web-based tools to maximize a national investment in the genexpert jeff takle , dir. of innovation...

Web-Based Tools to Maximize a National

Investment in the GeneXpert

Jeff Takle, Dir. of Innovation @Abt Associates2nd African Regional Training Workshop on

Xpert MTB/RIFJuly 24, 2013

Rapid diagnosis must lead to the rapid initiation of an appropriate treatment“

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USB modem,Wifi,

Mobile phone,Manual upload

How Does it Work?

eTB Manager or M&E tools

Targeted alert messages

Electronic patient records

Web database

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GxAlert– Open source, dev in 2012 by Abt Associates – Incorporates diagnostics for TB and flu (GeneXpert) and HIV (PIMA)– Active in India and Nigeria; early stage in 5 countries

TBGxMonitor– Developed in 2011 by Univ. of Witwatersand in South Africa– Active in South Africa; early stage in 13 countries

XpertSMS– Open source, dev in 2011 by IRD Pakistan– Active in Pakistan, Nepal, Kenya, Zimbabwe; early stage in 5 countries

RemoteXpert– Being developed by Cepheid, estimated launch December 2013– Pilot tested in South Africa

There Are Four Stable, Scaling-up Data Services Around the GeneXpert

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Providers Cartridge expirations Stockout management Utilization vs. disease load Deployment planning Procurement, warranty, and service

planning

GxAlert

What Does Each Software Do?

MOH Case+Population level Management Indicator reporting MDR treatment Drug demand / supply Integration into existing National

Health Information Systems (eTB*) MOH messaging Clinic / lab messaging Patient messaging

GxAlert

XpertSMS

Labs External Quality Assurance (EQA) Instrument Verification Pre-analytical, analytical and

post-analytical evaluation Errors and error rate

(by user, module, and machine)

TBGxMonitor

RemoteXpert*

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A Look Inside…GxAlert

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HIV Devices (PIMA) Can Report Directly into GxAlert

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Tracking Co-Infection Indicators at the Patient Level

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MOH Can Forecast Cartridge Needs By Observing Consumption Trends

Avg. # tests/yrper device438

Avg. Utilizationper device18%

Est. Overpurchasein Year 1-

$103,114

TBREA

CH-AbajiGH

ZANKLI L

AB

TBREA

CH-UATH

TBCARE-J

ERICO

TBREA

CH-KUJEGH

TBCARE-M

AINLAND

TBREA

CH-Kwali

TBCARE-N

IMR

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

25% 24% 24%16% 16% 13% 12%

6%

Utilization Rate of GeneXpert by Facility, Lifetime

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MOH Can Identify Malfunctions Earlier and Reduce Patient Re-visits

A serious outlier

Error Codes

Number of Error Results, by Module

Possible alert threshold

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MOH Can Set Thresholds for Errors: Above = Alert to Supervisor

Opportunity to identify “best practices”

Focus attention where needed most

Possible alert threshold

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A Look Inside…XpertSMS

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A Look Inside…XpertSMS

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A Look Inside…TBGxMonitor

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Each is Relatively Inexpensive to Bring to National Scale GxAlert ~$25,000 Yr1 to roll out nationwide and tech support

existing software; Yr2 ~$10,000

XpertSMS ~$25,000 Yr1 to roll out nationwide and tech support existing software; Yr2 ~$10,000

TBGxMonitor available to complement NHLS/Wits DCS EQA program. Independent use cost TBD.

Cepheid’s RemoteXpert, cost TBD, Dec 2013

Each of these software is capable of being connected with the others so installing a mix of software is possible

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Ways To Extend This Capability

Connect to an EMR (OpenMRS)

Connect to an M&E system

Connect to a case management tool (eTB Manager)

Connect to drug logistics program

Connect other diagnostic devices (Hain, MGIT, PIMA)

Automate portions of your indicator reporting

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Challenges Stable nationwide connectivity

Security

Stakeholder coordination

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Why Include These Tools in Your GeneXpert Implementation?

1. Patient benefits: start treatment faster, reduce spread of drug resistant disease, recover sooner

2. Identify and track population drug resistance patterns of TB cases

3. Shorten diagnostic response time from months to minutes, getting patients into treatment faster

4. Reduce waste and avoid stockouts through real-time forecasts

5. Dramatically improve data quality

6. Measure program adherence to the TB treatment protocols

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Acknowledgements MSH

KNCV

Nigeria NTP

India private sector labs

CHAI

IRD Pakistan

NHLS South Africa

USAID

CDC

Better patient treatmentFaster response to MDR-TB

More efficient TB logistics

Prepared by:Martha Benezet martha_benezet@abtassoc.comJeff Takle jeff_takle@abtassoc.com

Download slide deck @ www.GxAlert.com