A Short Code That Saves Lives
How a low-tech solution to the world’s deadliest diseases is capturing the attention of the elite medical community
Elizabeth, a Keheala patient with Tuberculosis attends her local health care facility in Kenya. Photographed by Creatis Agency
Some of the deadliest diseases in the world, like Tuberculosis (TB), HIV, Diabetes and Cardiovascular Disease, have accessible, effective treatments.
So why do 22 million people die from these diseases each year?
“Non-medical drivers of disease such as stigma, access to care challenges, burdensome treatment protocols, and a lack of information, motivation, and support make it difficult for patients to do the right thing and take their medication,” says Jon Rathauser, CEO & Founder of Keheala, a digital health startup.
Consider the deadliest infectious disease in the world: TB. TB kills 1.6 million people a year - or 4,000 people a day, which is more than malaria and HIV combined. Although effective and accessible treatment options exist, many patients struggle to adhere to a 6 to 18-month treatment regime. While many believe TB is a problem of the developing world, if left untreated, a TB patient can infect up to 20 people per year (that’s 8X as many as an Ebola patient) just by coughing, sneezing or even breathing on you. In fact, a third of the world’s population (or over 2 billion people) have latent or “silent” TB, and many don’t even know it. TB amongst a few of us affects us all.
The good news is that Keheala has a solution. Using basic feature phones and behavioral strategies, the company addresses the non-medical drivers of disease in order to motivate treatment adherence. Every interaction is designed to increase accountability, eliminate excuses, and communicate norms. These types of interactions are unique to Keheala’s product offering as many existing alternatives rely on one-way medication reminders to simply monitor adherence.
The proof is in the results. The article, “Digital Health Support in Treatment for Tuberculosis,” published in the New England Journal of Medicine (NEJM) on September 5th, details a 2016 study conducted in Kenya. In a 1,200-patient randomized controlled trial at 17 clinical sites in Kenya, 96% of Keheala’s patients achieved successful outcomes.
A patient uses Keheala’s mobile health platform. Photographed by Creatis Agency.
“Patients who we supported with our mobile platform were two-thirds less likely to fail to complete treatment” says Erez Yoeli, a research scientist at the MIT Sloan School of Management.
According to research from David Collins of Management Sciences for Health, Keheala’s impact would translate into 1,553 lives saved, 329 fewer drug-resistant cases and $24 million in cost-savings annually in Kenya.
The NEJM paper is co-authored by Yoeli; David Rand, an associate professor in the MIT Sloan School of Management; Jon Rathauser, CEO of Keheala, a digital healthcare firm based in Tel Aviv; Syon P. Bhanot, an assistant professor of economics at Swarthmore College; Maureen K. Kimenye and Eunice Mailu of the Kenya Ministry of Health; Enos Masini of the World Health Organization; and Philip Owiti of the International Union Against Tuberculosis and Lung Disease.
A Keheala supporter speaks to a patient about his treatment plan. Photographed by Creatis Agency.
Keheala provides the health infrastructure necessary to support individuals throughout the entire patient care cascade. Patients can easily access the platform via short codes (*694#), which are available on 99% of all phones. Basic feature phones or smartphones securely deliver reminders, disease information and enable self-verification of treatment, simplifying and informing the process of care. Supporters engage patients with care or problem-solving, as needed, while healthcare providers access predictive analytics to optimize scarce resources.
Among other things, patients receive daily messages asking them to verify that they followed their treatment regime. If patients fail to respond to these messages, they receive additional follow-up messages and then phone calls from Keheala supporters to verify adherence.
In this way, Yoeli explains, Keheala uses two key behavioral principles to change patient behavior: both “increased observability” of patients and “eliminating plausible deniability,” that is, denying patients the opportunity to make excuses for missed treatments.
According to Rand, “nonadherence with treatment regimes is a major problem in medicine that leads to serious negative health outcomes. But critically, the challenge is not medical — it's behavioral.”
“Solving some of the world’s greatest health challenges requires a deeper understanding of people. Behavioral insights coupled with accessible technologies enable us to tailor delivery models to patient needs, thereby increasing uptake and effectiveness. Investing in patient-centered solutions can maximize the impact of global health programs,” says Rathauser.
Keheala helps patients spend more time on the things that matter most in life. Photographed by Creatis Agency.
Today, the Keheala team is focused on scale. They are conducting a two-year randomized controlled trial that expands the geographical scope and analyzes cost-effectiveness. Predictive tools forecast treatment outcomes six months in advance with 95% accuracy, enabling personalized protocols. Going forward, they plan to extend Keheala’s offering across the entire care cascade, serving individuals who suffer from TB as well as HIV, Diabetes and Cardiovascular Disease.
This research was supported by Development Innovation Ventures (DIV), a fund of the United States Agency for International Development (USAID) that tests solutions to global development challenges through a year-round grant competition.