KHPT

Can you increase TB medication adherence amongst vulnerable populations?

Service design
Drug Sensitive Tuberculosis
Medicine adherence
2020

Approach

A 12-week sprint during the lockdown, to arrive at a set of interesting prototypes for vulnerable populations.

  • We conducted research with ~70 users, observing their current practices, enablers & barriers in adhering to their TB treatment
  • The extreme users we focused on were Migrant workers - who didn’t have a fixed base, Mining & Industrial workers - who were subject to dangerous work conditions and Urban vulnerable populations & Tea tribes who were hard to reach & convince
  • We focused on DSTB (Drug Sensitive Tuberculosis) patients who were seen dropping off the medicines around month 2-3, who weren’t regularly coming in for their free check-ups, and who were sometimes just forgetting to take their medication.

Key Strategic Lever

We realised that for most people, being on the medicine was an indicator that you still had TB. And so, they’d try to stop their medication at the 1st moment that they felt better. In most cases, this was at the point when they moved from the 2-month Intensive Phase medication (stronger, red-coloured tablets) to the 4-month Continuation Phase medication (milder, green-coloured tablets). Month 2 to 3 was seeming to be the breaking point in the journey.

Output

We created 9 interventions that helped with case finding as well as case holding & spanned across awareness to intent creation to action.

These 9 were piloted & evaluated on field from 2022-24, and while the results are very encouraging, there’s still scope to refine & improve these further.

Please read the report here: https://www.khpt.org/wp-content/uploads/2024/11/NIMHANS-Report-Final-28th-May-2024.pdf

A few simple ideas that were borne out of our Behaviour Design Codex

A deeper understanding of the USER
“A free checkup means it’s no good. They will make me wait for hours for substandard quality.”
Price-Quality Heuristic
Price-Quality Heuristic
To redesign the SYSTEM
Increase respect quotient - by seeing what a test is actually worth & why s/he’s getting it for free
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THE SIMPLE IDEA

6 coupons that were given to every patient - 1 for each of the 6 months, showcasing how much each test was worth as well as making that month’s test valid only till the end of that month

A deeper understanding of the USER
“If I’m feeling fine after 2 months of the red tablets, I should stop taking it rather than switch to the green tablets.”
Omission Bias
Regret Aversion
Regret Aversion
Illicit transference
Illicit transference
To redesign the SYSTEM
“If I’m feeling fine after 2 months of the red tablets, I should stop taking it rather than switch to the green tablets.”
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The Simple Idea

A 28-day-a-month reverse countdown calendar that corresponds to the 28-day pill regime, with a colour coding of red, orange & green rather than red pack to green pack.

A deeper understanding of the USER
“As long as I keep taking medication people think I still have TB. They expect some gap between taking medication & rejoining work.”
Status & self-image
Regret Aversion
To redesign the SYSTEM
Increase respect quotient - by giving a clear, visible marker of safety to rejoin the workforce once their 6-month medication is completed
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The Simple Idea

TB Vimukt Certificate

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