- technology dissemination fellowship program
- visiting practioners program
- yunus challenges
2007 – 2013:
value from waste
clean hands for health and prosperity
affordable small-scale energy storage solutions
indoor air quality pollution
tuberculosis drug adherence
2007 muhammad yunus innovation challenge:
Increasing Adherence to Tuberculosis Drugs in Rural Developing Country Contexts
Adherence to medication regimens, or the extent to which patients take the drugs they are prescribed, is estimated at only 50% worldwide. This surprisingly common problem is the cause of both individual treatment failure and public health problems across a wide range of diseases and countries.
The focus of this year's Yunus Innovation Challenge is on tuberculosis (TB). TB kills an estimated 1.7 million people every year, yet the vast majority of cases are curable. Adherence to TB drugs is low and is a major driver of the epidemic. The most successful program geared to increase TB drug adherence, Directly Observed Therapy, Short-Course (DOTS) is relatively expensive and, in 2002, was available only to approximately 37% of people with TB.
Click here for more information about the 2007 Yunus Challenge
Meet the 2007 winners
Keywords: mobile phones, incentives, youth, data collection
Description: The CellCentives team created an innovative solution comprising of a package of reminders, incentives and community involvement to help enforce drug adherence. Since TB tablets in India are packaged in sheets covered with foil, the team printed a hidden symbol corresponding to each tablet on the reverse side of packaging which patients saw when they removed the foil to access the pill for the day. Recognizing that youth between 15–34 account for over half of the TB cases in India, the team chose cell phones as the preferred means for delivery of incentives in the form of free cell phone minutes. The hidden symbols could only be entered during a limited time frame, thereby encouraging timely drug intake. Preset alarms on the phones remind patients when to take their drugs. CellCentives also incorporated a database allowing Public Health Administrators to adjust incentive levels in order to achieve desired levels of drug compliance and maintain the drug supply chain. Additionally, the team offered incentive schemes for the community-at-large to help enforce adherence and promote the use of their proposed solution.
After the Yunus Challenge: The team worked with the Cancer Research Center (CRC) to create a clinical trial setting to test the software on real subjects from the MIT community, in order to tweak the software interface for deployment in India.
TEAM TREATMENT BUDDY
Keywords: DOTS, support network
Description: Team Treatment Buddy created a more secure support network for patients and their peer workers, in order to improve the effectiveness of Directly Observed Therapy, Short-course (DOTS) programs. TTB divided patients into peer groups based on location, community, and gender that met 1-2 times a week. For each group, a paid local peer worker was recruited from those who have successfully completed the treatment, who acted as a liaison between the health center and the patients. The peer worker educated group members about TB, addressed questions and concerns, dispensed pills, and recorded symptoms and concerns through a tape-recorder. The peer workers also worked with patients who stopped attending the group sessions to find a way to help them stick to their drug regimen. By providing the patient with education and by shifting treatment from the individual to the community, TTB built patient trust. Peer workers were paid after they presented the group’s voice recordings, an incentive to build trust and do a thorough job. Patients were offered vitamins to encourage attendance.
Location: India (Bihar, villages around Nalanda, Rajgir, Vaishali)
Keywords: pill box, DOTS, data collection
Description: The uBox team created an inexpensive, highly compact, rugged pillbox that is left with the patient and which electronically records times of dosages and DOT worker visits. Success in Directly Observed Therapy (DOT) requires reliable, up-to-date knowledge of field conditions, which is often unavailable or otherwise error prone, since collection of data depends on the motivation and conscientiousness of DOT workers. The uBox electronically collected data that enabled timely and targeted intervention, leading to improved adherence and better patient care. It also allowed a rigorous evaluation of new incentive schemes and other program innovations. Costing about $4 each, the uBox requires virtually no training and doesn't rely on infrastructure or user literacy.
After the Yunus Challenge: uBox was one of 15 teams nationally to be awarded an Advanced Entrepreneurship Team Award by the National Collegiate Inventors and Innovators Alliance (NCIIA). The grant, along with the IDEAS award, helped cover expenses in the Bihar trial. Driven by this initial work with the uBox, in 2009 Manish Bhardwaj co-founded Innovators in Health with fellow MIT alum Bill Thies. Now based in Bihar, India, IIH develops technologies to reduce the burden of TB drug adherence, for both patients and programs.
XOUTTB (formerly New Dots)
Location: Nicaragua; Indonesia; Tanzania; Bihar, India; Karachi, Pakistan
Keywords: cell phones, incentives, urine test
Description: The XoutTB team created a system that is a combination of a novel remote monitoring device and microfinance-based incentives, to increase drug compliance in patients not served by Directly Observed Therapy, Short-course (DOTS). The team designed urinalysis test strips that detect whether patients have taken isoniazid, a drug that is commonly used throughout the entire course of TB treatments. Metabolites of isoniazid in the urine revealed codes on the test strips. The codes were reported by cell phone, since the technology is widespread and reduces the need for human resources in areas lacking the strong infrastructure needed for DOTS, which includes 1 million out of 9 million. Furthermore, customized microfinance incentives reward compliant patients with progressively increasing benefits (encouraging them to continue treatment even when side effects cause discomfort or symptoms are alleviated but infection persists).
After the Yunus Challenge: Today, the work of New Dots, now known as XoutTB, is being carried out through the MIT organization Innovations in International Health