Across Africa and Asia, affordable smartphones, digital technology, and the connective power of the internet are transforming health delivery. Countless blogs, policy briefs, and academic reports highlight the positive impact of digital solutions on health outcomes in low- and middle-income countries.
And yet, in some of these same settings, tuberculosis continues to have rampant and devastating consequences. TB kills more people than any other infectious disease, inflicting unconscionable suffering on some of the most vulnerable and marginalized communities.
To end the epidemic demands greater investment, better science, and more political will. There is also rising optimism that available technological innovations can solve many of the programmatic and logistical barriers that have hindered TB control efforts for the past 25 years.
Highlighted in the “Building a tuberculosis-free world: The Lancet Commission on tuberculosis,” released March 20, new technologies, both established and emerging, have the potential to revolutionize TB care for those that need it most.
Taking the conversation on ethics and technology beyond Silicon Valley
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Person-centered care
In most high-burden countries, numerous barriers to care prevent the most vulnerable patients from accessing the services needed to get diagnosed and treated for TB. Consequently, 3.6 million people with TB go undiagnosed each year.
To find and link these TB patients to care, programs around the world are using text messages to improve linkages across the health system. In addition, applications such as Facebook and WhatsApp are being used to provide patients with real-time support so they can complete the six months of antibiotics necessary to ensure a durable cure.
And yet this represents only a tiny fraction of the potential that smartphone technology can offer to help find, diagnose, and treat patients with TB. Behavior modification tools could be used to optimize medication adherence; reputational badges and feedback algorithms used in the gaming industry could be leveraged to drive patient traffic to high performing private sector providers; and GPS-enabled traffic apps could be deployed to streamline patient access to treatment.
Improving how TB programs function
Technology also has massive possibilities to strengthen governance, finance, and human resource systems for TB programs, optimizing integration and efficiencies. Affordable technologies are allowing us to rapidly leapfrog overstretched procurement distribution systems.
There is increasing enthusiasm that deployment of radio-frequency identifiers to track TB drug supplies, drones to deliver TB diagnostic equipment, and 3D printing to backfill supply gaps can have a substantial impact on the epidemic, especially in remote and unreachable communities. These systems are also likely to save money and stabilize markets, reducing the “bullwhip effect,” where small variations in patient demand are amplified at higher tiers of health.
Big data impact
Pooling data from disparate sources — TB program data, donor-agencies, implementing partners, academia, private health systems, social media, and even the defense industrial base — has the potential to provide unprecedented situational awareness and analysis capability at national, regional, and even facility levels.
Integrating and isolating diverse, complex collections of data, and providing privacy and security-assured distributive frameworks will allow front-line providers and national TB program managers to access visualization and decision-support systems. Such systems could provide user-friendly “dashboards” at each level of the health system.
We can envision a time when dashboard analytics provide national TB managers with real-time information on TB drug availability at TB clinics; epidemiological intelligence officers with precision data on TB transmission hotspots; and health ministers with impact assessments on social protection policies. The technology is already available to enable each of these scenarios. Falling costs and rising IT literacy mean that better use of data to solve TB’s biggest problems is almost within reach even in many low-income countries.
In sum, it is important to recognize that catalyzing a digital “revolution” in global TB will be slow, incremental, and heterogeneous.
To be maximally effective, digital innovation will need to be combined with other innovations to determine how TB services are delivered and funded. Nonetheless, if done well, advances such as these have great potential to improve TB programs and save lives.
It is unacceptable that TB, a curable and preventable disease, is the No. 1 infectious disease killer in the 21st century. As the Lancet Commission underscores, new digital technologies are one of the surest ways to build a TB-free world.
About the author
Michael Reid
Dr. Michael Reid is co-author of "Building a tuberculosis-free world: The Lancet Commission on tuberculosis." He is an assistant professor of medicine in the School of Medicine at the University of California, San Francisco and also works in the UCSF Center for Global Health Diplomacy and Delivery.
