“
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
2nd African Regional Training Workshop on
Xpert MTB/RIF
July 24, 2013
How Does it Work?
Targeted alert messages
USB modem,
Wifi,
Mobile phone,
Manual upload
Web database
eTB Manager or
M&E tools
Electronic patient records
Abt Associates
There Are Four Stable, Scaling-up
Data Services Around the GeneXpert
 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
Abt Associates
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
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*
Providers





GxAlert
XpertSMS
GxAlert
Cartridge expirations
Stockout management
Utilization vs. disease load
Deployment planning
Procurement, warranty, and service
planning
Abt Associates
A Look Inside…GxAlert
Abt Associates
HIV Devices (PIMA) Can Report
Directly into GxAlert
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Tracking Co-Infection Indicators
at the Patient Level
Abt Associates
MOH Can Forecast Cartridge Needs
By Observing Consumption Trends
Avg. # tests/yr
per device
Utilization Rate of GeneXpert by Facility, Lifetime
438
100%
90%
80%
70%
60%
Avg. Utilization
per device
50%
40%
30%
20%
10%
0%
25%
24%
24%
16%
16%
13%
12%
6%
18%
Est. Overpurchase
in Year 1
-$103,114
Abt Associates
MOH Can Identify Malfunctions Earlier
and Reduce Patient Re-visits
Number of Error Results, by Module
A serious outlier
Possible alert threshold
Error Codes
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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
Abt Associates
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
Abt Associates
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
Abt Associates
Challenges
 Stable nationwide connectivity
 Security
 Stakeholder coordination
Abt Associates
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
Abt Associates
Acknowledgements
 MSH
 KNCV
 Nigeria NTP
 India private sector labs
 CHAI
 IRD Pakistan
 NHLS South Africa
 USAID
 CDC
Abt Associates
Better patient treatment
Faster response to MDR-TB
More efficient TB logistics
Prepared by:
Martha Benezet martha_benezet@abtassoc.com
Jeff Takle jeff_takle@abtassoc.com
Download slide deck @ www.GxAlert.com