[Editors] MIT's smart pillbox targets TB

[Elizabeth Thomson]

MIT News Office
Massachusetts Institute of Technology
Room 11-400
77 Massachusetts Avenue
Cambridge, MA  02139-4307
Phone: 617-253-2700
http://web.mit.edu/newsoffice/www

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MIT's smart pillbox targets TB
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For Immediate Release
MONDAY, MAR. 3, 2008
Contact: Elizabeth A. Thomson, MIT News Office -- Phone: 617-258-5402 
-- Email: thomson at mit.edu

PHOTOS AVAILABLE

EDITORS: The story below is part of a new feature produced by the MIT 
News Office that explores the ways people from MIT are using 
technology--from the appropriately simple to the cutting edge--to 
help meet the needs of local people in places around the planet.


CAMBRIDGE, Mass.--Tuberculosis has long been eradicated from the 
world's industrialized nations but continues to take a terrible toll 
in a few poor, rural regions of Asia and Africa. Every year, 10 
million new cases are diagnosed and two million people die of the 
disease.

It's not that new treatments are needed--medical science long ago 
figured out how to cure tuberculosis using a cocktail of antibiotics. 
The problem is getting the medicine to the people who need it and, 
most difficult, making sure they follow the six-month regimen of 
daily doses.

Failure to follow the regimen not only leads to likely death of that 
patient, but fosters the development of antibiotic-resistant strains 
of the disease. "The problem is, how do you get people to take this 
complex regimen," says Manish Bhardwaj, a doctoral student in the 
Department of Electrical Engineering and Computer Science who works 
in the Microsystems Technology Laboratories.

After a year of hard work and about eight revisions, Bhardwaj and a 
team of collaborators think they may have found the answer. It's a 
high-tech solution in a simple, inexpensive and easy-to-use -package.

The first part of the two-component system is a kind of "smart" 
pillbox, called the uBox. It has 14 chambers that can each be loaded 
with several pills, which it dispenses from one chamber per day. To 
alert the patient that it's time to take the medicine, the box 
flashes its lights and sounds a buzzer. When the compartment is 
opened, the uBox records the exact time and prevents double-dosing by 
refusing to open again until the next treatment is due.

After two weeks, a health care worker reloads the box and digitally 
records and transmits the information stored in it. Doctors and 
public health services can then get complete data on compliance, 
patient by patient, in almost real time, instead of having to wait 
until the end of the six-month treatment.

"How do you know if pills are getting to the patients or if patients 
are taking them? Today, there's no good way of doing this," Bhardwaj 
says. If people fail to take all their pills, "it is possible to do 
harm by treatment that doesn't have good adherence." Missing 
medication can lead to the development of resistant strains, which 
can then be spread by that noncompliant patient. "The people they 
infect have no chance." Today, less than half of the patients that 
start the regimen successfully complete it.

"We want to make sure the worker is motivated," Bhardwaj says, and at 
present there's no way to tell which workers are diligent about 
making the calls and which ones may skip some of their appointed 
-visits. Accordingly, the uBox has an additional feature: a 
receptacle for a tiny key, like a headphone plug, which is carried by 
the visiting health care worker. At each visit the worker inserts the 
key, thus recording the fact that the patient really has been 
visited--another important gauge of compliance.

The second part of the group's new system is a cell phone, called the 
uPhone. By using special software, health care workers can record a 
patient's temperature, weight, and answers to a list of questions 
related to symptoms, which adds to the set of detailed patient data 
analyzed by doctors monitoring the study.

By looking at patterns of effects, the doctors can tell which field 
workers are achieving the best adherence rates with their patients 
and find out just what it is that those people are doing right. They 
can then be recruited to train additional workers.

Bhardwaj has been working with MIT alumni Goutam Reddy and Sara 
Cinnamon on the engineering and electronics of the pillbox, doctoral 
student Bill Thies and alumnus Pallavi Kaushik on the uPhone 
software, and MIT seniors Oliver Venn and Jessica Leon on fundraising 
and logistics.

Bhardwaj and Thiess went to Bihar province this January to begin 
their first field test of the product, conducting a training session 
for 22 workers who will, in turn, train the field workers to 
distribute the pillboxes in the field. In late April Bhardwaj will 
return to Bihar to train workers at two new sites. The first actual 
field test with 100 of the boxes and 10 cell phones should start in 
mid-May.

If all goes well, a second round of testing, using 1,000 uBoxes, is 
set to begin. After that, it all depends on the results--and on the 
ability to raise funds for future deployment. Health officials in 
India are already keenly interested in this test, and Bhardwaj is 
about to meet with representatives of the Bill & Melinda Gates 
Foundation to discuss possible collaboration and support.

The Ven. Tenzin Priyadarshi, MIT's Buddhist chaplain, helped to get 
the project started and says, "I am hopeful that the uBox-uPhone 
project will revolutionize the way we understand and provide health 
care in rural areas of the world."

While Bhardwaj is proud of the product his team developed, he is not 
proprietary about it. "We hope to make the uBox and the uPhone the 
standard of treatment in Bihar. We worked very hard to make something 
very simple and elegant," he says. "But we'd be delighted if someone 
beats us to it and builds a uBox cheaper. We hope other people will 
copy us."

--END--

--Written by David Chandler, MIT News Office