier, by the mHealth Alliance and the Stop TB Partnership which seeks to raise awareness about mHealth's potential to improve the reach and quality of TB care. The paper includes several examples of innovative mHealth projects and calls for more evidence on the benefits of using mHealth in TB.

"mHealth is emerging as one of the most potent weapons in the fight against TB. With these results from Karachi, there is now clear proof that using mobile phones and engaging with the private sector can help us to find and treat the estimated three million people a year that fail to access quality TB care," said Dr Lucica Ditiu, Executive Secretary of the Stop TB Partnership.

"As this project demonstrates, through TB REACH we are incubating innovations that have the potential to be scaled up through national health programmes or further donor funding," Dr Ditiu said. "We will soon issue a third call for TB REACH proposals that will launch a new wave of innovative projects, including many that feature mHealth components."

To further understanding about mHealth in TB, Interactive Research and Development (IRD), the organization which developed the scorecard used in Karachi, recently published a new report, mHealth to Improve TB Care. The report summarizes the experiences from 31 mHealth projects from around the world. The projects focused on helping TB patients stick to their treatment, enabling mobile diagnosis and raising awareness.

These early projects show great potential, the authors write. But more formal evaluations - such as those conducted in Karachi - are needed so that TB programme managers can make informed decisions on how to design and deliver their own mHealth projects.

"I know of no tool that holds as much promise as the mobile phone for closing the loop between diagnosis and successful treatment, effectively and affordably," said Aamir Khan, Executive Director of IRD. "Now we need to move towards implementing proven mHealth approaches more widely and at scale."

The Stop TB Partnership's TB REACH initiative funds innovative projects that result in early and increased detection of TB cases and ensure their timely treatment. Funded by a grant from the Canadian International Development Agency, TB REACH has so far funded 75 projects in 36 countries. The first wave of projects contributed to a 34% increase in the number of people found with TB in a population of more than 100 million people.

Read the article in the Lancet