No Longer a Bitter Pill to Swallow

In 2016 alone, India witnessed nearly 423,000 deaths due to tuberculosis (TB), with disease incidence being seven times that figure—the highest in the world. Despite its best efforts, the country is struggling to make a dent in TB morbidity statistics, with the major reason being the lack of treatment adherence. And if medication is consumed erratically, the disease progresses to the even more challenging drug-resistant stage. 
 
Since adherence to the National Tuberculosis Elimination Programme (NTEP) is critical to stall the spread of the disease, a DISQ team set out to improve the dosage and monitoring the process involved. Nishad Halkarni and Rahul Doshi built a fully indigenous, scale ready IoT-based pill dispenser, called TMEAD, to improve adherence outcomes and provide prioritized attention to healthcare workers. 
 
Innovation through Automation 
 
NTEP depends on manual pill dispensing for compliance and recording of treatment procedures, and it was observed that the information gathered about treatment adherence was often unreliable and open to manipulation. Since tracking and preventing missed doses is critical, the team designed TMEAD to be able to alert patients to take their medicines.

Depending on how long it has been since the last dose, the device follows an escalation matrix to alert caregivers, health workers, and eventually, the district administration. Apart from regime monitoring and avoiding interruptions in treatment, this solution also helps map disease analytics in real time. 

Getting Acceptance – and Results 
 
The TMEAD team has secured a grant from the India Health Fund to run a multi-state pilot, covering around 800 of drug sensitive and drug resistant patients across Maharashtra and Gujarat. They are also undergoing clinical validation trial from the Indian Institute of Public Health, Gandhinagar. 
 
Of course, this task was not without its challenges, starting from the fact that the pills in the dispenser need to be tamper-proof and blister packed, and should last a fortnight at least so that patients don’t have to keep travelling for refills. The device also needed to pack in enough battery power for a month, while still blending in at the patients’ homes to prevent further stigma. 
 
So far, both the patient response to the device as well as general treatment adherence has been good. With the district administration impressed with the results from the pilot phase, the team is now working to make the device available across Nashik, Wardha, Thane, and Ahmedabad Urban and Rural.