SEATTLE, Washington — Despite being a treatable—and curable—disease, tuberculosis (TB) is still one of the most prominent illnesses in Kenya. With extensive medication regimes and social stigmas surrounding the diagnosis, lack of adherence to TB treatment is one of the main causes of this infectious disease’s prevalence. Fortunately, Keheala, a health care organization, utilizes behavioral psychology and technology for tackling TB in Kenya through innovative, non-medical support for TB patients.
Jon Rathauser, founder and CEO of Keheala, explains that the non-medical drivers of disease—like access to care, community stigmas and lack of information or motivation—often thwart the best medical solutions. “Health systems often lack the resources or expertise to address these challenges,” Rathauser told The Borgen Project. “Keheala bridges this gap by extending the reach of the health care system directly to the patient.”
The World Health Organization lists TB as one of the top 10 causes of death worldwide.
While TB is found in all parts of the world, 95 percent of cases occur in developing countries with 25 percent of all TB deaths taking place in Africa. The illness is caused by bacteria that affects the lungs and symptoms include fever, cough (with or without blood), chest pains, night sweats and weight loss. Spread through the air, transmission occurs when an infected person sneezes or coughs.
Treatment plans for TB are lengthy—the standard regime includes six to nine months of four antimicrobial drugs. According to the Centers for Disease Control and Prevention, if patients stop taking the drugs too soon, they risk becoming sick again and/or if patients do not take the drugs correctly, the TB bacteria in their bodies may become resistant to drugs. The standard treatment plans also come with side effects like nausea, stomach pain and fever. This is why proper education and support for treatment adherence is key for positive health outcomes.
“TB is something you can live with for months or years like a bad cold or virus,” Rathauser explains. “People have competing concerns: Do I go to work to make money or do I go to the health facility to follow protocol? If I go to the local health facility, someone I know might see me so I’m going to travel to the next closest one.”
TB in Kenya
In 2017, a TB study conducted by Kenya’s Ministry of Health found that 558 per 100,000 people were infected with TB. While there are many key challenges for tackling TB in Kenya, ranging from inadequate testing facilities and lack of funding for multidrug-resistant bacteria, the cost and management of TB is the biggest obstacle.
While TB drugs are free, most TB patients live below the poverty line, making follow-up examinations and tests unlikely due to the cost. It is recommended that TB drugs be supplemented with a good diet and vitamins—another luxury many patients are unable to afford. Aside from the costs of a TB diagnosis, the illness in Kenya is a stigmatized disease. Many infected patients are ostracized by their families and communities, making the treatment process an isolating experience.
Keheala: Strategy and Impact
Keheala is an organization that understands the need for personalized assistance during TB treatment to bring patients positive outcomes. As an Israeli-based health care access organization with offices in Kenya, Keheala provides TB patients with education, motivation and a passionate support system outside of the clinical setting.
As mentioned above, the stigma surrounding TB is one of the biggest drivers of the lack of treatment adherence, so Keheala created a simple texting system for tackling TB in Kenya and keeping patients on track with their regimens.
Thanks to this solution, TB patients can now send a text code to Keheala to sign up for daily messages asking if they had taken their medication—this program helps to hold patients accountable; if they don’t respond or haven’t been actively responding to the texts, then they receive multiple reminders and a staff member reaches out to see how they are doing and discuss the treatment regime. “Our focus on technologies that are accessible from 99 percent of all phones (feature phones or smartphones) means that we can serve some of the most marginalized populations, today,” says Rathauser.
This innovative two-way system also ensures that the patient has access to resources and mentorship outside of the clinical setting. “We bring a unique approach that is built from the ground up to motivate the desirable behaviors,” says Rathauser. “Our focus has always been on solving problems in a way that ultimately gets us to the desired outcome: better health.”
Keheala has seen positive progress within its program—in a randomized controlled trial at 17 clinical sites in Kenya with 1,200 participants, 96 percent of the patients were able to achieve a successful treatment outcome. “We have an incredible team of empathetic and passionate people,” Rathauser says. “Our success today is attributable 100 percent to our team that believed in this concept when many others did not.”
One of the health targets of the U.N. Sustainable Development Goals is to end the TB epidemic by 2030. There has been significant progress made towards this agenda with TB diagnoses decreasing at a rate of about 2 percent per year and an estimated 54 million lives saved through proper TB diagnosis and treatment between 2000 and 2017 worldwide. In order to fully achieve the global target, it is imperative that TB-burdened communities create non-medical, behavioral psychology-based programs like Keheala to approach the TB epidemic.
– Trey Ross