The Desmond Tutu TB Centre (DTTC) recently received substantial funding from the Bill and Melinda Gates Foundation for an initiative to address some of the challenges of tuberculosis (TB).
South Africa had the highest TB incidence in the world in 2016, with 781 per 100 000 population. TB is the country's leading cause of death.
A research team from DTTC at Stellenbosch University's (SU) Faculty of Medicine and Health Sciences (FMHS) has been awarded a research grant of US$1,4 million (approximately R19 million) for a project aimed at reducing initial loss of follow up of TB patients in South Africa.
The project, named the LinkedIn study, will be jointly led by Prof Anneke Hesseling, director of the DTTC, housed in the FMHS' Department of Paediatrics and Child Health, and Dr Muhammad Osman, also from the DTTC. Another key team members is Dr Sue-Ann Meehan, who recently completed her PhD at the DTTC.
The LinkedIn study aims to produce a solution to reduce the initial loss to follow up (ILTFU) for TB patients. “ILTFU refers to patients who have already accessed health services and have been diagnosed with TB, but due to many reasons, are not notified to the TB program and are usually not on TB treatment. ILTFU TB patients are not counted as TB cases in the national TB program since they do not appear on TB treatment registers (the current surveillance tool to count the number and type of TB cases in South Africa). This is a serious concern, both to individual patients as well as to the health system," explains Osman.
“For patients, having a known diagnosis of TB and not being appropriately treated can have serious consequences, including death. For health systems, this results in underreporting of the TB burden in South Africa and ongoing TB transmission in communities," says Osman. “In our project, we will attempt to ensure all patients diagnosed with TB are automatically notified and appear in TB registers and thereafter attempt to link the patients with care at the appropriate facility."
LinkedIn will be implemented in the Western Cape, KwaZulu-Natal and Gauteng provinces. It will make use of, and strengthen existing TB reporting systems, which include online databases of patients diagnosed and notified on TB treatment, for the notification component. According to Meehan, these systems will be automated within the current health system, meaning that they will not create redundant parallel systems. “This is important, making the intervention more easily sustainable going forward," she says.
Osman explains that for the alert and response system, they will be developing an online application which will record the notifications and be able to SMS and trigger voice calls to patients. The system will vary in the three provinces. “At the most basic level, it will be able to trigger one-way SMS reminders to a patient about TB results, appointments at the facility, and their individual need for follow up. We will add more complexity that will allow two-way SMSs where patients can respond and engage with the system. In the Western Cape we will also try and integrate the notification system with a social media application, such as WhatsApp." Although mobile health has been used previously for other health issues, Meehan says this study is novel in that it's a first to use automated systems to address ILTFU amongst TB patients.
The study is also in line with the South African National Department of Health's (DoH) priority to find missing TB patients. “This is one of three funded studies that grew out of discussions from the newly formed South African TB Demonstration, Scale and Sustainability consortium, funded by the Bill and Melinda Gates Foundation, the South African Medical Research Council, and TB REACH," Meehan adds. Hesseling emphasises that these unique national level collaborative projects, offer potential real, practical and sustained benefits to TB patients and services in South Africa.
The allocation of the funds allow the DTTC team to demonstrate impact of the project in three provinces in a relatively short time-frame. The project is currently in its preparation phase and is expected to be implemented in the field in 2019. “Every project comes with its own challenges, and for this one it will be the limited time-frame. We'll need to hit the ground running," Meehan highlights.
Final results are expected to be available in early 2020. “The hope is to take positive results to implementation at scale at a national level," Hesseling concludes.