CONFIDENTIAL AND PROPRIETARY “ 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 (C) Abt Associates, Inc.

How Does it Work? Targeted alert messages eTB Manager or M&E tools Web database USB modem, Wifi, Mobile phone, Manual upload Electronic patient records

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

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* Providers Cartridge expirations Stockout management Utilization vs. disease load Deployment planning Procurement, warranty, and service planning GxAlert

A Look Inside…GxAlert

HIV Devices (PIMA) Can Report Directly into GxAlert

Tracking Co-Infection Indicators at the Patient Level

MOH Can Forecast Cartridge Needs By Observing Consumption Trends Avg. # tests/yr per device 438 Avg. Utilization per device 18% Est. Overpurchase in Year 1 -$103,114

MOH Can Identify Malfunctions Earlier and Reduce Patient Re-visits Number of Error Results, by Module A serious outlier Possible alert threshold Error Codes

MOH Can Set Thresholds for Errors: Above = Alert to Supervisor Focus attention where needed most Opportunity to identify “best practices” Possible alert threshold

A Look Inside…XpertSMS

A Look Inside…XpertSMS

A Look Inside…TBGxMonitor

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

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

Challenges Stable nationwide connectivity Security Stakeholder coordination

Why Include These Tools in Your GeneXpert Implementation? Patient benefits: start treatment faster, reduce spread of drug resistant disease, recover sooner Identify and track population drug resistance patterns of TB cases Shorten diagnostic response time from months to minutes, getting patients into treatment faster Reduce waste and avoid stockouts through real-time forecasts Dramatically improve data quality Measure program adherence to the TB treatment protocols

Acknowledgements MSH KNCV Nigeria NTP India private sector labs CHAI IRD Pakistan NHLS South Africa USAID CDC

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