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Office of HIV/AIDS & Tuberculosis
History of Use of GxAlert
in Nigeria
Debby Nongo
USAID Nigeria
Background on Nigeria
• 4th in terms of global TB burden
• Highest TB burden in Africa
• TB incidence: 322/100,000 population
• TB treatment coverage - CDR is 17%
• National HIV prevalence - 3.4%
• TB/HIV co-infection 17%
• Prevalence of MDR-TB among new
cases is 2.9%
• Service delivery points:
– >5,940 DOTS centers
– >1,925 AFB centers
– 377 GeneXpert sites
– 8 TB culture labs
Implementation processes
Proof of
concept
USB
Modem
3G Router
<5
machines
283/377
machines
connected
so far
What are we connecting and why?
Other Systems:
e-TB Manager
DHIS2, C360?
Decision
Makers
Donors, IPs
Patient
External
Stakeholders
T
B
P
R
O
G
R
A
M
National TB
Control
Programme (NTP)
State TB
Program
TB Local
Government
Area (LGA) Sup.
Health
Care
Facility
Health
Care
Facility
GX sites It takes at
least 6
weeks for
the data to
get here
Health
Care
Facility
Expected results….
• Real time feedback to patients, clinicians, and
program staff on test outcomes
• Real time notification to state program on MTB/RIF
resistance cases diagnosed
• Early warning system for:
– Non-functioning machines
– Cartridge stock level
– Warranty expiration
– QA issues
• Timely reporting of appropriate indicators
• Site-level visibility into Xpert site functionality
6
Successes
• 298 out of 377 sites installed and ongoing
• Great collaboration between donors
– USAID-funded dashboard development and roll-out to 200 sites
initially and will pick up where GF leaves off
– GF funding roll out to 100 sites
• Expanded original concept to address TB/HIV data needs
• Buy-in of National TB Control Programme and partners
7
A wealth of information is just a click away
8
GX
Alert
GON
Donors
Implementing
Partners
General
Health Care
Workers
(GHCWs)
Patient
Who actually has access to the information?
Site connectivity information and performance
10
How Information from the Dashboard is Managed
Current Practice
• NTP IT staff monitors
dashboard and updates NTP
Lab Unit of maintenance-
related issues (not sure how
often) and IPs are informed
once a quarter to resolve.
• Testing data from GxAlert is
not used for reporting
• Inventory module not used for
logistics planning
Proposed
• Expand relevant access to all
key stakeholders at different
levels.
– Implementing partners who
support the sites need access
to timely information to
respond to issues as they
come up
• Use GxAlert data real time and
not quarterly
• Ensure proper use of the
inventory module and data for
supply planning
11
Major Organizational Issues Affecting Project Success
• Issue: NTP’s reluctance to expand access to the
dashboard to include other key stakeholders who are
critical to ensuring successful operations
• Action Taken (or to be taken): Ongoing dialogue with
NTP to make them understand why it is critical to ensure
that access is granted to every category of end user of the
information available on the dashboard, as well as the
need to use this data for decision making.
• Lessons Learned: The need to define user agreements
from the onset of such a project is critical to success.
12
Major Operational Issues Affecting Project Success
• Issue: Gap in support to ensure optimal understanding and
utilization of the full capabilities of this tool.
• Action Taken (or to be taken): Development of a user guide
for facility staff as well as setting up a support structure to
quickly address issues as they come up.
• Lessons Learned: Availability of timely and accurate technical
support is critical to the success of using IT solutions especially
in challenging environments like Nigeria.
13
Next phase…..
• Sustain connectivity
• Figure out Unique Patient Identifier to help
integration across platforms
• Integrate with other systems (e-TB, DHIS, etc.)
• Provide timely maintenance support to sites
• Connect system with other diagnostic tools
THANK YOU

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History of Use of GxAlert in Nigeria

  • 1. Office of HIV/AIDS & Tuberculosis History of Use of GxAlert in Nigeria Debby Nongo USAID Nigeria
  • 2. Background on Nigeria • 4th in terms of global TB burden • Highest TB burden in Africa • TB incidence: 322/100,000 population • TB treatment coverage - CDR is 17% • National HIV prevalence - 3.4% • TB/HIV co-infection 17% • Prevalence of MDR-TB among new cases is 2.9% • Service delivery points: – >5,940 DOTS centers – >1,925 AFB centers – 377 GeneXpert sites – 8 TB culture labs
  • 3. Implementation processes Proof of concept USB Modem 3G Router <5 machines 283/377 machines connected so far
  • 4. What are we connecting and why? Other Systems: e-TB Manager DHIS2, C360? Decision Makers Donors, IPs Patient External Stakeholders T B P R O G R A M National TB Control Programme (NTP) State TB Program TB Local Government Area (LGA) Sup. Health Care Facility Health Care Facility GX sites It takes at least 6 weeks for the data to get here Health Care Facility
  • 5. Expected results…. • Real time feedback to patients, clinicians, and program staff on test outcomes • Real time notification to state program on MTB/RIF resistance cases diagnosed • Early warning system for: – Non-functioning machines – Cartridge stock level – Warranty expiration – QA issues • Timely reporting of appropriate indicators • Site-level visibility into Xpert site functionality
  • 6. 6
  • 7. Successes • 298 out of 377 sites installed and ongoing • Great collaboration between donors – USAID-funded dashboard development and roll-out to 200 sites initially and will pick up where GF leaves off – GF funding roll out to 100 sites • Expanded original concept to address TB/HIV data needs • Buy-in of National TB Control Programme and partners 7
  • 8. A wealth of information is just a click away 8
  • 10. Site connectivity information and performance 10
  • 11. How Information from the Dashboard is Managed Current Practice • NTP IT staff monitors dashboard and updates NTP Lab Unit of maintenance- related issues (not sure how often) and IPs are informed once a quarter to resolve. • Testing data from GxAlert is not used for reporting • Inventory module not used for logistics planning Proposed • Expand relevant access to all key stakeholders at different levels. – Implementing partners who support the sites need access to timely information to respond to issues as they come up • Use GxAlert data real time and not quarterly • Ensure proper use of the inventory module and data for supply planning 11
  • 12. Major Organizational Issues Affecting Project Success • Issue: NTP’s reluctance to expand access to the dashboard to include other key stakeholders who are critical to ensuring successful operations • Action Taken (or to be taken): Ongoing dialogue with NTP to make them understand why it is critical to ensure that access is granted to every category of end user of the information available on the dashboard, as well as the need to use this data for decision making. • Lessons Learned: The need to define user agreements from the onset of such a project is critical to success. 12
  • 13. Major Operational Issues Affecting Project Success • Issue: Gap in support to ensure optimal understanding and utilization of the full capabilities of this tool. • Action Taken (or to be taken): Development of a user guide for facility staff as well as setting up a support structure to quickly address issues as they come up. • Lessons Learned: Availability of timely and accurate technical support is critical to the success of using IT solutions especially in challenging environments like Nigeria. 13
  • 14. Next phase….. • Sustain connectivity • Figure out Unique Patient Identifier to help integration across platforms • Integrate with other systems (e-TB, DHIS, etc.) • Provide timely maintenance support to sites • Connect system with other diagnostic tools THANK YOU