On the ground experiences and challenges of a connected diagnostics-GX Alert in Nigeria

47th Union World Conference on Lung HealthLiverpool, England

Oct 26 - 29, 2016

Gidado M., Peter, N., Elom, E., Gabriel A., Rupert E., Useni S., Nkem C., Kuye J.

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

Presentation outline

Summary

Introduction

Processes

Lessons learnt

Challenges/Way forward

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)

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

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)

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.

What are we connecting and why?

GH Kumo

Kwali GH

IDH Kano

Zankli Lab

NIMR Yaba

SMS

Email

ComputerOther Systems:e-TB Manager

DHIS2

GeneXpert

Why Connect GeneXperts?

Connected via GxAlert

Implementation processes:

Proof of concept

Add a USB Modem

Add a 3G Router

<5 machines

>200 machines

We always ask for more:

Results-example--1

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

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)

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

Acknowledgement

NTP

USAID

KNCV/CTB

Abts & System one

GeneXpert lab colleagues

ThanksComments/Questions