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ConnecTB, a mobile health application for locating TB patient contacts

ConnecTB, a mobile health application for locating TB patient contacts
Publication date: 
Sep 2018

Where are our TB patients?

When a person is diagnosed with tuberculosis (TB), there is the risk that they have already pass on TB infection to people they live or work with. Those with compromised immune systems such as children, people living with HIV and patients with diabetes are at an even higher risk of becoming infected. 

The process of treatment is that after diagnosis at a health facility, TB patients are initiated on treatment and discharged to continue their treatment at home over several months. During this time, patients often struggle to take their medication as prescribed and interrupt treatment before completion. Interrupting treatment results in the TB bacteria becoming infectious once more, increasing the risk of a patient spreading the disease to anyone they interact with. 

For this, and other reasons, effective management of the close contacts of TB patients presents a challenge in national efforts to end new infections, and the TB epidemic in South Africa.  It is, therefore, critical to TB control efforts that the close contacts of TB patients are immediately located, assessed for symptoms and, if necessary, tested for TB.

Health facilities do not always have adequate resources readily available to visit TB patients in the communities where they live. For this reason, national community outreach programmes have been implemented to assist patients during their treatment journeys, and to also ensure that all their close contacts are being checked and tested for TB regularly. It is, however, also necessary to find innovative ways to locate discharged TB patients at their homes to support them and their close contacts more effectively.

Finding and geo-mapping patients

To address this need, the USAID Tuberculosis South Africa Project uses ConnecTB, a mobile Health (mHealth) application, to pinpoint the locations of TB patients by means of geospatial technology.  

The USAID Tuberculosis South Africa Project trains community-based workers to use ConnecTB. Post-training, participants are equipped with mobile devices and provided with lists of residential addresses of TB patients from the nearby health facility whose locations they need to verify. Each patient on the list is located individually and their location, type of TB, gender and age is captured on the ConnecTB application and uploaded.

What is the value of identifying patient location? 

As the geo-locations of TB patients are captured on ConnecTB, an interactive map of their residences is shown. By reviewing this map, geographical areas where many patients are living in close proximity can be identified and analysed to inform targeted interventions to reduce TB infections or increase treatment.  These areas are considered high-burden TB clusters and identifying, screening and testing the close contacts of TB patients in these areas has shown potential for finding undetected TB cases in communities in South Africa.

The project successfully conducted a geo-mapping exercise in Nelson Mandela Bay Metro (NMBM) district in Eastern Cape Province. A total of 88 patients registered and diagnosed with Extensively Drug-Resistant Tuberculosis (XDR-TB) were geo-mapped using the application. The resulting map shown here indicates that 53 (60.2 per cent) of the 88 patients were clustered in one residential area. Based on the identified hot spots, the USAID Tuberculosis South Africa Project initiated direct support for every XDR-TB patient in this specific area, focusing immediately on the identification and testing of their close contacts. From this exercise, 93 close contacts were identified as presumptive and were tested for TB. Of those tested, 21 (22.5 per cent) were diagnosed with TB and started on treatment.   

The USAID Tuberculosis South Africa Project also geo-mapped TB patients in Worcester, a town in Breede Valley sub-district in Cape Winelands, Western Cape province. In this area, 23 per cent of TB patients are under the age of five years; the highest rate of TB among children in Cape Winelands district and South Africa in its entirety. 

Again, the results of the geospatial mapping initiative indicated that most TB patients at the time lived in one residential area, on the outskirts of Worcester. Of the 101 TB patients located in this one area, 31 (30.6 per cent) were small children, the majority of whom were resident in the most southern part of the residential area and many in a single street. 

Additional indicators on the map, such as gender and age further informed the USAID Tuberculosis South Africa Project’s plans for targeted interventions. 

Managing contacts in the high-burden TB clusters

Once a high-burden TB cluster or hot spot is identified, the USAID Tuberculosis South Africa Project, together with the district team implements interventions that focus on locating close contacts and ensuring that TB patients in the area are found and linked to care at the local health facility.  All interventions comprise of supporting TB patients on their treatment journeys and undertaking regular general infection control assessments of the residences.  The support provided is also intended to educate TB patients, their contacts and the communities at large about TB prevention and treatment.  

Conclusion

The USAID Tuberculosis South Africa Project continuously engages local NGOs to implement proper contact management interventions and ensures that the Department of Health is regularly appraised of the results of geo-mapping exercises for consideration in their own planning.  The USAID Tuberculosis South Africa Project is working towards expanding this innovation to more districts in South Africa to find and support TB patients and their closest contacts.