TB remains a major public health problem in Bangladesh. The country ranks fourth in the world for both prevalences of TB and TB mortalities. It is estimated that about 81,000 people died in 2014 due to TB. In 2014, WHO reported 196,797 TB cases were notified to the national registry, 187,005 of which were new cases. Case notification rate of all forms of TB is low at 53%. Although there is no estimate of the prevalence of childhood TB, it is believed that childhood TB is severely under-diagnosed. MDR TB is an emerging threat in Bangladesh. According to WHO estimates, MDR-TB rate among all newly diagnosed cases is estimated at 1.4%, and among previously treated cases at 22%.
The TB CARE II Bangladesh project is a field support activity funded through the USAID TB CARE II Project, which is a cooperative agreement awarded to the URC led consortium in September 2010. The project, drawing on the Global Fund and the Government of Bangladesh expert resources, facilitates implementation of strategies to strengthen and expand TB DOTS, Programmatic Management of Drug Resistant TB (PMDT) programs, and health systems.
Aligned with National TB Control Programme strategic objectives and USAID/Dhaka strategic framework, the TB CARE II partnership’s activities complement the Global Fund and Government of Bangladesh efforts to strengthen all the components of Stop TB Strategy with a major emphasis on universal and early access to TB services, Programmatic Management of Drug Resistant TB (PMDT), and health systems strengthening.
The TB CARE II Project has made significant achievements in fighting against TB in Bangladesh. Key achievements include improved access to quality TB and MDR-TB Services, Laboratory Quality Assurance, Development of cPMDT Standard Operating Procedures, strengthening of social support services for MDR TB patients and strengthened support systems for the effective delivery of TB services at all levels.
TB CARE II mHealth Background
With the support of the USAID TB CARE II project, the National Tuberculosis Control Program (NTP) in Bangladesh initiated a Community-based Programmatic Management of Drug Resistance Tuberculosis (cPMDT) program to treat DR TB in 2011. The cPMDT program requires an initial 1-2 months of hospitalization for DR TB patients who are then transitioned to community-based care, allowing patients to receive DR TB treatment in their own community. After the introduction of cPMDT, a large number of DR TB patients are now being discharged after a short stay in the hospital. At the community level, these patients continue their treatment under the supervision of specially trained DR TB DOT (directly observed treatment) providers. Treatment for DR TB requires a complex drug regimen which needs to be maintained over years. The TB CARE II project has developed and introduced a TB mHealth application which is designed to support the DOT providers to ensure quality DOT, assist to quickly identify drug-related side effects and link patients to treatment, and above all assist in patient management by facilitating documentation of the management procedures. The mHealth application is a web-based monitoring tool which allows DOT providers and managers to keep track of services delivered and organize an electronic record of treatment history of the DR TB patients. This system is designed to get input from mobile devices used by the DOT providers (Smartphone) through a GPS enabled the mobile application.