Calling for Change: A telephone-based treatment support service for tuberculosis patients in south India
Summary:
Tuberculosis (TB) is the world' top infectious disease killer. India accounted for a quarter of the 10 million cases which occurred in 2018. Patients with TB need six months of treatment, however, due to an abatement of symptoms or uncomfortable side effects, patients often stop taking medication, raising the risk of drug resistance and death. Although TB patients are offered in-person visits by government health staff to monitor treatment adherence, many patients who take treatment in the private sector, do not opt for in-person visits by health staff, due to the fear of being ostracized by neighbours and relatives. In order to support such patients, since 2014, KHPT has been operating Careline - a free of cost, phone based counselling service. Careline is operated by a team of women, trained in counselling, reaching to patients in the south Indian states of Karnataka and Telangana. The Careline provides treatment literacy to patients and caregivers and counsels them through personal issues that could prevent treatment adherence, until completion of treatment. Also, TB Careline supports the state government in updating the treatment status of patients notified to the national registry from the private sector, who are otherwise not traced. Careline combines simple mobile technology with a human touch, and has reached out to 12186 patients between April 2014 and September 2019, with 7241 patients completing treatment. It has the potential to be scaled up across India in a cost-effective manner.
Background/Objectives:
India accounted for a quarter of the 10 million cases in 2018. TB patients' adherence to their full course of treatment is essential for complete cure. This is a programmatic challenge, as adherence is often affected by poor treatment literacy, side effects, stigma in families or workplaces and inadequate follow-up mechanisms after treatment initiation, especially amongst patients who choose to take treatment in the private sector. There is a need for innovative support options that meet varied patient preferences, to promote treatment adherence across patient categories.
Description of Intervention and/or Methods/Design:
KHPT, in 2014 started operating the Careline, a free-of-cost outbound phone counselling service, staffed by a team of women counsellors fluent in seven languages, in two states of south India. Careline provides TB treatment literacy to patients and caregivers consenting to use the service. Counsellors also provide support in resolving family, personal issues that prevent treatment adherence and follow up with them for two years after treatment completion. The Careline takes the onus off TB patients by providing at a time convenient to them. The counsellor-patient rapport, developed over months, has been instrumental for patients to adopt healthy behaviours aiding the completion of months-long courses of treatment. The Careline has an established call process; counsellors follow up patients once a week during the first two months of treatment, followed by fortnightly calls as treatment continues, and monthly follow-up calls for two years after treatment completion.
Results/Lessons Learned:
The Careline adds a human connect to technology, making it acceptable to the patient and caregivers, and increasing the efficiency of counsellors. While the counsellors follow an organized call process, the services offered during the calls are tailored to the patient's needs. Patients can also call counsellors as often as required. Counsellors are also trained to address specialised issues of bereavement, paediatric, geriatric and drug-resistant TB, and guide patients on availing government benefits, thus covering the spectrum of needs. The Careline has registered 12186 patients in the period since its inception in April 2014 to September 2019. Of these, 7241 patients have completed treatment and 2293 are on active treatment. Almost half of the patients who refused to continue treatment, were linked back to treatment. In particular, the elderly, caregivers of children with TB, the economically deprived and people living alone find the Careline very helpful.
Discussion/Implications for the Field:
The Careline shows how a simple phone-based intervention can be leveraged to complement existing SBCC strategies which promote health-seeking behaviours among target populations of large-scale health programs. The Careline offers non-intrusive services which protecting patients' privacy, since TB-related stigma is high. Technological advancement provides the scope to innovate and generate evidence around initiatives like the Careline to enhance linkages to patient support services, for all patients. The Careline can potentially increase the coverage of treatment adherence monitoring in a cost-effective manner, and be integrated within existing government systems to scale its services across geographies.
Abstract submitted by:
Vrinda Manocha - Karnataka Health Promotion Trust
Prarthana B S - Karnataka Health Promotion Trust
Vijayalaxmi Ganti - Karnataka Health Promotion Trust
Prakash Javalkar - Karnataka Health Promotion Trust
Prakash Kudur - Karnataka Health Promotion Trust
Karthikeyan Kumaraswamy - Karnataka Health Promotion Trust
Tuberculosis (TB) is the world' top infectious disease killer. India accounted for a quarter of the 10 million cases which occurred in 2018. Patients with TB need six months of treatment, however, due to an abatement of symptoms or uncomfortable side effects, patients often stop taking medication, raising the risk of drug resistance and death. Although TB patients are offered in-person visits by government health staff to monitor treatment adherence, many patients who take treatment in the private sector, do not opt for in-person visits by health staff, due to the fear of being ostracized by neighbours and relatives. In order to support such patients, since 2014, KHPT has been operating Careline - a free of cost, phone based counselling service. Careline is operated by a team of women, trained in counselling, reaching to patients in the south Indian states of Karnataka and Telangana. The Careline provides treatment literacy to patients and caregivers and counsels them through personal issues that could prevent treatment adherence, until completion of treatment. Also, TB Careline supports the state government in updating the treatment status of patients notified to the national registry from the private sector, who are otherwise not traced. Careline combines simple mobile technology with a human touch, and has reached out to 12186 patients between April 2014 and September 2019, with 7241 patients completing treatment. It has the potential to be scaled up across India in a cost-effective manner.
Background/Objectives:
India accounted for a quarter of the 10 million cases in 2018. TB patients' adherence to their full course of treatment is essential for complete cure. This is a programmatic challenge, as adherence is often affected by poor treatment literacy, side effects, stigma in families or workplaces and inadequate follow-up mechanisms after treatment initiation, especially amongst patients who choose to take treatment in the private sector. There is a need for innovative support options that meet varied patient preferences, to promote treatment adherence across patient categories.
Description of Intervention and/or Methods/Design:
KHPT, in 2014 started operating the Careline, a free-of-cost outbound phone counselling service, staffed by a team of women counsellors fluent in seven languages, in two states of south India. Careline provides TB treatment literacy to patients and caregivers consenting to use the service. Counsellors also provide support in resolving family, personal issues that prevent treatment adherence and follow up with them for two years after treatment completion. The Careline takes the onus off TB patients by providing at a time convenient to them. The counsellor-patient rapport, developed over months, has been instrumental for patients to adopt healthy behaviours aiding the completion of months-long courses of treatment. The Careline has an established call process; counsellors follow up patients once a week during the first two months of treatment, followed by fortnightly calls as treatment continues, and monthly follow-up calls for two years after treatment completion.
Results/Lessons Learned:
The Careline adds a human connect to technology, making it acceptable to the patient and caregivers, and increasing the efficiency of counsellors. While the counsellors follow an organized call process, the services offered during the calls are tailored to the patient's needs. Patients can also call counsellors as often as required. Counsellors are also trained to address specialised issues of bereavement, paediatric, geriatric and drug-resistant TB, and guide patients on availing government benefits, thus covering the spectrum of needs. The Careline has registered 12186 patients in the period since its inception in April 2014 to September 2019. Of these, 7241 patients have completed treatment and 2293 are on active treatment. Almost half of the patients who refused to continue treatment, were linked back to treatment. In particular, the elderly, caregivers of children with TB, the economically deprived and people living alone find the Careline very helpful.
Discussion/Implications for the Field:
The Careline shows how a simple phone-based intervention can be leveraged to complement existing SBCC strategies which promote health-seeking behaviours among target populations of large-scale health programs. The Careline offers non-intrusive services which protecting patients' privacy, since TB-related stigma is high. Technological advancement provides the scope to innovate and generate evidence around initiatives like the Careline to enhance linkages to patient support services, for all patients. The Careline can potentially increase the coverage of treatment adherence monitoring in a cost-effective manner, and be integrated within existing government systems to scale its services across geographies.
Abstract submitted by:
Vrinda Manocha - Karnataka Health Promotion Trust
Prarthana B S - Karnataka Health Promotion Trust
Vijayalaxmi Ganti - Karnataka Health Promotion Trust
Prakash Javalkar - Karnataka Health Promotion Trust
Prakash Kudur - Karnataka Health Promotion Trust
Karthikeyan Kumaraswamy - Karnataka Health Promotion Trust
Source
Approved abstract for the postponed 2020 SBCC Summit in Marrakech, Morocco. Provided by the International Steering Committee for the Summit. Image credit: Karnataka Health Promotion Trust