TERMS OF USE

This Terms of Use (‘Terms’) is an electronic record in terms of the Information Technology Act, 2000 and rules there under as applicable and the amended provisions about electronic records in various statutes as amended by the Information Technology Act, 2000. The Terms are published in accordance with the provisions of Rule 3 (1) of the Information Technology (Intermediaries guidelines) Rules, 2011 and Rule 4 of the Information Technology (Reasonable security practices and procedures and sensitive personal data or information) Rules, 2011 of Information Technology Act, 2000 amended through Information Technology Amendment Act, 2008 that require publishing the Terms of Use and practices for access and usage of any functional Application.

These Terms govern the use of the “Cough against TB” application for mobile and handheld devices (‘Application’), and the services provided through the same. By accessing the Application, whose ownership is jointly and severally vested with the Central TB Division (CTD), which is the apex institution for managing the National TB Elimination Programme (NTEP) for the entire country at the central level and Artificial Intelligence unit of National Entrepreneurship Network (NEN-AI) under their brand name Wadhwani AI, a non-profit organization with a registered office at Tower no. 3, 6th floor, SJR I park, EPIP Zone-1, Whitefiled road, Bangalore 560066, KA, India and Program office at C/o Okhla NSIC Phase III, Metro station building, 1st Floor, 5th Level, Shambhu Dayal Bagh, New Delhi-110020, India, (hereinafter referred jointly to as ‘The Organization’, ‘we’, ‘our’ or ‘us’). These terms outline the rules, regulations, and conditions that the users of our Application (a “user”, “you”, or “your”) must adhere to when using the Application. This Application is operated and managed by NEN-AI and you hereby expressly consent to have read, understood and agreed to be bound by the Terms. Please bring to our attention any content on the Application you believe to be inaccurate, inappropriate or in violation of these rules for which you may please write to us at coughagainsttb@wadhwaniai.org.

Please read these Terms carefully before you download, install, or use the Application.

General Terms

The headings of each section in these Terms are only for the purpose of organizing the various provisions under these Terms in an orderly manner and shall be used by you to interpret the provisions contained herein in a manner as may apply to you. Further, it is specifically agreed by you that the headings shall have legal or contractual value on your usage of the Application.

The use of this Application is solely governed by these Terms of Use, Privacy Policy that is uploaded on the Application. You expressly agree and acknowledge that these Terms of Use and Privacy Policy are co-terminus in nature and that termination of either one will lead to the termination of the other.
You unequivocally agree that these Terms of Use and the Privacy Policy constitute a legally binding agreement between us, and that you shall be subject to the rules, guidelines, policies, terms, and conditions applicable to your use of the Application, and that the same shall be deemed to be incorporated into these Terms of Use and shall be treated as part and parcel of the same. You acknowledge and agree that by clicking on the “I Agree” button, you signify your acceptance of these Terms, and your agreement to be bound by them and that your act of visiting any part of the Application constitutes your full and final acceptance of these Terms of Use and the Privacy Policy.

We reserve the sole and exclusive right to amend or modify these Terms, with prior notice to users, in which case, in order to continue using the Application, you will be required to accept the revised Terms. If you do not adhere to the changes, you must stop using the Application at once. Your continued use of the Application will signify your acceptance of the changed terms.

Application Overview

The Cough against TB Application is an AI-powered cough-sounds-based screening solution to assess the likelihood of pulmonary tuberculosis in individuals, for the early detection and treatment of tuberculosis (TB).

Eligibility

By accessing this Application, you confirm and warrant that you are a registered Health Care Worker (HCW) as designated by the National TB Elimination Program (NTEP) and are residing in India and above the age of 18 years. You shall only be considered as a valid and authorized user of this Application if you fulfill the requirement of this Clause in the manner described herein.

The HCW will screen such individuals above 7 years of age who are not currently undergoing treatment for tuberculosis (TB) after obtaining informed consent. In cases where potential subjects are between the ages of 7 and 18 years, the screening process necessitates obtaining ‘Informed Consent’ from their parents or legal guardians. Additionally, the Application shall not be used to screen individual subjects who fall below the age of 7 years or exceed the age of 100 years or who are active TB Patients or users who do not offer their ‘Informed Consent’ for ’the assessment.

The Application is exclusively intended for use by HCWs specifically designated by the National Tuberculosis NTEP. It is strictly prohibited for individuals other than the designated HCWs to utilize the Application.

You further represent that you will comply with these Terms and all applicable local, state, national and international laws, rules and regulations. You shall not use the Application if you are not competent to contract or are disqualified from doing so by any other applicable law, rule or regulation currently in force.

Privacy Policy

We are firmly committed to protecting your privacy. Our privacy policy is available here.

Permitted Use of the Application

You agree that you will only use the Application in good faith and will not provide false or misleading information about yourself, the subjects to be recorded, or your symptomatic and clinical status. You agree that you will not indulge in any act that may impair the performance or functionality of the Application.

Our services are not intended and meant for anyone under the age of 18 (Eighteen) years. We do not knowingly collect personally identifiable information from children under 18 years of age. We shall not and cannot be held liable in any manner for any information shared on the Application by any person below the age of 18 years and for all such persons, children and concerned, parent or guardian supervision is advised. You agree that all information given by you is governed by our Privacy Policy and its updated versions in the future, and you consent to all actions we take with respect to your information consistent with our Privacy Policy. We will use the data that you have submitted to provide customized services to you as per the terms acceptable to us in our sole discretion.

The Organization may verify details furnished by you, and if any information furnished is found incorrect, false or misleading and if, in our opinion, you have violated any provision of these Terms of Use then we shall have the right to disable your access to the Application without any prior intimation. You shall indemnify and hold harmless the Organization, its subsidiaries, affiliates, and their respective directors, agents, and employees, from any claims made by any third party or penalty imposed due to your breach of these Terms or your violation of any law, rules, or the rights of a third party.

You hereby acknowledge that the Organization or its affiliates, officers and representatives shall not be responsible for any costs, damages, liability, or other consequence of your use of the Application. You further agree and allow the Organization to use your data for storage, research and betterment of this Application.

HOW TO USE THE APPLICATION

Prerequisites

The Application can be installed on any smartphone with the following minimum specifications:

• Android smartphone running OS version 7 and newer.
• A working microphone on the smartphone.
• Internet connectivity on the smartphone.

Authentication

The Application authenticates the HCW using an OTP delivered on the registered mobile number via SMS.

Data Entry

The Application registers and authenticates the HCW using personal information, NTEP programmatic information (location and level posting), and OTP delivered via SMS (as detailed in the Privacy Policy).
Personal and symptomatic data of the subject needs to be entered, as per the instructions provided in the form.

You shall refer to Annexure 1 and Annexure 2 for safety measures.

Before recording the cough sounds on the Application, you shall ensure the following do’s and don’ts for each subject:

DOs

• Obtain informed consent from all individuals being screened, after explaining the procedure in the individual’s preferred/local language.
• Record the sounds in a well-ventilated and noise-free area.
• Ensure that both the health staff and the individual being screened(subject) is wearing a mask throughout the process.
• Hold the smartphone at an arm’s length/3-feet distance from the individual’s face.
• Follow infection prevention protocols (as per national guidelines) at the time of using the App.
• Ensure referral and diagnosis of all presumptive TB cases.

DON’Ts

• Do not screen individuals who do not offer consent.
• Do not collect any cough sounds without following the recommended infection control protocols.
• Do not register individuals falling under the exclusion criteria.
• Do not let the subject directly cough into the smartphone.
• Do not connect any external audio input device, e.g., headphones, earphones, external mic.

INTERPRETING THE RESULTS AND TAKING ACTION

The Application processes the symptomatic data along with the cough audio and provides the results as follows (please refer to the next disclaimer section for more information about the results):

• Likely to have pulmonary tuberculosis

Based on the automated inference, the individual’s chances of having pulmonary tuberculosis are high and they should consult a doctor and get tested to confirm the diagnosis.

• Not likely to have pulmonary tuberculosis

Based on the automated inference, the individual’s chances of having pulmonary tuberculosis are low and they should consult a physician if symptoms continue.

Disclaimer

• The AI model in the Application was trained on data captured at the facility-level (healthcare facilities).
• The AI model has been trained on a data set containing subjects above 7 years of age and below 100 years of age. The model should not be used for individuals below 7 years of age or individuals above 100 years of age.
• The Cough against TB – HCW AI model using both solicited symptoms and cough sounds achieved a sensitivity of 90% and specificity of 60% on test data.
• The sounds were recorded using smartphone microphones. No external attachments for audio input (e.g., for better clarity of audio signals) were used.
• For any issues related to the above, please email coughagainsttb@wadhwaniai.org.

YOUR CONTENT

The Application enables you to add your details as specified therein which may be generalized in nature and is not considered as Personal Information or Confidential Information. All material that you upload, publish, or display to others, which is not considered as confidential information via the Application will be referred to collectively as “Your Content.” Your Content is not confidential or proprietary once shared on the Application. You grant and warrant that you have the right to grant us a non-exclusive, non- revocable, worldwide, transferable, royalty-free, perpetual right to use your content in any manner for any purpose, including the right to translate, display, reproduce, modify, sublicense, and distribute without any payment due to you.
We advise you to use discretion in sharing Your Content on the application, especially regarding sharing any personal or potentially sensitive information. The Organization shall in no manner be responsible for any claim, dispute or conflict arising as a consequence of your actions. You shall not submit any information, content which violates any other persons’ ownership, legal, or moral rights, and You shall adhere to all copyright laws, privacy laws and all relevant laws of India.

RIGHTS YOU ACKNOWLEDGE

You hereby acknowledge that by accessing this Application you are given access to the content that is protected by our copyrights, trademarks, and other intellectual and proprietary rights (“Rights”) and except as expressly provided otherwise, terms of use and applicable copyright, trademark and other laws govern your use of the Application and its content. You may not reproduce or distribute the content in the Application without prior written consent of the Rights holder, which is the Organization.

DISCLAIMER OF WARRANTIES

Though efforts are made to ensure that the information and content provided as part of the Application are correct at the time of inclusion on the Application, there is no guarantee to the accuracy of the information. We do not make representations or warranties as to the fairness, completeness or accuracy of the information on the Application. There is no commitment to update or correct any information that appears on the Internet or on the Website/ Application. Information is supplied upon the condition that the persons receiving the same will make their own determination as to its suitability for their purposes prior to use or in connection with the making of any decision.

INTELLECTUAL PROPERTY

Unless expressly agreed to in writing, nothing contained herein shall give you a right to use any of the trade names, trademarks, service marks, logos, domain names, information, questions, answers, solutions, reports and other distinctive brand features, save according to the provisions of these Terms that shall be available on the Application. All logos, trademarks, brand names, service marks, domain names, including material, designs, and graphics created by and developed by either the Application or such other third party and other distinctive brand features of the Application are the property of the Application or the respective copyright or trademark owner. Furthermore, concerning the Application, we shall be the exclusive owner of all the designs, graphics and the like, related to the Application.

The Organization and the Central TB Division (CTD) shall jointly own all rights, titles and interests, including all related intellectual property rights, in and pertaining to
i. the App and any suggestions, ideas, enhancement requests, feedback, recommendations or any other offerings;
ii. the text, graphics, user interfaces, visual interfaces, photographs, trademarks, logos, sounds, music, artwork and computer code; or
iii. other information provided by You, however, in accordance with the applicable laws.

Third-party trademarks, if any, may appear on this Application and all rights therein are reserved to the registered owners of those trademarks. You, the user of the Application, shall be solely responsible for any violations of any laws and for any infringements of any intellectual property rights caused by your use of the Application.

You shall not use any of the intellectual property displayed on the Application in any manner that is likely to cause confusion among existing or prospective users of the Application, or that in any manner disparages or discredits the Application, to be determined in the sole discretion.

You are aware of all intellectual property, including but not limited to copyrights, relating to said services residing with the Organization, and that at no point does any such intellectual property stand transferred from the Organization.

You are further aware that any reproduction or infringement of the intellectual property of the organization by You will result in legal action being initiated against You by the respective owners of the intellectual property so reproduced/infringed upon. It is agreed by You that the contents of this section shall survive even after the termination or expiry of these Terms of Use and/or Privacy Policy.

INDEMNIFICATION

By accepting these Terms, You agree that You shall defend, indemnify and hold us, our affiliates, our licensors, and each of its officers, directors, other users, employees, attorneys, third party service providers, if any, and agents harmless from and against any and all claims, costs, damages, losses, liabilities and expenses (including attorneys’ fees and costs) arising out of or in connection with:
a. Your violation or breach of any term of these Terms or any Applicable Law or regulation, whether or not referenced herein;
b. Your use or misuse of the Application.
c. Your violation of any rights of another;
d. Your alleged improper conduct according to these Terms of use;
e. Your conduct in connection with the Application;

You agree to fully cooperate in indemnifying Us at your expense. You also agree not to settle with any party without consent from Us.

LIMITATION OF LIABILITY

Under no circumstances shall we or our affiliates be liable to you or anyone else for any damages arising out of use of the services, including liability for consequential or incidental damages. You agree that the liability of The Organization, its affiliates, partners, and licensors, if any, arising out of any kind of legal claim related to the service shall not exceed the amount you paid, if applicable, for the use of the service.

We will not be responsible for any loss (including loss of profits, revenue, contracts, anticipated savings, data, goodwill or wasted expenditure) or any other indirect or consequential loss that is not reasonably foreseeable to both you and us when a contract for the services by us to you was formed.

We will not be held responsible for any delay or failure to comply with our obligations under these conditions, if the delay or failure arises from any because which is beyond our reasonable control. This condition does not affect your statutory rights.

DISCONTINUANCE, MODIFICATIONS, RESTRICTIONS

We may discontinue, change, suspend, or restrict access to this service or any part of the service at any time without any prior intimation or notice and without liability to you or any third party.

EXCLUSIVE JURISDICTION

By using this service, you consent to the exclusive jurisdiction of the courts in Delhi in all disputes relating to these Terms or use of the Application. In the event of breach of the Data Privacy Policy or Data breach, the organization shall be entitled to claim specific injunction in addition to other remedies as available in law.

USER DATA

We shall use the User data in cases including but not limited to:

i. For verifying your identity, eligibility, registration and to provide services.
ii. For facilitating the services available on the application.
iii. For publication of information.
iv. For enabling communication with other users of the application.
v. For generating analysis/research.
vi. For sending communications and notifications.

Please get in touch with us if you object to any purpose of data processing. However, please note that if you object or withdraw consent to process data as above, we may discontinue your access to the services given through the Application.

RIGHT TO RECTIFY
You have the right to rectify any inaccuracy or incompleteness in your personal data held by us. You can do so in the profile section of the Application by writing to us on coughagainsttb@wadhwaniai.org.

STORAGE
We shall ensure that your confidential information is stored in our secure databases with restricted access. To protect your Personal Information, we have implemented adequate security technology and will update these measures as appropriate.

DATA RETENTION AFTER CLOSURE OF YOUR ACCOUNT
If you wish to close your account on the Application, please let us know by submitting a request to coughagainsttb@wadhwaniai.org. We will retain information about you in our databases for as long as your account is active or as needed to provide you services and in accordance with applicable laws. Our retention and use of your information will be as necessary to comply with our legal obligations, resolve disputes, and to enforce agreements. The retention period may extend beyond the end of your relationship with us, as required for us to have sufficient information to respond to any issues that may arise later or for our records, to provide you services if you reopen your account. Please note that there will be a latency in deleting your information from our servers and backed-up or disaster recovery versions may exist even after deletion.

ACCESS TO INFORMATION
We will respond to your request about access to the information we collect about you within the timeframe required by applicable law. The following persons may have access to the user data:
a. Administrators: We may provide access to your information to our authorized administrators for data annotation/research purposes, who are bound by confidentiality obligations towards the same.
b. Affiliates: We may provide information we collect to our affiliates. For example, we may disclose Personal Information to our affiliates to respond to your requests for information or the services.
c. Legal and Regulatory Authorities: We may be required to disclose your Personal Information due to legal or regulatory requirements. In such instances, we reserve the right to disclose your Personal Information as required to comply with our legal obligations, including but not limited to complying with court orders, warrants, or discovery requests. We may also disclose your Personal Information:
i. to law enforcement officers.
ii. to comply with a judicial proceeding, court order, or legal process served on us.
iii. to enforce this Privacy Policy or the Terms of use or our other policies or agreements.
iv. for an insolvency/bankruptcy proceeding involving all or part of the asset to which the information pertains.
v. to respond to claims that any Personal Information violates the rights of third parties.
vi. or protect the rights, property, or personal safety of the Organization, out users or the public. We may not inform you prior to or after disclosures made according to this section.

Notwithstanding anything mentioned hereinabove, the Organization shall not be responsible for any additional information you may choose to provide directly to any service provider or any third party.

DEFECT REPORTING
You can report any defects or bugs in the App or the Services to coughagainsttb@wadhwaniai.org. We will make every endeavor to address all reported bugs and defects.

FEEDBACK
You may provide feedback to improve the Application on coughagainsttb@wadhwaniai.org. Any feedback you provide shall be the sole property of the Organization and you waive any rights to compensation or attribution for such feedback.

QUESTIONS
Please contact us regarding any questions or grievances. Please email us at coughagainsttb@wadhwaniai.org.

TERMINATION
These Terms and the license rights granted hereunder shall remain in force unless terminated for any of the following reasons:
(a) immediately for any unauthorized use by you;
(b) immediately if you assign or transfer (or attempt the same) any rights granted to you under this Terms;
(c) immediately, if you violate any of the terms and conditions of these Terms.

Termination or cancellation of these Terms shall not affect any right or relief to which The Organization may be entitled, at law or in equity. Upon termination of these Terms, all rights granted to you will terminate and revert to The Organization. Except as set forth herein, regardless of the reason for termination of this Terms, the fee charged, if any, for access to the Application is non-refundable. The services of the app are provided at a non-chargeable basis. We do not intend to charge any cost for the application or its provided services.

NO AGENCY

These Terms shall not create any agency, partnership, or joint venture or other relationship between you and us. Each Party remains independent. Neither party shall assume or create any obligation of any nature whatsoever on behalf of the other Party or bind the other Party in any respect whatsoever.

ACKNOWLEDGEMENT TO DONORS

We duly acknowledge that this Application has been developed with the due support from the Central TB Division and financial contribution of our Donors USAID (under the Trace TB Program). We are thankful for their contribution and support without which this Application would not have come into existence.

SEVERABILITY

If any provision of these Terms is invalid as per applicable law, held by a court of competent jurisdiction or arbitral tribunal to be unenforceable under applicable law, then such provision shall be excluded from these Terms and the remainder of the Terms shall be interpreted as if such provision were so excluded and shall be enforceable in accordance with its terms; provided however that, in such event, these Terms shall be interpreted so as to give effect, to the greatest extent consistent with and permitted by applicable law, to the meaning and intention of the excluded provision as determined by such court of competent jurisdiction or arbitral tribunal.

WAIVER
No provision of these Terms shall be deemed to be waived and no breach excused, unless such waiver or consent shall be in writing and signed by the Organization. Any consent by Organization to, or a waiver by Organization of any breach by you, whether expressed or implied, shall not constitute consent to, waiver of, or excuse for any other different or subsequent breach.

APPLICABLE LAW AND DISPUTE RESOLUTION
These Terms are legally binding of the expression of intent of the Parties. You hereby agree that, in the event of any dispute between the Parties relating to the use of this Application or any condition mentioned herein, the Parties shall seek to resolve the dispute by settling amicably through informal discussions and negotiations underpinned by principles of transparency and trust. In the event such discussions fail within a period of 45 days, either Party shall have a right to approach the courts in Delhi, India which shall have exclusive jurisdiction over all disputes.

The Parties agree that these Terms and any contractual obligation between Organization and User will be governed by the laws of India.

Annexure 1: Disinfection of Smartphones

For all devices used for data collection, we shall follow the below recommendations, as issued by the Ministry of Health and Family Welfare (MoHFW).

1. MoHFW guidelines

• For electronics such as smartphones, tablets, touch screens, remote controls, and keyboards, remove visible contamination if present.
• Follow the manufacturer’s instructions for all cleaning and disinfection products.
• Use of wipeable covers for electronics.
• If no manufacturer guidance is available, consider the use of alcohol-based wipes or sprays containing at least 70% alcohol to disinfect touch screens. Dry surfaces thoroughly to avoid pooling of liquids.

2. Guidelines issued by leading smartphone manufacturers

• Before you begin, power down your device, remove any case or cover and unplug any accessories.
• Wipe the exterior surface of the phone with a soft, lint-free microfibre cloth.
• Manufacturers warn against applying liquid cleaning solutions directly on the phone as that may damage the device, particularly the oleo phobic coating which helps protect the display from fingerprint smudges.
• Liquids and water could even get into open spaces, particularly on devices that don’t have an IP rating, so you could end up damaging your phone.
• For disinfecting the phone, dampen the corner of your cleaning cloth with a small amount of distilled water or disinfectant.
• You can use a hypochlorous acid-based (50-80ppm) or alcohol-based (formulated with more than 70% ethanol or isopropyl alcohol) product and wipe the front and back of your phone gently without too much pressure.
• Avoid wiping the device excessively. Manufacturers also caution against using compressed air or applying spray bleaches or liquid solutions directly on the phone.
• These cleaning guidelines are meant for glass, ceramic and metal surfaces, not for soft accessories that are made from materials like plastic, rubber or leather.
• If you use cases or covers on your phone, it would be a good idea to disinfect them as well, since they tend to capture a lot of dirt and grime anyway over time.

Annexure 2: Safety Measures for HCWs

The following measures will be undertaken to prevent infection during data collection.

• Persons with the willingness and dedication to work in this situation will only be recruited with written informed consent.
• The staff will be trained by qualified trainers on infection prevention and control practices before joining duty to attend health facility.
• Infection prevention measures during data collection will be ensured, such as:
  • Cough sound will be collected at a well-ventilated place and away from other people.
  • Individuals will cough with a mask on their face and all the cough hygiene measures.
  • Data collection devices will be disinfected as per the instruction of the manufacturer or as per Annexure 1.
• Staff will be allowed to work in health facilities for not more than 6 hours, and all precaution measures will be followed as per the IPC guidelines.
• Any staff that develops respiratory symptoms will be removed from their data collection duties.

Implementation of appropriate infection prevention and control (IPC) measures

The following measures will be undertaken to prevent infection during data collection.

• Persons with the willingness and dedication to work in this situation will only be recruited with written informed consent.
• The staff will be trained by qualified trainers on infection prevention and control practices before joining duty to attend health facility.
• Infection prevention measures during data collection will be ensured, such as:
  • Cough sound will be collected at a well-ventilated place and away from other people.
  • Individuals will cough with a mask on their face and all the cough hygiene measures.
  • Data collection devices will be disinfected as per the instruction of the manufacturer or as per Annexure 1.
• Staff will be allowed to work in health facilities for not more than 6 hours, and all precaution measures will be followed as per the IPC guidelines.
• Any staff that develops respiratory symptoms will be removed from their data collection duties.

Implementation of appropriate infection prevention and control (IPC) measures

IPC is a critical and integral part of data collection from patients, as per the guidelines of the Ministry of Health and Family Welfare (MoHFW).
Standard precautions will always be routinely applied, including hand hygiene, avoiding direct contact with patients’ respiratory secretions, standard precautions for safe waste management and cleaning and disinfection of equipment (including data collection devices).
Implementation of infection prevention and control measures for patients with suspected or confirmed nCoV infection as per the guidelines of the MoHFW.