web-based tools to maximize a national investment in the genexpert jeff takle , dir. of innovation...
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“. Rapid diagnosis must lead to the rapid initiation of an appropriate treatment. Web-Based Tools to Maximize a National Investment in the GeneXpert Jeff Takle , Dir. of Innovation @Abt Associates 2 nd African Regional Training Workshop on Xpert MTB/RIF July 24, 2013. - PowerPoint PPT PresentationTRANSCRIPT
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“
Abt Associates
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
Abt Associates
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 [email protected] Takle [email protected]
Download slide deck @ www.GxAlert.com