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Down to a TMEAD

SenseDose Technologies is a recent grantee of the India Health Fund (IHF). Cofounders Nishad Halkarni and Rahul Doshi came into the IHF ambit when they participated in Quest 2019 and responded to the challenge of patients not adhering to their prescribed medication regimen. 

The result of that association was TMEAD (tuberculosis monitoring encouragement adherence drive), a ‘smart pill dispenser’ that helps TB patients manage their medication while making sure they don’t miss any doses. 

“If you have to take 10, 12 or 15 tablets a day, it’s hard to keep track,” says Mr Halkarni. “The medication regimen keeps changing and then there are people who are older or cannot read. It’s difficult for them to keep up.” 

TMEAD, says Mr Halkarni, has three parts. At the heart of this is an Internet of things-enabled pill dispenser, a reusable device that can hold up to 15 days worth of medication segregated by dosage, and is powered by a rechargeable battery. The device alerts patients with a reminder when they need to take their medicine. When the pills are finished, the patient or the caregiver can top it up with another fortnight’s worth of medication. 

If the patient forgets to take her medication, the TMEAD system also alerts her primary caregiver. If that alert goes unheeded, a signal is sent to the government-designated field worker known as the TB health visitor (TBHV). This interventionist may be in charge of 50 or even 100 patients and would find it impossible to monitor their medical regimen individually. An alert when a patient has missed a few doses usually leads to a quick call by the TBHV to the patient. 

The third piece is a web dashboard that is linked to every dispenser and collates big-picture data on usage and trends. This enables the patient’s pharmacist to keep refills ready before the current lot runs out. In on-ground trials conducted by SenseDose in Nashik and Ahmedabad, the medication monitoring has been done by local NGOs who have taken the responsibility of installing the smart dispensers in patients’ homes and topping them up. The dashboard also provides data to officials monitoring TB over large areas (like a city). 

“IHF’s grant to us is divided into three parts,” explains Mr Halkarni. “The first was for clinical validation and to conduct independent assessment of the TMEAD device. The second was to seek assistance from the Indian Institute of Public Health in Gandhinagar to actually conduct clinical trials. And the third part was for something called design for manufacturing, which helped us create a device that could be manufactured at scale.” 

Mr Halkarni adds that IHF went above and beyond the scope of their relationship to help SenseDose with deployment of TMEAD. “They connected us to crucial stakeholders in the TB ecosystem, NGOs and on-ground officials who could help with adoption and deployment.”

When TMEAD was deployed in Nashik, it was found that patient adherence rates had increased to 92%, compared to the India average of 62% adherence. An estimated 85% adherence is needed to reach global TB goals. These improved patient outcomes achieved by TMEAD also prompted the district TB office of Ahmedabad to use the device among 350 drug sensitive TB patients there. This will be followed by a roll out across Gujarat. 

In keeping with IHF’s mandate, SenseDose is exploring the option of multiplexing TMEAD. “We want to see if the pill dispenser can be used for other ailments that require long-term medication, such as geriatric care,” adds Mr Halkarni.