Tuberculosis (TB) is one of most common causes of death globally. In 2016 alone, more than 10.4 million people fell sick to TB and 1.7 million TB-related deaths were reported. The WHO says India, in particular, and developing markets, in general, lead the count for the occurrence of TB in the world even as the local authorities provide free and effective medications to anyone who is ill. From a report: “One of the biggest barriers to recovery from TB is medication adherence,” explains Microsoft Researcher Bill Thies, who is also the Chairman and Co-founder of Everwell Health Solutions, a Bangalore-based healthcare start-up. “Patients have to take daily drugs for a full six months, or else they do not fully recover, and are at risk of developing drug resistance. While medication adherence might sound like a simple problem, it turns out to be an enormously complex and heavily studied multi-disciplinary problem. If patients start feeling better after a few weeks, how can we convince them to take toxic drugs for another five months — especially if patients have little or no understanding of germs and antibiotic resistance?”
The popular recommended practice to ensure medication adherence is Directly Observed Treatment or DOTS, which involves the patients going to a healthcare centre where they ingest the medication in front of a health worker. As it was implemented at the start of their work, patients needed to visit the centre three times per week for the first two months and once a week for the remaining four months. The system involves an unnecessary burden on the patients, who are typically from low-income groups — every visit means travel expense and loss of work.
There are ways to ensure that a patient has taken medication on time — we have things like smart pills, and you can send texts to people to remind them about the pills — but in places like India, these solutions are beyond the reach of people. So in 2013, Thies and his colleagues, along with Microsoft Research Program Manager and TEM collaborator, started a project called 99DOTS to explore if any low-cost tech solution could be employed. They did find one, and it involves making a “missed call” to people. Here’s the fascinating story of what happened next.