The Usefulness and Feasibility of Mobile Interface in Tuberculosis Notification (MITUN) Voice Based System for Notification of Tuberculosis by Private Medical Practitioners – A Pilot Project

Health care providers are required to notify every TB case to local authorities. The Revised National TB Control Programme (RNTCP) has formulated a web portal called NIKSHAY for both public and private health care providers to facilitate TB notification. However, this method has its inherent difficulties, including the possibility of details not reaching the Nodal Officer when sent as hard copy or problems due to internet access. A private practitioner can provide details of TB patients via paper or email to the Nodal Officer, who will then upload it in the NIKSHAY website. To address these difficulties, a mobile phone based voice enabled TB notification system was developed. The system, known as Mobile Interface in TB Notification (MITUN), allows private medical practitioners to notify TB cases by making a simple voice call through a mobile phone to a designated number and providing patient details. The study was conducted during September 2013 to October 2014 in Chennai, a city of 7 million people in South India. Permission was obtained from the health authorities for the conduct of the study. The study aimed to determine the usefulness and feasibility of MITUN voice based system for notification of TB cases by private medical practitioners. The technology used in MITUN is Voice Net, a Personalized Voice based Information Retrieval and Transaction System (PVIT) jointly developed by IITM's RTBI and its incubated company, Uniphore Software Systems. Voice Net is a system that can retrieve and deliver information to end-users over the mobile phone by nothing more than voice interactions. The information is categorized into domains and into sub-domains, so that the necessary information can be obtained by walking through the set of questions, which guide the users towards the specificity of the information they are looking for. The process involved in TB notification through MITUN includes registration of private medical practitioners and notification of TB cases. Registration of private medical practitioners involves providing their name, medical registration number, phone number, and complete address. Notification of TB cases involves calling the designated MITUN telephone number and supplying patient details as required by NIKSHAY. The medical registration number is the unique identification number for the practitioners who are registered in MITUN. A total of 266 private medical practitioners were approached for the study, of whom 184 (69%) participated in the study. Of the participants, 11 (6%) practitioners used MITUN for TB notification. Reasons for not using MITUN include lack of time, referral of patients to government facility, issues related to patient confidentiality, and technical problems. Suggestions for making mobile phone based TB notification process user-friendly included reducing call duration, including only crucial questions, and using missed call or SMS options. The study found that the performance of MITUN voice based system for TB notification in the present format was sub-optimal. Perceived problems, logistical, and practical issues preclude scale-up of notification of TB by private practitioners. The study suggests that the system needs to be fine-tuned to suit user-requirements and customized accordingly to make it more user-friendly and feasible for private medical practitioners to use.