Digital health: the answer to managing neglected tropical diseases?

Vaish Sundaresan, Communications Officer at DigitalHealth.London, provides an overview of what Neglected Tropical Diseases (NTDs) are and current digital health developments that could contribute to the World Health Organisations’s target of eliminating 90% of NTDs by 2030.

Today is Neglected Tropical Disease (NTD) day, a day which recognises the importance of eradicating a group of diseases which affect some of the poorest communities in the world. Currently, over 1.7 billion people worldwide continue to suffer from NTDs (1). 

The term “neglected” is used as the management of these diseases is usually absent from most global health agendas. There is little awareness of these diseases, meaning they receive low investment. Moreover, the symptoms and long term effects of these conditions are unfortunately a victim of stigma and social exclusion (1).

To date, 47 countries have eliminated an NTD, and in 2020, 600 million fewer people required interventions against NTDs than in 2010. However, a lack of resources has been seen as a significant barrier to the control, elimination, and eradication of NTDs, further intensified by COVID-19 (1). 

The WHO has set out an overarching global target of a 90% reduction in the number of people requiring treatment for NTDs by 2030, as set out in the 2021-30 Roadmap for Neglected Tropical Diseases. Fortunately, considerable progress has been made in improving the diagnosis and ongoing management of these conditions through digital tools, which could make a significant difference in helping to reach this goal. 

Smartphone-based platforms 

The charity Sightsavers have developed the TT Tracker for trachoma – one of the oldest existing NTDs. Trachoma is responsible for the blindness or visual impairment of about 1.9 million people and is the cause of about 1.4% of all blindness worldwide (2). 

The platform is a smartphone-based app which helps health workers to collect and analyse information about patient’s operations. The surgery to treat trachoma itself is straightforward, taking around 20 minutes, however, check-ups are critical to ensure that the surgery has been successful and that patients are no longer at risk of going blind. It can be challenging to bring patients back for check-ups, as those most affected by the disease often live in remote places, miles away from the nearest health clinic. This can make it hard to monitor patient recovery and assess any additional care needs (2).

The TT tracker helps health workers locate those who are in need of follow-up visits, the platform collects patient data when they first register for surgery, and then throughout their treatment journey (2).

Based on the information collected, the TT Tracker sends online and email updates to staff, telling them which patients need to be followed up with and at what time. Even if different stages of a patient’s treatment journey happen in different locations with different medical teams, the surgeon in charge of their care has easy access to all the information they need through the app (2).

Another example of a successful digital tool is iChagas, a platform used to support the treatment of Chagas, a silent disease that affects over six million people worldwide and is endemic in 21 countries in Latin America. Despite being the deadliest parasitic killer in Latin America, fewer than 10% of people are diagnosed and just 1% receive proper treatment (3).

The iChagas app provides health workers with access to the latest medical and scientific information on how to diagnose and treat Chagas, in an easy to digest format. The platform has been designed to meet the needs of health workers and patients, and features general and updated information focusing on best practice clinical practice and healthcare. It works both online and offline and is free (3).

Artificial intelligence 

Last year, DeepMind, in partnership with EMBL-EBI, released 3D shapes of nearly 200,000 proteins that constitute over 25 organisms on the World Health Organization’s priority list of NTDs and antimicrobial resistant bacteria. This database is openly accessible to any biologist and researcher working on these organisms and the diseases they cause. 

This work has huge implications for drug discovery, through seeing how proteins fold, biochemists may be able to identify molecules that could help treat neglected diseases.  Particularly in low and middle income countries, this data could help accelerate NTD research and innovation in the diagnosis and treatment of these diseases. 

Development considerations 

Whilst digital tools are emerging as a key player in helping improve the diagnosis and management of NTDs, there are certain considerations that must be taken into account. 

Digital tools are usually developed in high-income countries, therefore it is imperative that local stakeholders from low and middle income endemic countries are involved from the earliest phases of development. If not, there could be the risk of limited engagement from scientists and clinicians from endemic regions, which could negatively impact the use, and eventually scale, of these technologies (4).

In terms of data consent, individuals should be notified if their personal information is being used and stored, and made aware of where, who and how. Special care must be taken in ensuring the data consent process is respectful of culture, language, religion, gender, age and socioeconomic status (4). 

Many of the countries affected by NTDs have significant limitations in health-care infrastructure and the implementation of such tools could unintentionally draw resources from other programmes. Once again, ensuring local stakeholder engagement from the outset may help mitigate these issues. Stakeholders could then be able to conduct assessments to determine the impact, both positive and negative, and take any appropriate actions, prior to roll-out (4).

Final thoughts

It is clear that there is huge scope for digital tools to help in the diagnosis and management of NTDs. With this year’s theme of #WorldNTDDay centred around the need for investing in innovative therapies, hopefully this will mean an increase in the number of digital tools in this area of medicine. Globally, we must all work together as a collective to ensure we meet the World Health Organization’s target of eliminating all NTDs by 2030.  

References:

1. World NTD Day: https://worldntdday.org/ 

2. Sightsavers: https://www.sightsavers.org/protecting-sight/ntds/tt-tracker/

3. DNDi: https://dndi.org/ 

4. Artificial intelligence, diagnostic imaging and neglected tropical diseases: ethical implications: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7133484/ 

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