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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 Bastos Management Sciences for Health – Brazil. ICIUM Conference – Antalya, Turkey – November 15 th , 2011.

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Dr. Luis Gustavo Bastos Management Sciences for Health – Brazil

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  1. Monitoring Drug Resistant Tuberculosis Treatment in Brazil through an Innovative Web-based Information System Dr. Luis Gustavo Bastos Management Sciences for Health – Brazil ICIUM Conference – Antalya, Turkey – November 15th, 2011

  2. 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

  3. 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 e-TBM can be used for TB + DR-TB Programmatic Management DR-TB cases TB suspects TB cases DR-TB suspects LAB DATA ENTRY IN ONE SINGLE WEB-BASED SYSTEM Health Unit (HU) 1st + 2nd LINE DRUG MANAGEMENT AT ALL LEVELS OF THE SUPPLY CHAIN LAB COMMODITIES MANAGEMENT Epidemiological surveillance / NTP Management

  4. www.etbmanager.org

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

  6. Note: Simulation Data for Demo

  7. Note: Simulation Data for Demo

  8. Note: Simulation Data for Demo

  9. New developments - Averagemonthlyconsumptionandestimated stock onhand Note: Simulation Data for Demo Note: Simulation Data for Demo

  10. Note: Simulation Data for Demo

  11. E-TB Manager: Data from Brazil

  12. DR-TB Case Reporting (Jan 2000 - Sep 2011) New Guidelines Capacity Building Activities Launched new MIS (Apr 2004) New Training Program MDR-TB Data Base / e-TB Manager– Hélio Fraga National TB Reference Center / Fiocruz/MoH - Brazil

  13. 4,075 new MDR-TB cases (+ 734 retreatment) Jan 2000 to Dec 2010 Previous TB Treatment 98% Pulmonary TB

  14. Adverse reactions (45% of registered patients)

  15. Comorbidities and Associated Factors (33% of registered patients) 98% were tested for HIV with 8% positive results

  16. Initial DR-TB Treatment Cohort Outcomes (Jan 2000 - Dec 2009) Patients non-DOT presented almost 3 times more treatment default than those with DOT

  17. Lessons learned

  18. Countries using e-TB Manager - 2011 16,000 cases 1,700 cases 8,000 cases 471 cases 5,000 cases In production In pilot phase In discussion Only Drug Mngt platform

  19. 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, cure rates, medicines management…) Increased awareness for accurate and updated information needs at all levels for strategic decision taking Reduction of delays: diagnosis (results release) => treatment

  20. 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

  21. Upcoming developments • 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 …)

  22. Thank you for your attention! Questions & Answers Discussion gbastos@msh.org

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