Presentation: Cracking the Nut Health Conference
26
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.
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Transcript of Presentation: Cracking the Nut Health Conference
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.
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
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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.
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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.
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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.
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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 SoftwareSource Code Available for freeAny funded development available to all users/countries
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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.
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Why Connect GeneXperts?
Connected via GxAlert
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GxAlert Allows Data to Flow Across the Health System
GH Kumo
Kwali GH
IDH Kano
Zankli Lab
NIMR Yaba
SMS
ComputerApp
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
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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..
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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.
Q1 2014 Q2 2014 Q3 2014 Q4 2014 -
50
100
150
200
250
74
110
181
122
194
180
232
143
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 quar-ters report di-
rectly from Gxalert
Percentage of Patient en-rolled on
treatment in-creased in Q4
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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).
Open-source
MOH-owned data
Appropriate treatment, faster
Value for MoneySecure, patient privacy
Proxy for disease burden
QUESTIONS?www.GxAlert.com
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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)
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End of seesion
Session will be rounded up with answers to the
Simple and Big questions in the slides below:
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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
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"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
“
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Are patients getting into appropriate treatment faster because of a data connectivity solution?
Big QuestionsCan 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
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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
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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
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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
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Could a data connectivity solution serve as a proxy for measuring disease burden?
Big QuestionsCan 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
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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.
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.
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.
QUESTIONS?www.GxAlert.com
Contact:Kehinde Jimoh Agbaiyero, Abt Associates
[email protected] Macek, SystemOne
OR
