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Cost Effective Technology for Effective and Rapid TB Response in Nigeria

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By Chris Macek, Jeff Takle and Kehinde Jimoh of SystemOne. Cracking the Nut Health Conference. July 2016.

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Cost Effective Technology for Effective and Rapid TB Response in Nigeria

  1. 1. Cost Effective Technology for Effective and Rapid TB Response in Nigeria Cracking the Nut Health Conference Kehinde Jimoh , Chris Macek, Jeff Takle FHI 360 Conference Center in Washington, DC.
  2. 2. Abt Associates Outline  Session Objectives  Background  Approach and Process of Using GxAert  Value of integrating the GxAlert application  Implementation of Innovation  Results  Breakout session  To share Lessons Learned
  3. 3. Abt Associates Session Objectives  To orient participants to the Cost effective technology-supported GxAlert system in Nigeria.  To present our we achieved an improvement in DR- TB patient enrollment.  To share lessons learned to date.
  4. 4. Abt Associates Background  Nigeria is a Country in W/Africa with a population of 165 million  Nigeria is ranked 13th among the 27 high DR-TB burden countries in the world  Prevalence of MDR-TB among New Cases is 2.9%  Prevalence of MDR-TB among Retreatment Cases is 14.3%  Number of GeneXpert Site is 210 presently  Nigeria is implementing technology- supported GxAlert system to improve DRTB patients notification and enrollment in about 200 Labs Presently.
  5. 5. Abt Associates Challenges to Intervention  Reporting TB testing results is a lengthy process due to a continued reliance on paper records and slow data transit systems.  Quality of results data is often poor and subsequent program management decisions are not always timely or focused on priority needs.
  6. 6. Abt Associates What is GxAlert? GeneXpert Health Systems Connects the device via secure network. Allows automatic real-time reporting of test results. Send GeneXpert MTB/RIF diagnostic results in real time to a secure web-based database in mere seconds so it can become “actionable” within the health system. Open-Source Software Source Code Available for free Any funded development available to all users/countries
  7. 7. Abt Associates Approach and Process of GxAert  GxAlert is configured on GeneXpert systems and by installing a modem/Router from a telecom that encryps and gives access to internet to send out the results.  Data can be analyzed and aggregated by: Device, Facility, LGA, or State in a Gxalert Database (Dashboard)  The system then sends the results in an SMS alert to program decision makers at the state and national TB program, shortening the new-case reporting period from months to seconds.
  8. 8. Abt Associates Why Connect GeneXperts? Connected via GxAlert
  9. 9. Abt Associates GxAlert Allows Data to Flow Across the Health System GH Kumo Kwali GH IDH Kano Zankli Lab NIMR Yaba SMS Email Computer App Other Systems: e-TB Manager DHIS2 • Connects diagnostic devices • Collects custom data • Sends alerts, notifications and reports to different level of care providers • Monitors and manages cartridge inventory • Records service, warranty, and maintenance events • Integrates with other health systems
  10. 10. Abt Associates Development of government ownership, strategies to encourage and engender ownership  The government of Nigeria was involved in the design of the pilot right from the beginning.  Selection of facilities for the pilot was done by the government and they were involved and supported the installation processes to all facilities.  SMS notification was sent to the NTP director and his team for prompt notification.  Login and Access to the data collected from all the pilot facilities was first created and shared with the government staffs (national/ state and facility view).  The analysis of the data was done in collaboration with the Government to enable take policy decision and initiate quick enrolment of Rifampicin Resistance patients that were reported into care and treatment..
  11. 11. Abt Associates Results  The proportion of DR-TB patients enrolled for treatment based on GxAlert messages received from 35 GeneXpert facilities jumped to 85% in March, 2015 from only 50% enrolled in April 2014.  SMS or text message alerts are sent to TB Local Government supervisor, State program manager and National Program DR-TB enrollment officer upon GeneXpert confirmation of a MTB+ Rif+ case to speed treatment initiation.  Weekly reports of all new TB+ cases are both emailed and sent by SMS to local health officials to ensure better connection between diagnosis, enrollment and treatment.
  12. 12. 74 110 181 122 194 180 232 143 - 50 100 150 200 250 Q1 2014 Q2 2014 Q3 2014 Q4 2014 Trend of DR-TB cases enrolled between Q1 2014 to Q4 2014 DR-TB cases enrolled RIF resistant cases detected RIF Resistant cases diagnosed within 4 quarters report directly from Gxalert Percentage of Patient enrolled on treatment increased in Q4
  13. 13. Abt Associates Lessons Learned  This innovation has made it possible to get diagnostics results immediately back to clinicians and patients.  It identified $100k’s worth of commodities that would expire before use; led to immediate reallocation and redesign of NTP logistics unit approaches to GeneXpert supplies.  We saw gains in supervisor capability, improved the focus of training, enhanced site selection.  Diagnostic machine utilization, and machine uptime and improved adherence to maintenance regime (calibration and module replacement). 
  14. 14. Open-source MOH-owned data Appropriate treatment, faster Value for Money Secure, patient privacy Proxy for disease burden QUESTIONS? www.GxAlert.com
  15. 15. Abt Associates Breakout session  Participants will be divided into four groups to look at the following case studies, discuss and identify solution to the problems in their various group before rounding up with a plenary. (Case studies will be shared to all participants)
  16. 16. Abt Associates End of seesion Session will be rounded up with answers to the Simple and Big questions in the slides below:
  17. 17. Abt Associates Can we get better quality data, faster? Does it lead to NTP action? Do results get to patients? Many more steps in here… Are patients getting into appropriate treatment faster because of a data connectivity solution? Big QuestionsSimple Questions 1 "GxAlert has revolutionized the TB control program in Nigeria with faster diagnostic results (with better accuracy) in real time. It has further made patients’ enrollment in treatment centers much easier." — Elom Emeka Director/Medical Laboratory Team Lead , NTP/Nigerian Federal Ministry of Health “
  18. 18. Abt Associates Are patients getting into appropriate treatment faster because of a data connectivity solution? Big Questions Can we get better quality data, faster? Does it lead to NTP action? Do results get to patients? Simple Questions “We saw 3x the level of MDR we expected!” 1
  19. 19. Abt Associates Can a data connectivity solution demonstrate “Value for Money”? Big Questions Can errors be better managed? Simple Questions Can stockouts be prevented? Can it optimize Site Selection? Build supervisor training specifically around reducing 2008, 5006, and 5007 errors Set up 5011 SMS text alert to contact Cepheid tech support 2
  20. 20. Abt Associates Can a data connectivity solution demonstrate “Value for Money”? Big Questions Can errors be better managed? Simple Questions Can stockouts be prevented? Can it optimize Site Selection? Good news is that better training leads to fewer errors! 2
  21. 21. Abt Associates Can a data connectivity solution demonstrate “Value for Money”? Big Questions Can errors be better managed? Simple Questions Can stockouts be prevented? Can it optimize Site Selection? Needs cartridges Has more cartridges on hand than they can use before expiration 2
  22. 22. Abt Associates Could a data connectivity solution serve as a proxy for measuring disease burden? Big Questions Can we report WHO indicators automatically? Simple Questions Self-configure new indicators  By MTB  By Rif  By Age  By Sex  By DR Suspect  By HIV status  Custom… 4
  23. 23. Abt Associates Recap: Take Home Messages  GxAlert eliminates the need for human error in data entry, reduces the lag time, and helped pinpoint patients that should be place on care.  GxAlert strengthened surveillance of DR-TB, TB in children and TB in the HIV infected, speeding response and improving programmatic decision made for enrollment and placement of DR-TB patient on treatment.  The use of GxAlert SMS notification of GeneXpert testing suggests a scalable model for sustainability: Installation is done once and in-country.
  24. 24. Abt Associates Recap: Take Home Messages  GxAlert eliminates the need for human error in data entry, reduces the lag time, and helped pinpoint patients that should be place on care.  GxAlert strengthened surveillance of DR-TB, TB in children and TB in the HIV infected, speeding response and improving programmatic decision made for enrollment and placement of DR-TB patient on treatment.  The use of GxAlert SMS notification of GeneXpert testing suggests a scalable model for sustainability: Installation is done once and in-country.
  25. 25. Abt Associates Recap: Take Home Messages  GxAlert eliminates the need for human error in data entry, reduces the lag time, and helped pinpoint patients that should be place on care.  GxAlert strengthened surveillance of DR-TB, TB in children and TB in the HIV infected, speeding response and improving programmatic decision made for enrollment and placement of DR-TB patient on treatment.  The use of GxAlert SMS notification of GeneXpert testing suggests a scalable model for sustainability: Installation is done once and in-country.
  26. 26. QUESTIONS? www.GxAlert.com Contact: Kehinde Jimoh Agbaiyero, Abt Associates Kehinde_Agbaiyero@abtassoc.com Chris Macek, SystemOne chris@systemone.id OR

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