World TB Day: Microsoft’s ‘99DOTS’ project enrolled over 93,000 patients in 4 years

In a world flooded with technological advancements, can a missed call save lives? This is happening as part of a project developed by software giant Microsoft in India.

The project, named "99DOTS" and which began in 2013, helps patients with Tuberculosis (TB) in India get medication adherence and monitoring via missed calls and SMSes.

From a modest pilot involving just 20 patients in early 2014, 99DOTS has enrolled over 93,000 patients in just four years, with 41,000 patients currently under treatment.

"99DOTS is a great example of such a project, where we've invented a very simple but unusually effective technology to solve a global health problem. And we are making this technology openly available to the global health community," Sriram Rajamani, Managing Director, Microsoft Research India, said in a statement.

TB is one of the top 10 causes of death globally, with 10.4 million people falling ill with the disease and 1.7 million related deaths reported in 2016 alone. Even though TB is curable and preventable, over 95% of related deaths happen in low and middle-income countries. India leads the count in TB chart even though free and effective medications are available, according to the World Health Organisation.

"One of the biggest barriers to recovery from TB is medication adherence," Bill Thies, senior Researcher at the Microsoft Researcher India, said in a statement.

"Patients have to take daily drugs for a full six months or else they do not fully recover, and are at risk of developing drug resistance."

However, "once patients start feeling better after a few weeks, it becomes very difficult to convince them to take toxic drugs for another five months - especially if patients have little or no understanding of germs and antibiotic resistance", Thies added.

This is where "99DOTS" project plays a significant role. In the project, each anti-TB blister pack is wrapped in a custom envelope, which hides a phone number behind the medication. When a patient dispenses his or her pills, they can see these hidden numbers. After taking daily medication, patients make a free call to the hidden phone number.

The combination of the call and patient's caller ID yields high confidence that the dose was "in-hand" and they took the dose, Thies said. The team also developed an SMS reminder system for patients when they did not take their medication as well as a dashboard and escalation system for healthcare workers and government agencies where they could monitor the progress of patients under their care and find out patients who were at risk.

Missed doses trigger SMS notifications to care providers, who follow up with personal, phone-based counselling. Real-time adherence reports are also available on the web. The traditional medication adherence programme "Directly Observed Treatment" or "DOTS" involves the patients going to a healthcare centre where they ingest the medication in front of a health worker.

"99DOTS gives the patients the freedom and ownership of their treatment. They are able to take the medication wherever they are. It also provides them the privacy of not having to visit a health centre," explained Andrew Cross, the CEO and Co-founder of Everwell Health Solutions.

Cross was earlier Programme Manager at Microsoft Research and teamed up with Thies to build up 99DOTS.

"Unlike DOTS, which treats every patient the same way, we can identify patients who don't need monitoring and focus on only those patients who are at risk, and therefore focus the limited resources of the healthcare sector to outreach and counsel those patients," he said.