Infectious diseases continue to be one amongst the top ten leading causes of deaths worldwide.

 

In low-income and middle-income countries, AIDS (caused by HIV) and TB (caused by Mycobacterium tuberculosis) are a major burden. The TB and HIV co-infection has contributed to nearly half a million deaths last year. This accounts for 22% of deaths due to TB and 36% of HIV-related deaths in 2015.

Despite efforts by the World Health Organisation (WHO), global alliance programs and various foundations, the control of these two diseases has remained a challenge.

What are the challenges?

  1. Ineffective existing treatment methods
  2. Emergence of mutant drug-resistant strains
  3. Lack of new preventive and therapeutic strategies

Problems of Underreported Cases

A recent study showed the poor reporting of TB cases in private sector in India, setting off alarm bells, as there are twice as many unreported cases in public sector in India.India tops the list of countries afflicted with high TB burden and yet suffers from the lack of a unified surveillance, disease reporting and monitoring system.

TB free India

The National Strategic Plan (NSP) 2012-2017, envisioned a TB free India through new regulations in the screening, diagnosis, reporting, treatment, disease monitoring and extension of the services of Revised National TB Control Programme (RNTCP) for patients seeking treatment in the private sector. The Standards for TB care in India is based on WHO guidelines and in 2012 TB was made a notifiable disease in India. However, owing to the vast, highly unregulated and non-compliant private sector, these regulations have not yet been implemented successfully.

“Majority of AIDS-related deaths are due to TB”- WHO

40% of Indian population is infected by Mycobacterium tuberculosis, but 90-95% of these latent TB infections do not develop into active TB. TB is an opportunistic infection that surfaces in its active form in individuals with compromised immunity as in the case of AIDS Hence co-infection with HIV increases the activation of latent TB by 20 times. Likewise TB accelerates AIDS progression in HIV-infected individuals. Therefore TB and HIV co-infections are lethal as both infections act in synergy, further weakening the immune system and exacerbating disease symptoms that lead to death of affected individuals.  The co-infection further adds to the existing challenges and gaps in the detection and treatment of these diseases. The problem is compounded by a significant number of HIV positive population (2.1 million) in India.

Infectious diseases continue to be one amongst the top ten leading causes of deaths worldwide.Click To Tweet

Digital help for better health

It is imperative to develop unified and standardised strategies for creating awareness amongst the public about TB, HIV and TB-HIV co-infections. The potential of digital health needs to be tapped in order to achieve a scalable impact.

The Global Task Force on digital health for TB was established by WHO in March 2015 to promote the integration of digital health in the ‘End TB Strategy’ (end the global TB epidemic by 2035). So far this program has helped identify target product profiles (TPPs) of digital health products that have the potential to address challenges faced by TB patients and health care providers. The TPPs broadly address patient care, surveillance, program management and eLearning.

In India, where the number of mobile subscriptions have crossed the 1 billion mark in 2016, digital health via the mobile health platform (mHealth) offers great scope in advancing health care.  In fact there are a number of existing mHealth initiatives including MOTECH launched by Grameen foundation mainly for HIV patient self-care and eMOCHA TB detect app.

However, the mushrooming of too many mHealth platforms that lack an integrated approach would be ineffective in making a population level impact and result in wasteful resources and efforts.  The goal should ideally be to bring together the various scattered efforts into a one-stop digital health platform that unifies public and private health sectors.

It should provide awareness and promote patient self-care while improving the relationship of patients and their health care providers. This is especially important in tackling the TB and HIV burden in India and in raising awareness on TB-HIV co-infections that are key to realising the End TB Strategy.

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Dr Lakshmi Ramachandran is a scientific writer/consultant with interests in drug discovery and healthcare. She has a broad research background in molecular biology and drug discovery and works as a scientific writer at the MBI, National University of Singapore.