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Does mHealth aids to increase referrals,

early diagnosis and treatment initiation

of TB patients ? Pilot study from tribal
district in India
The Union South-East Asia Office
Dr Archana Trivedi
Background and Challenges

Rural Health Care Providers (RHCPs) are most often first

point of contact for curative services in remote areas with
limited public health services.
Identifying and ensuring testing of presumptive TB patients
is a constraint.
Paper based referral mechanism is used.
Front Line Workers often lack information about referred
chest symptomatic cases.
Validating referrals is resource intensive , time consuming &

To demonstrate effectiveness of mHealth for real time referrals, early

diagnosis & treatment initiation of TB patients in a tribal district.
Geography of implementing site

Khunti was formed in 2007 from Ranchi, the state

Population of 531,855, one lakh of which is below
poverty line (BPL)
Population is isolated with poor livelihood

RHCPs envisages a community of health worker at

village level, mobile, qualification not health related.
Mobile application developed in collaboration with
Dimagi, easily customizable
Piloted in three blocks of a tribal district (Khunti)
covering a population of 45,000.
Tracks referrals & follow up for diagnosis and treatment
of Tuberculosis efficiently.
Creates real-time central database

Two interoperable modules of the application -

1. Module for RHCPs and NGO supervisors
1. Referral form for chest symptomatics
2. Includes video with counseling messages
3. If the patient doesn't reach center within 7 days for a test, the patient,
NGO supervisor, and RHCP receive SMS with the patient information to
follow up.
4. Basic DOTs protocol support
Module for Lab Techs
Record sputum examination results at the Designated Microscopy Center
25 RHCPs are referring through mobile and 69 through non-mobile.
3 LTs using the application
Application Workflow - Tracking of TB symptomatics

NGO Supervisor

Presumptive TB Patients

Result of Sputum Examination

Results of Sputum
Referred Presumptive
TB Patients
Audio Visual Clips: Counseling messages
Key Findings

June 2013 - Sept 2016

Indicators Mobile (25) Non-Mobile (69)

Intervention arm Control arm
Presumptive TB patients identified 1302 717

Tested 976 636

Total Diagnosed (238) 146 92

Successful referrals per RHCP 41 Referrals 10

Diagnosed TB patients per RHCP 7 Reduces 2

delay in
Diagnosed within 1 day of referral 57% (n=81) 29% (n=40)
Initiates early
Initiated treatment within 7 days of 55% (n=78) 30% (n=44)
mTB for TB care & prevention (June 2013 - Sept 2016)

Mobile users 25 RHCPSs

Control group 69 RHCPSs
CommCare DEMO: UNION's TB application

Link -