In India, for many years, being diagnosed with HIV was tantamount to a death sentence, as accessing HIV health clinics and counselling and testing centres run by the government wasn’t always as simple as it should be, especially in rural areas. Even mental illness is overlooked, disparaged, and generally neglected. Consider this, for every one million Indians, there are just three psychiatrists, according to the World Health Organisation (WHO), which is 18 times fewer than the commonwealth norm of 5.6 psychiatrists per 100,000 people. By this estimate, India is short of 66,200 psychiatrists. As if being sick wasn’t bad enough, both the conditions come with a social stigma that can make sufferers hide their illness.
However, over the last few years, mental illness and HIV, to a large extent, have become manageable conditions. So what’s changed? Creating mobile tech solutions, online healthcare companies have come up with medical treatment and counselling for patients directly into the home — or smartphone — cutting queues. They have made treatment simpler, affordable, while also tackling societal stigma by providing confidential, individualised and interactive counselling service.
“The purpose of technology is to enhance the quality of life, and we are trying to do that for HIV patients” says Ravi Gopalan, CEO of ArguSoft, which devised a health app to prevent transmission of Aids from mother to child. “Using the app, health workers stay connected with the patients to counsel, ensure adherence and follow-ups, and better manage the associated conditions.”
Since the government HIV programme hinges on field workers who maintain information on each patient in reams of paper and report back through layers of hierarchy, ArguSoft’s app — combining video, instant messaging and internet telephony — has made it easier to register HIV-positive mothers in the system, share treatment information with doctors and provide regular updates.
“Over 2,500 outreach workers across 22 states in India use our app to track HIV positive pregnant women, consolidate data and whether children born to them carry the virus,” says Gopalan.
The app also tracks availability of safe delivery kits at the health facility, and post-delivery the child is monitored until 18 months for drug adherence. “Tracking completes after the final tests declare the child HIV negative,” adds Gopalan.
Digital health tools not just make it possible for patients to get prescriptions for a daily HIV-prevention pill through an app or web-based platform, with the medicine delivered to their door in a matter of days, it is also a convenient and discreet service.
“More than 90 per cent of the patients want to keep their medical condition confidential because of social stigma, and the anonymous nature of online services solve the problem of inconvenience and fear of revealing themselves to someone known,” says Madhur Gopal, CEO of RXpress, a web-based platform that treated more than 1,200 patients in the last two years, and seen a five-times increase in monthly consultations in the last eight months.
Its treatment module helps medical professionals communicate with the patients through emails and SMS, and in the process tackle issues such as long waiting times, unnecessary queuing, missed appointments and prescription reminders. “Apart from tele-support by trained nurses and pharmacists, we provide medical consultations with doctors as well,” says Gopal.
According to WHO, social discrimination is the main reason why people are reluctant to get tested, disclose their HIV status and take HIV medication, while a survey by National Family Health Survey found that nearly 82 per cent women and nearly 70 per cent men in India lack comprehensive knowledge of HIV/Aids and safe-sex practices. A disturbing truth, and even more concerning in a country that has the third-highest number of people living with HIV in the world. An estimated 2.1 million people are living with the virus in the country.
“Social stigma is deeply-rooted, but we are making it easier for affected people to be less hesitant in seeking help by directly giving the affected person a mobile interface, which is secure and private, to connect with the health worker at a time of their choice,” says Gopalan.
Meanwhile, public concern around mental health is at an all-time high — India ranks high on the global depression list: one in 20 individuals suffers from the disease, according to WHO. Put simply, mental illness is India’s ticking bomb. And yet, despite growing problem, a study by The Lancet found that only about one in 10 people receive evidence-based treatment.
EPsyclinic, through its online platform and counselling app, helps mental health patients through video chats and calls, matching patients to the best treatments and experts. It counsels over 2,500 patients daily, and has over 100 mental health professionals.
Online counselling is just as effective as face-to-face therapy, says Shipra Dawar, founder of ePsyclinic. “Anybody going through a tough time can easily find us online, and get help from our therapists, who are trained in online therapy. It is is convenient, too, as it takes a minimum of six to eight sessions for a patient to get past their issues.”
But similar to HIV, many patients put off seeing a mental health professional, says Dawar, for fear that they will be looked down on if they venture anywhere near a psychiatric unit. And a big advantage of online therapy is the disinhibition effect, she added, where people feel more comfortable opening up and discussing problems when they are online.
Since access to mental health services continues to be a major challenge — the country has only 443 public mental hospitals, but six states, mainly in the northern and eastern regions, with a combined population of 56 million people, are without a single mental hospital — online therapy services, Dawar says, are tackling the problem emanating from poor infrastructure.
“We are not just filling in the gap but also making treatment easier, with structured assessment.”
The interest in improving access to behavioural health therapists combined with the reality that many people just don’t feel comfortable seeing a therapist in person makes it all the important to give a more personalised approach to behavioural healthcare, says Dawar. “We have delivered positive outcomes to more than 90 per cent of people who took therapy from us.”
Silver Oak Health, another online therapy platform among a dozen in the country, provides an eight-week online programme — video-based learning sessions, with weekly calls from cognitive behavioural therapy trained experts. “The cloud-based product allows patients to learn coping skills at home and can be accessed from a computer or a mobile device. It is discreet, convenient and extremely affordable,” says Rohit Koliyot, vice-president for marketing at Silver Oak Health.
But mental health awareness outweighs assessment and therapy, says Dawar. India has one of the world’s highest suicide rates for youth aged 15 to 29, according to a Lancet report.
“Thousands of vulnerable people, aged between 15-26 years, are being left at increased risk of suicide because of lack of awareness. Young people — struggling with their careers and relationships — form a sizeable portion of those seeking medical support,” she adds.
Patients range from students suffering from exam-related stress, ADHD and conduct disorder to adults having anxiety disorders, marital issues and addictions.
When it comes to HIV, mothers and young children are among the most vulnerable groups. In India, around 49,000 women living with HIV become pregnant and deliver every year, and research suggest that mother-to-child transmission accounts for over 90 per cent of new HIV infections among children. But Gopalan says such transmission can be prevented. “It’s challenging to ensure adherence in anti-retroviral treatment, but our programme has reduced the number of cases by ensuring pregnant women take their medication and monitoring their medicine supply is replenished.”
Echoing the same point of view, Gopal of RXpress says since maintaining a strict adherence to anti-retroviral treatment is a tall order, its reminder system ensures patients “don’t miss a single dosage” and follow the guidelines provided by doctors. “Our integrated services also help patients to reduce expenses by up to 20 per cent, as we aim to bring up to 30 per cent overall reduction in healthcare expenses in HIV disease management in the country through our predictive technology,” Gopal adds.
Along with managing the disease, Gopal says its doctors and nurses help HIV patients to lead a normal life. “Online consultation has helped HIV patients to consider HIV as any other lifestyle disease.”
Overall, it has been observed that online HIV programmes tend to be more successful than offline. A big factor is its easy access. “People living in remote areas can now access some of country’s best doctors. Also, unlike other medical conditions, consultation on the treatment of HIV depend on the diagnostic reports, which can be easily examined by doctors online and offer their suggestions,” says Gopal.
“In online treatment, compliance in HIV patients improved to more than 90 per cent as compared to 70 per cent in offline healthcare support,” he adds.
It’s not hard to see why online health services and counselling is growing in popularity. Tech is a part of modern life – especially for millennials, the biggest group of users on online health services – and government-run services are inadequate. Also, health services for HIV and mental illness are more likely than others to look for new ways of doing things, mainly because they have fewer resources.
Suparna Dutt-D’Cunha is a writer based in Pune, India.