A comprehensive digital platform to support the patient journey and cascade of care for Tuberculosis treatment and support
September 2020 marked the 2nd anniversary of the Government of India’s relaunch of Nikshay, India’s digital platform for Tuberculosis (TB) monitoring and treatment. Everwell is a proud technical partner to the Central TB Division, WHO, and the entire Nikshay ecosystem supporting and implementing the vision for a unified digital platform to support patient care, provider workflows, and the digitization of the cascade of care. To date, Nikshay has over 1.47 Crore episodes recorded on the platform, more than 900 Crore digital payments made to support TB-affected people and providers, 4.98 lacs patients on a digital adherence technology, and is launched pan-India with over 14,000 healthcare providers interacting with the platform daily via a web or mobile interface.
These days, technical systems, platforms, and apps are everywhere. If you’ve got a problem (and even if you don’t!), as they say: there’s an app for that. The challenge for healthcare programs is that there are often too many apps: niche systems that perform singular tasks very well, but do not integrate or work together. As an example, many health systems may have one system for notification, another for diagnostics and test results, yet another for contact tracing, and several others for digital payments, DS-TB vs MDR-TB treatment, supply chain and inventory, etc. And that’s only for TB. There will be entirely separate, disjointed systems to support other public health initiatives.
For users, that means a complicated work experience managing multiple systems with differing workflows which can lead to data misalignment/ clashes/ duplication and extra work. Health workers jobs are difficult enough, and where technology should ease their burdensome workloads, a flood of platforms and systems, each with their own vision and support system behind it, can ultimately add to their burden.
Nikshay’s goal is to solve these problems by providing a comprehensive, single-window platform to digitize technical operating guidelines and TB treatment workflows. Nikshay has independent modules for various stages in the cascade that all work seamlessly together on a single platform.
A provider can register a case from a person who approaches a clinic with symptoms. They can request test results from a variety of connected diagnostics machines or methods, and should the result come back as indicative of TB, can initiate the person on treatment through Nikshay. Medications are dispensed, and where available, the person can also be provided a digital adherence technology (read more about DATs here). Throughout treatment, providers can view their care population to understand who has taken medication, where test results are pending, see aggregated reports on relevant variables, and reach out to patients through various virtual care mechanisms.
For people under care, their records are unified by a single Nikshay ID and stored safely and securely in encrypted servers in-country. Should they migrate or move locations, their records can be transferred seamlessly to their new locale and a new provider can pick up support with access to their historical record. They receive monthly financial support through government schemes called direct-benefits transfers (DBT) to help with nutrition, livelihood and transportation, and can reach out to a network of healthcare providers throughout their treatment for personalized, differentiated care
Under the hood, Nikshay is powered by the Everwell Hub. The Everwell Hub is our open source, comprehensive yet customizable, digital platform for healthcare programs globally. The Hub is developed on principles for user-centered design, simplicity, and above all leveraging technology to amplify human capacity to provide the highest quality care to people managing or recovering from life-threatening diseases.
Our work started with innovations in adherence, beginning with large scale deployments of 99DOTS across geographies in India. Based on user feedback, and ultimately the ask for options and solutions that catered to the variety of needs of those taking anti-TB medications, we integrated two other adherence solutions: evriMED/MERM pill boxes and video-observed therapy (VOT). We received positive feedback from programs and users, however the reach of the technology was limited by the same challenges that many programs face: it only supported adherence and was not linked to other technical platforms used by the program.
To address this challenge, we worked with the Central TB Division, WHO, and the Nikshay ecosystem, to expand our adherence platform into what is now the Everwell Hub. These efforts were supported by funding from the Bill & Melinda Gates Foundation, USAID and the Global Fund. We worked with the program to expand workflows for DS- and MDR-TB, incorporate private sector workflows, integrate with banking infrastructure to enable DBT payments in line with government schemes, promote virtual care by expanding our adherence infrastructure to include alternate ways of communicating with patients remotely, and build a robust and comprehensive data and reports visualization service. Looking forward, we’re excited to further develop workflows for better integration with private providers, LTBI treatment, connections with other digital health initiatives for public health, and the best possible experience for providers and users.
Today, we’re exceptionally proud that the Everwell Hub supports over 1/5th of the world’s active TB population to receive quality care as they seek to recover from TB, and in support of the world’s commitments to EndTB this decade. The Everwell Hub has been deployed globally for adherence support under several TB REACH initiatives, and as the technical partner powering the ASCENT rollouts. We have also partnered with organizations working in HIV and mental health support, and have adapted workflows for COVID-19 monitoring and treatment.
To learn more about our work, please check out our platform, the Everwell Hub, and stories from our partners in the field.
We’re incredibly thankful to support, and be supported by, our outstanding partners and collaborators in the Central TB Division of India, the WHO, and the entire ecosystem of partners working daily to eradicate TB, and the people recovering from a challenging, yet ultimately curable disease if we work together to provide the highest quality care.