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RESEARCH LETTER
Year : 2021  |  Volume : 38  |  Issue : 1  |  Page : 98-99  

Effective use of telemedicine in Mumbai with a cohort of extensively drug-resistant “XDR” tuberculosis patients on bedaquiline during COVID-19 pandemic


Department of Pulmonary Medicine, P. D. Hinduja and Medical Research Centre, Mumbai, Maharashtra, India

Date of Web Publication31-Dec-2020

Correspondence Address:
Samridhi Sharma
Department of Pulmonary Medicine, P. D. Hinduja and Medical Research Centre, Mumbai, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/lungindia.lungindia_464_20

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How to cite this article:
Udwadia ZF, Sharma S, Mullerpattan JB, Gajjar I, Pinto L. Effective use of telemedicine in Mumbai with a cohort of extensively drug-resistant “XDR” tuberculosis patients on bedaquiline during COVID-19 pandemic. Lung India 2021;38:98-9

How to cite this URL:
Udwadia ZF, Sharma S, Mullerpattan JB, Gajjar I, Pinto L. Effective use of telemedicine in Mumbai with a cohort of extensively drug-resistant “XDR” tuberculosis patients on bedaquiline during COVID-19 pandemic. Lung India [serial online] 2021 [cited 2021 Feb 27];38:98-9. Available from: https://www.lungindia.com/text.asp?2021/38/1/98/306018



India has the largest number of drug-resistant tuberculosis (DR-TB) patients in the world, with almost 150,000 new cases detected annually.[1] Its management is challenging as it involves prolonged treatment with potentially toxic drugs. This warrants close monitoring to ensure minimization of risk to patients during treatment.

The recent COVID-19 pandemic has the potential to undermine our efforts to overcome this disease and can influence the outcomes of treatment. Therefore, health-care providers need to adapt and find novel means of helping patients.

A nationwide lockdown was instituted in India on March 24, 2020.[2] Since then, we proactively replaced our system of having patients with extensively drug-resistant TB visit clinic with telemedicine services.

The collaborative effort of P. D. Hinduja Hospital, Mumbai, and RNTCP ensures that patients in private sector access bedaquiline (BDQ). So far, 30 patients have been enrolled and are being closely monitored. These patients formed the cohort being studied and online consultations (via Skype, Zoom, and WhatsApp) were done where a list of symptoms and directions were discussed [Table 1].
Table 1: Structure of each patient's telemedicine consults

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Patients were also recommended blood tests, audiometry, electrocardiogram (ECG), and other tests consistent with the guidelines. Patients were encouraged to conduct tests at the nearest laboratory and share results electronically. Healthy family members were prompted to collect patients' monthly quota of BDQ and other TB drugs from our center, in order to minimize the exposure of COVID-19 to patients. For ease of travel, they were provided with both new prescriptions and letters requesting passage to facilitate travel. A follow-up call was done ensuring patient received all the TB drugs.

A questionnaire was administered to each patient to determine the main challenges encountered during the lockdown and to assess the acceptability of telemedicine. We surveyed the results and compiled their feedback regarding the current situation of COVID-19, including its effect on their ongoing TB treatment.

Of the 30 patients in our cohort, 28 contributed to the results of our questionnaire. 78% of patients reported that they were experiencing considerable problems during the lockdown in terms of drug collection. 64% of patients reported difficulties in finding a laboratory to perform ECG and other tests. 21% of patients reported difficulties related to transportation, and 7% of patients reported issues regarding the administration of injectable [Figure 1].
Figure 1: Problems faced during lock down

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After 2 months of telemedicine, 68% of patients preferred the convenience of telemedicine to direct contact. Only 27% of patients preferred the previous system of direct interaction with a physician, while 5% of patients had no specific preference.

The most striking fear among patients was of losing access to BDQ, which could lead them to develop resistance to the drug.

Our findings suggest that it is possible to reach out with teleconsultation to our patients and effectively guide them through their symptoms, drug side effects, monitor results, and ECG, and arrange for them to receive prescriptions without interruption. While inexpensive and expedient, telemedicine may risk compromising the quality of care associated with a physical examination; however, in times of COVID 19, this is a trade-off we may have to accept.[3]

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
World Health Organization. Global Tuberculosis Report 2019. Geneva: World Health Organization; 2019. Available from: www.who.int. [Last accessed on 2020 Jun 02].  Back to cited text no. 1
    
2.
Gettleman J, Schultz K. Modi Orders 3-Week Total Lockdown for All 1.3 Billion Indians. The New York Times; 2020 ISSN 0362-4331. Available from: https://www.nytimes.com/2020/03/24/world/asia/india-coronavirus-lockdown.html. [Last accessed on 2020 Jun 01].  Back to cited text no. 2
    
3.
Webster P. Virtual health care in the era of COVID-19. Lancet 2020;395:1180-1. Available from: www.thelancet.com. [Last accessed on 2020 Jun 01].  Back to cited text no. 3
    


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