e-tb manager: a comprehensive web-based tool for …€¦ · multidrug-resistant tb (mdr-tb) is a...
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e-TB Manager: gA Comprehensive Web-Based Tool
for Programmatic Management of TB and Drug Resistant TBof TB and Drug-Resistant TB
Management Sciences for HealthManagement Sciences for Health
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Facts about TB*TB is contagious and airborne; each untreated person with active TB can infect ~ 10 to 15 people a yearOne third of world population infected with TB (most vulnerable – people with HIV)1 8 million died in 2007 (TB is leading killer of people1.8 million died in 2007 (TB is leading killer of people with HIV ~500,000 in 2007) 9.27 million new TB cases registered in 2007gTB is a worldwide pandemic: among the 15 countries with the highest estimated TB incidence rates, 13 are in Af i hil h lf f ll i i A iAfrica, while half of all new cases are in six Asian countries (Bangladesh, China, India, Indonesia, Pakistan and the Philippines)
* from: http://www.who.int/features/factfiles/tuberculosis/en/index.html
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Facts about TB contFacts about TB, cont. Multidrug-resistant TB (MDR-TB) is a form of TB that does not respond to the standard treatments using firstdoes not respond to the standard treatments using first-line drugs – 511,000 new MDR-TB cases in 2007 Extensively drug-resistant TB (XDR-TB) occurs when y g ( )resistance to second-line drugs developsWHO’s Stop TB Strategy aims to reach all patients and achieve the target under the Millennium Developmentachieve the target under the Millennium Development Goals (MDG): to reduce by 2015 the prevalence of and deaths due to TB by 50% relative to 1990 and reverse the trend in incidenceRequired investment to achieve the MDG target is estimated at US$ 67 billion (there’s a 40 billion gap)estimated at US$ 67 billion (there s a 40 billion gap)
* from: http://www.who.int/features/factfiles/tuberculosis/en/index.html
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International ResponseInternational Response
Guidance: WHO, StopTB, UNIONGuidance: WHO, StopTB, UNIONTB control is well standardized (consensus on forms, guidelines, recommendations)
Funding mechanisms: The Global Fund, UNITAID, Bill Gates, governments (USAID, DfID, etc)Sources of TB medicines: GDF, GLCTechnical resources: UNION, KNCV, MSF, PIH, ICRC, MSH tMSH, etc.
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Information management for TB:Information management for TB:
•Information tools are required by Global Initiatives (GLC/GDF, Stop TB…)WHO ERR working group revised formsWHO ERR working group revised formsCatalogue (existing software)
http://www.who.int/tb/err/catalogue/
But to date there was no tool integrating consistently all programmatic dimensions for management purposesprogrammatic dimensions for management purposes
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NTP ChallengesgMost countries will not reach MDG by 2015
Lack of actual support from governmentspp gLow detection rate (poor diagnosis, advocacy, education)Poor compliance with treatment (by providers and patients)High default rateCo-infection with HIV I t ti i d l ( th GDF t i )Interruptions in drug supply (even the GDF countries)Spread of MDR/XDR TB (increased length of treatment and costs = X 1000)costs X 1000)Lack of proper supervision, recording and reporting
Many of the challenges can be addressed through strengthening MIS
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e-TB Manager: Web based systemg yAligned with WHO recommendations for DOTS and DOTS Plus programs (standard data collection recording andPlus programs (standard data collection, recording and reporting)Easy online information sharing / consolidation between different levels and data extraction tool to other interfacesRapid response to case and drug management issues Database protected by a validation process from upper levelInternal security features and unique patient identificationDeveloped with open sources technical solutions, no additional licenses neededCan be used with a mixed system of online reporting and paper system at periphery levelsEasily customized, translated, adaptedy , , p
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Online notification and follow-up, recording clinical and laboratory results, tracking patient transfers in and out,
providing data on patients regimen schemes, treatment adherence, patient contacts’ evaluation,
consultation agenda
Treatment and case management
First Line medicines management
Medicine needs’ forecasting,
ordering, distributing,
Data extraction
Information and surveillance management
dispensing, and recording of stock movements + DM
indicatorsat all levels
Second Line medicines
management
tool / Operational and clinical
research
at all levels
For easy data analysis and export to statistical interfaces
Mapping of TB and MDR/XDR cases, epidemiological indicators, surveillance reports,
previous treatment history, co-morbidities, up-dated information with ready access online
at central and periphery levelsat central and periphery levels
e-TB Manager
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For the system to support the TB program appropriately, there must be clear guidelines and coreclear guidelines and core staff must be experienced in MDR-TB managementMDR TB management
DiagnosisTreatment protocols, patient managementmanagementConsistent flows for pharmaceutical management
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www.etbmanager.org
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Note: Simulation Data for Demo
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Note: Simulation Data for DemoNote: Simulation Data for Demo
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Note: Simulation Data for Demo
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Note: Simulation Data for Demo
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Note: Simulation Data for Demo
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lh25
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Slide 24
lh25 this doesn't show much--you could just use the next slide and talk about administrationlhall, 05/22/2008
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Name displayed in the system
Address (where to send orders to)
Region and locality (also used in user view)
Checked if the unit is a treatment health unit (case management)
Checked if the unit stores medicine (medicine management module)
Enables the unit to use the medicine receiving module
Select who is going to deliver medicine orders to this unitg g
Used to calculate the quantity estimated when creating a new order
If checked, the user may change the quantity estimate when creating a new Check it if the unit y gorder
If the order has to be authorized before delivering, select the unit that authorizes it
If the unit registers medicine dispensing enter the
delivers medicine to other units (order delivery)
If the unit registers medicine dispensing, enter the dispensing registration frequency (daily, weekly or monthly)
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Note: Simulation Data for Demo
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Note: Simulation Data for Demo
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Note: Simulation Data for Demo
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Online tools for medicines forecasting, ordering, distribution, and dispensing
Tracks stocks positions at central and periphery level;p p y ;Calculates upcoming needs for medicines dispensing at p gtreatment centers / sitesControls estimated and real consumptionProvides reports and indicators
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Distribution flow:S
Central Warehouse
Sources:GLC/GDF
MoHGF
Regional Regional RegionalRegionalWarehouse
RegionalWarehouse
RegionalWarehouse
DistrictDistrict DistrictDistrict District
TreatmentCenter
TreatmentCenter
TreatmentCenter
TreatmentCenter
TreatmentCenter
TreatmentCenter
TS TSTS TSTS TS TS TS TSTSTSTSTS
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Note: Simulation Data for Demo
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Note: Simulation Data for Demo
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Note: Simulation Data for Demo
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Note: Simulation Data for Demo
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Note: Simulation Data for Demo
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Epidemiological Reportsp g p
Incidence/incidence Co-morbiditiesrate
Prevalence/prevalence t
Previous treatments/treatment history
C t i ti i irateDemographic characteristics
Contamination originContacts identificationand evaluationcharacteristics
Resistance patternsClinical/X-rays patterns
and evaluationAdverse reactionsTreatment outcomes/Clinical/X rays patterns
HIV/AIDS(diagnosis/co-infection rate)
Treatment outcomes/cohort analysis(filters)
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Operational Reportsp p
Suspects or cases search/identification L b t t l ( ti t h t) ithLaboratory exams at a glance (patient or cohort) withconversion rates
Treatment history/regimens at a glance (patient orTreatment history/regimens at a glance (patient or cohort)
Case management agenda (dates for examsCase management agenda (dates for exams, appointments, defaulters list, etc.)
Mapping case transfersMapping case transfersTreatment adherence/medicines dispensing reportsTreatment costs (Social Security systems)Treatment costs (Social Security systems)
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Note: Simulation Data for Demo
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Note: Simulation Data for Demo
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Note: Simulation Data for Demo
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Note: Simulation Data for Demo
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Resistance ProfileJan. 1994 – Mar. 2009 (n= 3,798)
Brazil or States
City of Residence
Month/Year Begins
Month/Year Ends
Residence
Treatment Health Facility
Nº of treatments for DR-TBGenerate Report
Probably DR-TB Confirmed DR-TB
Resistance Profile
Probably DR TB Confirmed DR TB
Sensitive to R
Sensitive to H
Sensitive to RH
Sensitive to all drugs tested
Other combinations of resistance
Source: DR-TB Data Base – Hélio Fraga Reference Center / Fiocruz / MoH
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Evaluation of Contacts (Pará State) Jan. 1994 – Mar. 2009 (n= 1,218 identified)( , )
City of Residence Identified Examined with TB
Source: DR-TB Data Base – Hélio Fraga Reference Center / Fiocruz / MoH
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e-TB Manager: Where Are We Today ?
Currently adopted as national TB surveillance MIS for DR-TB in Brazil (including all re-treatment cases for better prevention of MDR-XDR(including all re treatment cases for better prevention of MDR XDR emergence)Integrated with the national DR-TB MIS in Romania and MoldovaActive field pilot testing in the Philippines, Dominican Republic and Uk i ( MOH )Ukraine (on MOH server)Being adapted for: Armenia, Georgia, Azerbaijan, UzbekistanRequests from countries: Namibia
Collaboration with WHO – a possibility for e-TBM to become a WHO-recommended MIS toolWHO request to implement in: Kenya, Ethiopia, Bangladesh, Vietnamq p y , p , g ,
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Challenges and Lessons LearnedE-TBM cannot just be installed and used:
Need for extensive TA to streamline the existing MIS forNeed for extensive TA to streamline the existing MIS for TB (procedures, SOPs, data forms)Need for adaptation to country requirementsTraining of users, TOT
Lack of clear national treatment guidelines for TB and MDR TB, and SOPs for lab and drug managementWHO is constantly changing data formsLack of infrastructure: must develop PC-based
i i l d t bprovincial databases
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Challenges and Lessons Learned contChallenges and Lessons Learned, cont.Need to sign a MOU:
NTP may lack authority, bureaucratic procedures Engaging stakeholders – national working groupsCompetition (most NTPs already have some electronic tools in place)V li it d f di f TBM i l t tiVery limited funding for e-TBM implementationPartnering with other projects in the field is crucial (b t t l h t f li l ti )(but not clear how to formalize relations)Endorsement from major players is important (WHO KNCV UNION GDF/GLC UNITAID etc )(WHO, KNCV, UNION, GDF/GLC, UNITAID, etc.)
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Implementation steps in a new country: May take from 2-3 months to one yearfrom 2 3 months to one year
Recon-
• Present e-TBM main features• Understand country’s health system
structure, operation, standards for TB d/ DR TB d d
• On-site pilot on selected TB units to evaluate system ff ti fit ithnaissance
visitand/or DR-TB, and needs
• Define necessary system customization• Define working group, responsibility
matrix and MoU
On-site piloteffectiveness, fit with current flows and procedures and acceptance by end users
System customization
• Customize e-TBM functionalities and interfaces to address country needs
Final system adjustments
• Adjust system based on pilot outcome
Remote testing
• Remotely test initial e-TBM version to identify potential bugs and need for further adjustments
Implementation/ training
• Implement system on country’s proprietary server and train IT personnel
• Train potential trainers or end users (depends on number of
System adjustments
• Adjust system based on remote testing outcome
Maintenance
sites)
• Guarantee remote on-going support to country`s IT team and end usersadjustments
59
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System cost to USAID/MSH, from customization to implementation and maintenance, ranges from US$50-70k ESTIMATIVE
Estimates based on a comprehensive cost model designed for e-TBM
System cost to USAID/MSH
PROJECT SCHEDULE AND CHARACTERISTICS COST (USD)
System cost $70.112
DurationPHASES weeks Programmer MSH Other1. Reconnaissance visit 1 2 2 1 $10.9282. System customization 4 6 2 0 $14.4003. Remote testing 1 0 $04. System adjustments 1 2 1 0 $5.2005. On-site pilot 1 1 1 1 $7.7286. Final system adjustments 1 2 1 0 $5.2007. Implementation/training 1 1 1 2 $12.256
Total to implement 10 14 8 0 $55.712
Time required (weeks FTE per phase) Number of intl. trips
Intl.* Weeks FTE* Intl.* Weeks FTE*
p
8. Maintenance/support 52 6 2 0 $14.400
MonthlyInfrastructure MONTHLY cost $6.194
IT infrastructure Number requiredServer 1 $283Computers 40 $1.111Internet access 40 $1.600
HelpdeskFTE required 1 $3.200
1. Reconnaissance visit2. System customization
1-
14
11
tripsProg. MSH
1-
26
22
tripsProg. MSH
3. Remote testing4. System adjustments5. On-site pilot6. Final system adjustments7 I l t ti /t i i
--1-1
-1111
-½ 1½1
--1-2
2121
11117. Implementation/training
8. Maintenance/support1-
14**
11**
2-
16**
12**
60* FTE: Full Time Equivalent; Intl.: International
** Within the total phase duration (52 weeks)
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Ongoing operational and maintenance costs for host country depend on number of sites and infrastruture required ESTIMATIVE
Monthly maintenance/operational cost to host countryEstimates based on a comprehensive cost model designed for e-TBM
PROJECT SCHEDULE AND CHARACTERISTICS COST (USD)
System cost $70.112
DurationPHASES weeks Programmer MSH Other1. Reconnaissance visit 1 2 2 1 $10.9282. System customization 4 6 2 0 $14.4003. Remote testing 1 0 $04. System adjustments 1 2 1 0 $5.2005. On-site pilot 1 1 1 1 $7.7286. Final system adjustments 1 2 1 0 $5.200
$
Time required (weeks FTE per phase) Number of intl. trips
7. Implementation/training 1 1 1 2 $12.256Total to implement 10 14 8 0 $55.712
8. Maintenance/support 52 6 2 0 $14.400
MonthlyInfrastructure MONTHLY cost $6.194
IT infrastructure Number requiredServer 1 $283Computers 40 $1.111Internet access 40 $1.600
HelpdeskFTE required 1 $3.200
• Number of total sites*• Number of servers required• Number of IT** infrastructure
required (computer + internet)
201
20
601
20
1001
50required (computer internet) 50
61* Influences number of support staff required. Model assumes 1 helpdesk FTE can support up to 50 sites
** Information technology