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Text for the Cure

Perhaps the hardest part of fighting contagious diseases is simply getting patients to take their meds. For tuberculosis, which kills nearly 1.6 million people a year, the drug regimen lasts at least six months and often carries unpleasant side effects. Patients who skip doses risk developing drug-resistant TB, which is costly to treat and prone ...

Perhaps the hardest part of fighting contagious diseases is simply getting patients to take their meds. For tuberculosis, which kills nearly 1.6 million people a year, the drug regimen lasts at least six months and often carries unpleasant side effects. Patients who skip doses risk developing drug-resistant TB, which is costly to treat and prone to dangerous outbreaks. A team of students at the Massachusetts Institute of Technology (MIT), however, has devised a novel solution: bribe patients with cellphone minutes.

The students’ big idea, which has been put to the test in Nicaragua, rests on a new technology called paper microfluidics. Rather than visiting a clinic every day or receiving constant reminders at home, patients are given a device that spits out a small strip of paper, coated with chemicals, every 24 hours. As with a home pregnancy test, patients urinate on the strip, which detects drug compliance. Instead of a plus or minus sign, the system reveals a numerical code that the patients then send via text message to a central server. (To ward off potential cheaters, there is a new code every day.) Those whose codes register a high enough compliance rate each month earn free cellphone minutes, a powerful incentive that’s inexpensive to implement.

For Jose Gomez-Marquez, program director of MIT’s Innovations in International Health initiative, the project’s genius is its combination of psychology and economics. "We knew that it couldn’t just be a technological approach to the problem," he says. "It had to be a combination of behavior modification with the aid of technology." So far, trial runs of the project in Nicaragua have been a hit — so much so that TB patients outside the study are asking to take part, too.

Until the special strips of paper can be mass-produced, the scope of the project remains limited. But Miguel Orozco, a Nicaraguan health researcher who is assisting the program, envisions the venture catching on. "They can do [the treatment] from their homes," Orozco says. "You have people living with tuberculosis happy to have their own mobility and independence."

Next up for the MIT team is attempting to export the program elsewhere. They are already laying the groundwork for bringing the technology to Ethiopia and have launched a clinical trial in Pakistan. Urdu’s complex alphabet is proving to be a logistical challenge, but free cellphone minutes? It’s an idea that needs little translation.

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