Nimcure

Management of chronic diseases requires appropriate medication adherence for effective treatment outcomes. Poor adherence to prescribed medication contributes greatly to complications, death and increased healthcare costs associated with chronic diseases. Furthermore, Nigeria's healthcare system and individual health seeking behaviour contributes poorly to efficient treatment outcomes. Worsening the situation, COVID-19 crisis resulted in treatment interruptions of millions of people on treatment regimens, irregular drug supply, due to shutdown of healthcare facilities. Healthcare workers were careful to interact with patients due to fear of being infected. 

Our team designed a solution that improves drug adherence, foster patient and caregiver interactions, better connect patients with healthcare centres, prevent treatment interruptions, reduce healthcare costs and provide patient education on their condition.

Globally, Nimcure will aid reduction in morbidity and mortality rates resulting from chronic diseases, transmission rates of communicable diseases, and address issues of stigmatisation associated with infectious diseases such as HIV and Tuberculosis.

Nimcure aims to solve the problem of patient adherence to medications. Non-adherence to recommended treatment regimens for a curable disease like Tuberculosis (TB) leads to cases of treatment failure, TB re-infection, occurrence of adverse drug reactions, morbidity and multi-drug resistance. Medication adherence refers to the correlation of “the extent of an individual's behaviour to taking medication, following a diet, or executing lifestyle changes, with recommendations from a healthcare giver. Although TB is curable, there has been an increase in drug resistance cases because patients are not following their treatment regimens. Currently, Nigeria ranks sixth among the countries with high TB burden and first in Africa signifying the need for an innovative approach in addressing TB cases in Nigeria. The country’s TB incidence rate rose from 418,000 cases in 2017 to 429,000 cases in 2018, with death rate also rising from 155,000 to 157,000 within the same period, and TB treatment coverage stagnant at 24%. To drastically reduce the mortality and morbidity rate of TB and other chronic diseases, Nimcure hopes to provide quick and easy access to healthcare systems, and the needed interventions to ensure adherence to medication among TB patients, thereby improving attainment of desired treatment outcomes.

The Nimcure app is a digital health application used to improve medication adherence to treatment of Tuberculosis and other chronic diseases. On the Nimcure platform (Patient app, Caregiver app, Admin Dashboard and Epid),  patients are paired with health caregivers who support and manage their treatment remotely. Moreso, the app innovates around the current method of treatment, Directly Observed Therapy (DOT) by the use of Video Directly Observed Therapy (vDOT). With Nimcure, patients are able to record short videos to log their daily dosage, track treatment progress, receive key notifications and reminders as well as contact their health caregivers. Health caregivers through the Nimcure Caregiver app, can monitor patient treatment including assessing video submissions, appointments, manage patient treatment progress and contact them directly.

It leverages the use of non-intrusive technology to help patients and health caregivers better manage their treatment. Its features include a visual treatment schedule with treatment milestones, notifications and reminders as well as a points and rewards system. The app will provide patients with information about healthcare within their proximity as well as the contact details of the different healthcare centres, enabling patients to connect to healthcare providers at the tap of a button.

Our primary aim is to support and enhance medication adherence to TB (a curable disease of public health interest) in Nigeria, thereby improving TB treatment outcomes. Nigeria with over 200 million population needs a concise effort in controlling the spread of diseases like TB with its catastrophic health expenditure. We set out to improve the lives of the 51% TB patients experiencing ruinous costs with 93% being drug resistant TB patients (based on the human capital catastrophic cost estimation threshold of 20%), indicating the severity of TB in the country.

The use of Nimcure provides patients with easy access to remote healthcare and treatment follow-up, and increases patient coverage by health caregivers. It would also impact the patients by ensuring completion of treatment within the stipulated period of time thereby preventing multidrug resistant TB (MDR-TB). The incorporation of a points and rewards system would motivate individuals who are preoccupied, getting well or tired of taking their drugs and decide to neglect prescribed time and dosage, to remain faithful to therapy.

Prior to development of our solution, TB management in Nigeria was achieved through a more conventional control model known as the directly observed treatment short-course (DOTS). Although DOTS has contributed to TB control in Nigeria, there are still some limitations to the service.  The DOTS service requires day-to-day contact with TB patients and facilitates close monitoring for the development of adverse outcomes combined with other interventions such as emotional support. However, this is not being fully achieved both on the part of the patients and the health caregivers because of factors such as stigmatisation, cost of clinic visits, patient work schedules, imbalance in healthcare-patient ratio and pressure on existing health structures. Furthermore, with the new normal (COVID-19 precautionary measures) DOTS practices have become extremely difficult for both patients and health caregivers. Our solution seeks to address these shortcomings.

Our team considered focusing efforts on improving communication, to educate patients on the side-effects of drugs, as well as consequences of not adhering to treatment. However, outcomes from our ideation session with relevant stakeholders highlighted the fact that patients were provided with sufficient information regarding this, through personal counsellors and caregivers. What we then realised was that factors such as poverty (not being able to pay for daily transportation costs at the health centre), travel time and the stigma associated with TB infection, prevented patients from accessing the free treatment.

A smartphone medication adherence–oriented app (adherence apps) can potentially consolidate all of the user’s medication-specific information and thereby provide a more streamlined process to educate the individual about his/her disease or care. Adherence apps can be downloaded for little to no cost, and their benefits may be realised by anyone taking prescription medications. However, these apps may prove most beneficial for patients with complex medication regimens or for caregivers of others or family members. The growing prevalence of smartphones in Nigeria and their constant, easy accessibility make adherence apps appealing to many because they cost little and can provide user-specific information.

Using historical and current data, the Platform enables the surveillance and detection by visually mapping TB incidences by location so as to prevent outbreaks and potential epidemics as well as ensure effective TB management. Data is collected and verified real-time, to ensure proper follow-up and treatment of confirmed TB patients. In these challenging times, it remains vital that access to TB treatment and adherence support is maintained to continue optimal bacterial clearance and minimise TB-related mortality due to COVID-19. Our goal is to ensure that TB patients recover fully within the stipulated treatment duration. 

Pilot: The Nimcure platform has been piloted through a clinical trial process in a DOTS centre and TB reference laboratory in Yaba, Lagos. A total of 100 TB patients from different communities reporting at the DOTS centre were recruited. The outcome has been submitted for peer-review by African scientists and is currently under review. We hope to repeat this in other DOTS centres across the country.

To solve the problem of adherence, Nimcure will better connect patients with healthcare centres. Our solution is innovative because it uses geolocation data to provide TB patients with information about centres closest to them. It also displays contact information of the different healthcare centres, so that patients can connect to healthcare providers at the tap of a button, facilitating observed therapy and treatment counselling to outpatients; using feedback mechanisms.

As a personalised digital patient care tool, it leverages the use of non-intrusive technology to help TB patients better manage their treatment. By designing an intuitive application, with features such as a visual treatment schedule with treatment milestones, notifications and reminders, a points and rewards system, patients and caregivers are both empowered to better manage TB treatment. Also, plan to incorporate in our solution is a language barrier breakthrough with users being able to use any of other major Nigerian languages of communication they are comfortable with. The social system will bring together a combination of actors, institutions and agencies that are essential parts of Tuberculosis treatment in Nigeria. These institutions and actors including patients’ family members will form the key social system for this innovation.

In addition, this will also minimise public health resources (reducing travel costs and time for staff and patients), reduce potential transmission to caregivers (through prolonged visual contact), increase privacy for patients, and it is a more convenient and less intrusive method of treatment.

It has been piloted in a reference TB laboratory in Lagos, a state in one of the six geopolitical zones in Nigeria with 30 participants and all successfully completed their treatment using Nimcure. In the next one year, we hope to deploy it in Rwanda, Kenya as well as one state each of the remaining five geopolitical zones in Nigeria after which it is expected to be incorporated into the National TB control program. In the next five years, apart from the TB community, we are projecting to scale it up for management of other chronic disease such as hypertension, HIV and cancer.

Indicators such as pill counts, logged dosage are ways the app monitors adherence. Caregivers reports on patients' response to dosage time, and prompt video submissions  would help track patients adherence which ensures successful treatment outcomes. One key indicator to measure our solution’s progress is a significant increase in the proportion of enrolled patients that complete their drug regimen with negative sputum culture results. Also, early warning signs on TB spread as indicated on Nimcure Epid and increase in TB patient enrollment across DOTS centers will serve as a measurable indicator. Early detection of spread patterns, increase in patients enrolment and medication adherence would reduce the spread of TB and mortality rate which aligns with the sustainable development goals of the United Nations for TB in the year 2030. 

Our solution team is part of a Government Organisation, the Nigerian Institute of Medical Research (NIMR) which is the foremost medical research institute in Nigeria and an agency of the Federal Ministry of Health saddled with the primary mandate of health/medical research to inform health policy. NIMR is a medical institute that houses a DOTS clinic and TB reference laboratory centre in Nigeria.

Full time staff: 7

Part Time Staff: 3

Technical staff: 4

Our team comprises health and application software development experts. We are capable and uniquely positioned to deliver this solution because Research and Innovation is our Organisational major strategic drive. Our Team Lead is an innovative researcher with a proven track record in providing services to HIV/TB patients in a National HIV/TB Reference Laboratory for more than a decade. He also pioneered the drive through Covid-19 testing centre in Nigeria in 2020, with over 30,000 tests conducted so far, using an electronic Covid-19 Epid platform which is able to schedule appointments for testing and for surveillance. Currently, there are over 45,000 people registered on the Covid-19 Epid platform. We also have a tech team led by the co-founder of Co-Creation Hub, Nigeria’s foremost social innovation centre that has experience working closely to support startups in the health industry . Other members of the team include an array of bright, young and dynamic health researchers whose inputs were pivotal in the development process of the project Nimcure, as well as skilled and competent software developers responsible for the development and technical management of the Nimcure app and platform. We are part of a larger organisation that can provide administrative support with a proven record of accountability.

The team is made up of a diverse selection of individuals with varying skill sets. We believe everyone has something to offer with whatever ability they possess. Our team consists  of more females playing key roles, with team members from different ethnic groups across the nation and partners outside Nigeria, spreading up to east Africa.

Having designed an innovative solution (Nimcure) which addresses an urgent public health need, it is of great necessity to ensure it is properly deployed and adopted in the healthcare system. Funds generated from this grant will aid our team’s deployment of the solution to other TB facilities in other communities and states within Nigeria. It would also help in developing the Nimcure app to feature multiple languages so that the non-educated population can also benefit from the use of the application. Solve serves as a conduit for insightful leaders across industries and sectors, with dedicated spaces to create awareness, enhance development and aid adoption of the solution. Also, it creates a platform to rub minds and receive adequate mentorship to guide us through the expansion phase of our solution. One of the barriers we might encounter is the incorporation of our solution into the National TB control program. Being beneficiaries of the Solve grant increases our team's recognition and product visibility through its array of wide network and public relations. And will help us gain credibility thereby facilitating our solution’s incorporation into the National TB control program by health governing bodies.

Business Model: We seek to interact with mentors experienced in the development of business models who will guide us on how to map out more strategic approaches to product innovation and all round enhancement of user experience. Experts in this field could also assist us in reviewing our product development process. 

Financial: Interaction with partners will also help in generating funds. Also, access to financial officers will play a central role in our solution’s financial control and evaluation plan. Prizes won in the Solve’s Challenge will aid in the development of this solution and attract potential investors.

Product/ Service Distribution : We have a plan to target multiple distribution partners across different fields to enable us to integrate our value chain to create a whole product solution.

We would like to partner with some Solve partners such as Access Afya as we tend to use the same process in the management of chronic and infectious diseases such as TB through the use of digital health solutions. Also, Solver Kinedu’s app fosters relationships between caregivers and children. This also aligns with our solution development. Partnership with these Solvers will improve the features on our solution.