Incentivizing Case Finding

Incentivizing Patient Referrals

Depression Screening

Digital Stories

TB and Diabetes

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OpASHA provider in a treatment center administers medicine for TB to a patient in India

J-PAL Evaluation

In 2009, we teamed up with the Abdul Latif Jameel Poverty Action Lab (J-PAL) at the Massachusetts Institute of Technology (MIT) to evaluate OpASHA’s treatment model.

J-PAL is “a network of 64 affiliated professors around the world who are united by their use of Randomized Evaluations (REs) to answer questions critical to poverty alleviation.”

The Research Project

Research Question: Can positive or negative financial incentives for health workers encourage them to find new tuberculosis cases and prevent patients from defaulting on treatment?

The biggest challenge in controlling the spread of tuberculosis is finding and treating infected people before they have a chance to spread the disease to their friends and neighbors. J-PAL is investigating whether providing incentives for the providers, not the patients, is more effective in not only detecting new cases, but in influencing patients to finish their treatment, even after symptoms disappear. More details about J-PAL’s research project with OpASHA are listed on their website.

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Elderly OpASHA TB Patient

Research with University of Chicago, JHU, and University of Maryland

Title: Leveraging Patients’ Social Networks to Overcome Tuberculosis Under-detection in India

Operation ASHA, Johns Hopkins University, University of Maryland and University of Chicago in collaboration are conducting a randomized controlled trial to compare the effectiveness of different types of incentives to current patients and prospective patients. If successful, incentivized patient-to-patient referrals could become part of the standard public health toolkit in the detection of TB and other communicable diseases (e.g. HIV/AIDS, STDs) and can help find even more patients than providers alone.

Trial will be completed in 2017. For more information, click here.

A young TB patient with his father in their home. Operation Asha brings the child his TB medicine every day as the family can not afford the transportation cost to the local goverment DOTS center. Operation Asha helps the poor within the slums of Phnom Penh who would otherwise not complete the heavy regiment that is required of a TB victim.

A young TB patient with his father in their home. Operation Asha brings the child his TB medicine every day as the family can not afford the transportation cost to the local government DOTS center. Operation Asha helps the poor within the slums of Phnom Penh who would otherwise not complete the heavy regiment that is required of a TB victim.

Research with University College of London

The treatment program for TB may benefit from screening for depression and providing effective interventions to improve mood and feelings of helplessness and hopelessness, where appropriate. Treating psychological problems in patients with TB may substantially improve treatment adherence and enhance quality of life, as well as reduce the burden of TB as an infectious disease.

Operation ASHA is carrying out a study in collaboration with the Mental Health Department of the Medical School of the University College of London to investigate the prevalence of symptoms of depression in individuals who either have symptoms of TB or are suffering from TB. The data will be analyzed to ascertain whether depression status is related to adherence to the DOTS program. If the predicted association is demonstrated, an intervention program developed in the UK but readily transferable to an Indian community context, could be implemented at a later stage to test the hypothesis that improvement in depression also improves patients’ adherence to TB treatment.

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Research with University of Chicago

Ci3 of University of Chicago launched a Digital Storytelling project with Operation ASHA. The research project, funded by a 2-year grant from the Bill and Melinda Gates foundation, will conduct workshops with underprivileged teens in Lucknow. We hope to  better understand the social determinants of adolescent health and well-being through group activities such as games and storytelling. Ultimately, the goal is to empower youth to develop strategies for improving gender equality and sexual and reproductive health.

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TB and Diabetes Study

With 1.7 million TB cases and over 60 million diabetes cases, India unfortunately has nearly the highest global burden of both these diseases. It is a well-known fact that Type 2 Diabetes is associated with an altered immune response to TB, more so if the blood sugar stays high for a long period. Patients with both diabetes and TB take longer to respond to TB treatment. Diabetes can also worsen the clinical course of TB. A recent World Health Organization (WHO) study in Kerala cemented the link in India finding that half of TB patients included tested positively for diabetes. The current diabetes epidemic may lead to a flood of TB patients. According to WHO guidelines, all TB patients should be screened for diabetes. However, in India, only patients with drug-resistant TB are currently screened for diabetes. Early detection of diabetes among drug-sensitive TB patients can increase care and control of both and reduce morbidity and mortality associated with both diseases.

Through a six-month pilot, Operation ASHA investigated the potential ways and means of establishing a sustainable model for diabetes management among TB patients.

OpASHA in the News