Dr. Luis Gustavo Bastos Management Sciences for Health – Brazil

Monitoring Drug Resistant Tuberculosis Treatment in Brazil through an Innovative

Web-based Information System

Dr. Luis Gustavo BastosManagement Sciences for Health – Brazil

ICIUM Conference – Antalya, Turkey – November 15th, 2011

A comprehensive web based tool conceived for strenghtening TB programs by integrating case management, medicine control and

surveillance information into a single platform

Case notification and management

Medicines supply and stock control

Epidemiological surveillance / Reports Information

2

Overview of e-TB Manager: key interfaces and main features Easy online and real-time information

sharing + data consolidation among different levels within one user – friendly platform

Notification of lab results + sample management (diagnosis: smear + culture + DST (all techniques including new LPAs) + HIV status – data encoded by Lab or Health Unit and validated at central level

Comprehensive medicine management and control with an automated patient based quantification tool for ordering process at all levels + demand and forecasting tool

Ensures patient data confidentiality and database reliability through a central level validation process

Developed with open-source solutions (no license required) that can be fully customized to address specific country needs

Aligned with WHO recommendations for DOTS and DR-TB programs, including WHO standard forms for reporting and recording

LABLABHealth Unit (HU)

Health Unit (HU)

Epidemiological surveillance / NTP Management Epidemiological surveillance / NTP Management

1st + 2nd LINE DRUG MANAGEMENT AT ALL LEVELS OF THE SUPPLY CHAIN

1st + 2nd LINE DRUG MANAGEMENT AT ALL LEVELS OF THE SUPPLY CHAIN

DATA ENTRY IN ONE SINGLE WEB-BASED

SYSTEM

DATA ENTRY IN ONE SINGLE WEB-BASED

SYSTEM

TB suspects

TB suspects TB casesTB cases DR-TB

suspects

DR-TB suspects

e-TBM can be used for TB + DR-TB Programmatic Management

DR-TB casesDR-TB cases

LAB COMMODITIES MANAGEMENT

LAB COMMODITIES MANAGEMENT

www.etbmanager.org

Divided into 4 modules - each one providing essential functionalities for effective TB management

Note: Simulation Data for Demo

Note: Simulation Data for Demo

Note: Simulation Data for Demo

New developments- Average monthly consumption and estimated stock on hand

Note: Simulation Data for Demo Note: Simulation Data for Demo

Note: Simulation Data for Demo

E-TB Manager: Data from Brazil

DR-TB Case Reporting (Jan 2000 - Sep 2011)

MDR-TB Data Base / e-TB Manager– Hélio Fraga National TB Reference Center / Fiocruz/MoH - Brazil

Launched new MIS (Apr 2004)

New Training Program

New Guidelines

Capacity Building Activities

4,075 new MDR-TB cases (+ 734 retreatment)Jan 2000 to Dec 2010

Previous TB Treatment 98% Pulmonary TB

Adverse reactions (45% of registered patients)

Comorbidities and Associated Factors (33% of registered patients)

98% were tested for HIV with 8% positive results

Initial DR-TB Treatment Cohort Outcomes(Jan 2000 - Dec 2009)

Patients non-DOT presented almost 3 times more treatment default than those with DOT

Lessons learned

Countries using e-TB Manager - 2011

In productionIn pilot phaseIn discussion Only Drug Mngt platform

5,000 cases 471 cases

8,000 cases

16,000 cases

1,700 cases

An MIS implementation is an opportunity to strengthen TB/DRTB programs and motivate core staff:

Better understanding of guidelines + complementary roles (multi-disciplinary team), contributing to better clinical care, work “ambiance” and patient support

Constructive forum for knowledge/experience sharing + motivating transparent environment in comparing data and results

among states, treatment centres (e.g. contacts evaluation, curerates, medicines management…)

Increased awareness for accurate and updated information needs at all levels for strategic decision taking

Reduction of delays: diagnosis (results release) => treatment

Adv effect notification => adequate therapeutic conduct + PV

TB/DR-TB descriptive epidemiology => better monitoring + action taking

Reduction of SLDs stock-outs/overstocks/wastage

Better monitoring of: Irrational prescribing and lack of adherence Excess reporting Additional efforts to change and implement policy

Training is a crucial step for implementation

Clear criteria for selection of appropriate participants Implementation planning as a core part of the training Demonstrated administrative/ managerial support

Desktop version for countries with low internet coverage

Link with GIS (Geographic Information Systems)

Use of SMS (Text Messages) for rapid data exchange

Enhanced laboratory module with WHO (all lab commodities, including rapid diagnostic kits management, equipment management, EQA, performance Indicators …)

Upcoming developments

Thank you for your attention!

Questions & AnswersDiscussiongbastos@msh.org