This document summarizes Nigeria's experience implementing the GxAlert connectivity tool for GeneXpert machines. Key points include: - GxAlert allows GeneXpert machines to report test results in real-time via a secure online network, making results actionable within the health system. - Over 200 GeneXpert machines in Nigeria are now connected via GxAlert. This enables real-time notification of test results, machine errors, and stock levels. - Challenges include inconsistent internet availability, incomplete primary data, and a need to better integrate GxAlert with other electronic reporting systems like e-TB Manager and DHIS2. Support is also needed to sustain connectivity and uniquely identify patients.

1. On the ground experiences and challenges of a
connected diagnostics-GX Alert in Nigeria
47th Union World Conference on Lung Health
Liverpool, England
Oct 26 - 29, 2016
Gidado M., Peter, N., Elom, E., Gabriel A.,
Rupert E., Useni S., Nkem C., Kuye J.

2. Acknowledgement & declaration of
conflict of interest
 All colleagues in NTP; Abts associates and system
one; USAID.
 I have no conflict of interest and I take
responsibilities for the content of the presentation

3. Presentation outline
 Summary
 Introduction
 Processes
 Lessons learnt
 Challenges/Way forward

4. Summary
GxAlert connectivity is a laboratory
management tool if implemented
effectively.
However
“matching the right technology with
the right problem can be challenging”
(Lombardo, & Buckeridge, 2007)

5. Introduction--1
 4th in-terms of Global TB burden
 Highest TB burden in Africa.
 TB incidence: 322/100,000 population
 TB treatment coverage-CDR is 15%,
 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
• 245 GeneXpert sites
• 8 TB culture labs

6. Introduction---2
 Real time paperless data century –
the role of internet.
• “Chose technology that aligns with fiscal realities;
technology that are flexible & scalable”
• “Engage stakeholders in the entire processes”
• “Implementing connectivity is a journey and should be
Step wise”
• “Who is the costumer, & what is/are the goals of the
connectivity”
• “Management of expectations”
Lombardo, & Buckeridge (2007)

7. Lab connectivity in Nigeria
GeneXpert
Health
Systems
Connects the device via
secure network. Allows
automatic real-time
reporting of test results.
Routes the information so it
can become “actionable”
within the health system.

8. What are we connecting and
why?
GH Kumo
Kwali GH
IDH Kano
Zankli Lab
NIMR Yaba
SMS
Email
Computer
Other Systems:
e-TB Manager
DHIS2
GeneXpert

9. Why Connect GeneXperts?
Connected via GxAlert

10. Implementation processes:
Proof of
concept
Add a USB
Modem
Add a 3G
Router
<5
machines
>200
machines

11. We always ask for more:

12. Results-example--1

13. Results ---2
 Real time feedback to patients and clinicians on
readiness of result
 Real time notification/Alert to state program on
MTB/Rif resistance case
 Early alert:
• Non functioning machine
• Cartridge stock level
• Warranty expiration
• Error rates
 Timely reporting of appropriate indicators

14. Challenges:
 Variation/Availability of internet by states/lab sites
 Quality of primary data-incompleteness of variables in
request forms
 Summary dashboard not available for the direct user
 Lack of unique identification number with difficulties
to link GxAlert with other electronic reporting system
 Legal framework or enabling policy on electronic
reporting
 Security, privacy and confidentiality related issues
(currently non connection among military sites)

15. What are we asking for now
 How can we…
• Sustain Connectivity
• Have Patient Unique Identifier
• Integrate with other systems (e-TB, DHIS)
• Dedicated Staff to Train, Provide on Site
Supportive Supervision, Monitor and
Troubleshoot when a lab does not report
• Connect system with other diagnostic tools

16. Acknowledgement
 NTP
 USAID
 KNCV/CTB
 Abts & System one
 GeneXpert lab colleagues

17. Thanks
Comments/Questions