As discussed in the Access to ICT section, many DAT products are designed to piggyback off the data transmission functionalities of feature phones and smartphones, and as such can only service the Potential Addressable Market (PAM) segment with relevant ICT access.
The alternative design choice is to integrate cellular transmission technology into the DAT product. This approach has potential to service a greater proportion of the PAM, including potential users who do not have access to feature and smart phones. However, this design choice is still ultimately limited by the geographic reach of cellular network.
Cellular network availability is a major constraint to the market serviceable by all currently available DAT products. Outside of HICs, persons infected with TB living in rural areas often lack consistent 2G/3G network coverage. Geographically, this trend strongly affects the South-East Asia and Africa regions.
Lower levels of urbanization in Africa likely mean a higher proportion of persons infected with TB live where network coverage is inaccessible or unreliable. This adds a further layer of complexity and challenges to growing the DAT for TB market in the Africa region (in addition to more dispersed potential demand, limited diagnostic capability, and low rates of ICT access). In the near term, DAT markets in Africa may be disproportionately tilted towards urban areas until network coverage improves.
In the South-East Asia region, greater diagnosed TB burden combined with higher rates of urbanization, assures a larger serviceable market size in the near term. Here, the challenge posed by low cellular network accessibility in rural areas is primarily whether country markets can create incentives to facilitate equitable DAT access. In the near term, manufacturers and program managers may prioritize the substantial TB market in urban areas which is easier (and less costly) to address.
Looking ahead, manufacturers may tailor product features to account for populations outside of current network coverage, such as through:
- Asynchronous data transmission: Data on adherence events are transmitted on an irregular basis, whenever DAT can access cellular network coverage.
- Automated reminders: DAT product analyzes adherence data without network connection, detects different types of causes for non-adherence and automatically issues appropriate behavioral change prompts to encourage behavioral change. Prolonged non-adherence, requiring direct contact by health care workers, would remain difficult to address.
An additional consideration is the additional cellular network usage costs potentially incurred by persons infected with TB using DAT. Usage costs in individual country telecommunication markets are affected by a range of market factors. For example, in India, government policies encouraged hyper-competition between cellular providers for subscribers, leading to significant investment in infrastructure and the lowest usage costs in the world.
High cellular network usage costs in specific country markets may present a barrier to DAT adoption. In such contexts, subsidization of usage costs may be a necessary precursor to widespread DAT use.
Use the interactive diagram below to explore trends and implications of cellular usage costs. Only information on SMS affordability is provided. Data on the affordability of internet usage is difficult to collect and aggregate given the many modes of access available (ex: public WiFi, broadband, 3G/4G/LTE, etc…)