By Judith Owoicho
Tuberculosis is a big burden in Africa. The region accounts for more than half of the 30 high-burden TB countries worldwide. In 2020, at least half a million lives were sadly lost to this curable and preventable disease in Africa.
Efforts have been made in funding and creating more testing and diagnostic options, however, in many rural villages in Africa, access to modern diagnostics facilities is a significant challenge that results in delayed diagnosis, inadequate treatment, and poor health outcomes for tuberculosis. Lack of the necessary infrastructure and resources, such as electricity, water, and transportation, to set up and operate modern diagnostic facilities continue to impede the elimination of tuberculosis in the region. More effort is required to connect rural populations with central modern diagnostics facilities for TB/HIV diagnostics and care.
Digital technology has shown significant potential in advancing disease surveillance, monitoring, management, and care. It is being applied in innovative ways to help overcome barriers to prevention, detection, treatment, and management of infectious diseases including tuberculosis, to promote treatment adherence, support learning and knowledge dissemination progress in low and middle-income countries. One of such technologies is the Health Telematics Infrastructure (HTI).
Bridging the gap between rural population and urban diagnostic facilities
eHealth Africa worked with the Charité University of Medicine to design HTI, a digital solution to improve, analyze, and evaluate the diagnosis and treatment of TB and HIV. It was implemented in St. Francis Referral Hospital (SFRH), Ifakara Health Institute (IHI) in Ifakara, and Kilombero District, Central Tanzania. The system is a low-cost open-source software solution that captures data, tracks samples, and provides healthcare workers and patients with real-time feedback via SMS. With this digital platform, nurses can access a TB Diagnostics Dashboard on an android phone to view patients' information and make decisions based on their test results. Patients or disease suspects are registered using an OpenDataKit form template, while sputum/blood samples are labeled with pre-printed QR codes to track shipment status from collection to the central diagnostic facility. Laboratory staff enter the test results into the HTI database, and rural healthcare staff/patients are informed about the availability of test results via SMS messages. So, Instead of patients traveling to facilities, samples and information are transported and managed by the HTI system, which works under low-bandwidth and unstable internet conditions, anywhere with at least 2G coverage.
Overall, the system significantly shortened the previously long turnaround time from first symptom until treatment initiation, it eliminated the paper based workflow and delayed information transmission replacing it with a digital workflow. It shortened the long distance to the molecular test facility by providing mechanisms for village level tests and it eliminated the high financial burden by moving samples and data instead of patients.
Community engagement and involvement
Digital tools such as the HTI offer viable solutions to the challenges faced by rural communities, enabling them to access high-quality healthcare regardless of their location. To ensure the success of digital solutions especially in rural communities, it is important to involve local communities in the planning and implementation process. Community engagement can help to identify the specific needs and challenges faced by rural populations, as well as the most effective ways to address them. In rural Tanzania, there was awareness creation for the communities and in addition, capacity building for community health workers. This ensured that more cases of TB were identified and the rapid spread of the disease curtailed. By involving local communities and organizations in the process, we can ensure the success of these initiatives and work towards a future where all populations have access to modern diagnostics facilities for effective management and control of infectious diseases.