First published in the Daily Maverick 168 weekly newspaper.

The field testing of an app that allows healthcare workers to track, trace, follow up, and monitor tuberculosis (TB) patients without having to go out into communities – reducing their risk of becoming victims of criminal attacks or contracting the disease or another infection such as Covid-19 – has begun in Wells Estate in Nelson Mandela Bay.

“We have included patients with TB but also [those with] the drug-resistant types,” said Professor Darelle van Greunen of Nelson Mandela University’s Centre for Community Technology.

The Wells Estate building where the DigiTB app is being tested. (Picture: Supplied)

“What makes this app different from others was that it was designed in a way that healthcare workers do not have to leave their offices to monitor TB patients, to do follow-up consultations or to provide counselling,” she explained.

She said the Eastern Cape Department of Health had shown enthusiasm for the project. “But I was particularly struck by the excitement of the healthcare workers.”

The app, called DigiTB, reduced the risk of infection for nurses and community healthcare workers, especially during the Covid-19 pandemic, and also minimised their risk of being attacked and robbed while they were doing their rounds, Van Greunen said.

Earlier this year, several nurses and healthcare workers doing follow-up work to trace close contacts of patients who tested positive for Covid-19 were attacked and robbed in Nelson Mandela Bay.

“With this app, they can work from their office,” Van Greunen said.

She said they were testing the app from a building in Wells Estate where there was no internet and no electricity. “If it could work from there, it can work from anywhere.”

The project is being rolled out with the assistance of Mfesane, an NGO that works in the health sector in Wells Estate and has been assisting in TB programmes in the area.

Nearly 400,000 in SA have TB

South Africa’s first National TB Prevalence Survey, released on 5 February, highlighted the need for a digital solution to what was a bigger TB crisis than expected.

The study found that in 2018 an estimated 390,000 people had become ill with tuberculosis in South Africa. This is higher than the World Health Organisation’s estimates, published in 2020, of 360,000 people.

Another finding was that, of the estimated 390,000 people who fell ill with TB in 2018, only about 236,000 were diagnosed.

Researchers said in their conclusion that technology and mobile health solutions should be used to widen the reach of care.

The app was developed with funding from the Discovery Foundation and the Technology Innovation Agency.

Van Greunen said the purpose of DigiTB was to trace, track and monitor TB patients, in order to prevent patients defaulting on treatment or being lost to follow-ups.  

It allows healthcare workers to create an electronic medical record for a patient, capture patient data and record medication compliance. Patients who default on their medication are alerted with an SMS message.

Van Greunen said the app provided for video observational technology, which allows nurses or healthcare workers to see their patients taking their pills.

The app also provides information to health workers and patients about counselling and gives answers to frequently asked questions, as well as information about the side effects of TB medication.

The DigiTB app. (Picture: Supplied)

Van Greunen said the app also allowed health workers to compile a heat map of TB infections by locating and tracking TB patients’ movement in the workplace, social environment and on public transport.

“This information will enable the Department of Health to focus [its] TB preventative efforts at high-risk areas,” she said.

Van Greunen added that medication compliance was one of the most critical factors in the treatment of TB, and healthcare workers are in some cases required to physically monitor their patients taking their pills.

All this and video too

Video observation treatment (VOT) adds video calling to the app, so healthcare workers can observe pill-taking.

“The healthcare worker can observe the patient taking the medication without physically being present with the patient. This functionality proved to be very useful during the State of Disaster restrictions,” Van Greunen said.

The app also serves as a tool to empower community healthcare workers when counselling patients during home visits. It allows them to do a rapid assessment of people who are in contact with the patient. 

“The health workers who have been introduced to the app are very excited about it,” she said.

The pilot project will run for the next six months. “We want to test the technology and also see if we have missed something,” Van Greunen said. DM168

This story first appeared in our weekly Daily Maverick 168 newspaper which is available for free to Pick n Pay Smart Shoppers at these Pick n Pay stores.