1. MSFeCARE-Vacci Deployment of a vaccination calculator to improve prescriptions and data collection in a mass multi-antigen vaccination campaign
Nicolas Peyraud, Anna Righetti, Michel Quere, Samuel Nzalapan, Theodore Wanteu, Geraldine Duc, Maya Shah, Clotilde Rambaud-Althaus
20th

2. Background Multi-antigen vaccination campaign
Mambéré Kadei prefecture, CAR
Target : 50’000 children <5 years
3 rounds Dec2015, Feb2016, Apr2016
5 vaccines, 9 antigens
(Polio, DTC-HepB-Hib, Pneumococcus, Measles, Yellow fever)
Different vaccination schedules
Varying rules acc. to age at 1st dose
 VERY COMPLEX RULES
©Pierre-Yves Bernard/MSF
C. Rambaud-Althaus – MSFeCARE Vacci– MSFUK-Scientific Day – 20th May 2017

3. Background Simplified rules Decision support tools
©Pierre-Yves Bernard/MSF
Unnecessary doses prescribed
Missed opportunities
Wastage of vaccines
C. Rambaud-Althaus – MSFeCARE Vacci– MSFUK-Scientific Day – 20th May 2017

4. MSFeCARE Vacci-app e-decision support system Data collection tool
Android application
Computed rules of vaccination
Data collection tool
Offline data collection
On-device activity report
Anonymous data
Not a patient file
C. Rambaud-Althaus – MSFeCARE Vacci– MSFUK-Scientific Day – 20th May 2017

5. Feasibility study During the 2nd Round 4 volunteers prescribers
©Pierre-Yves Bernard/MSF
During the 2nd Round
4 volunteers prescribers
2 sites
1324 consultations from Feb 2016
Outcomes
Improved appropriateness of vaccination prescriptions
No technical problems encountered
Positive user experience
No loss of data
C. Rambaud-Althaus – MSFeCARE Vacci– MSFUK-Scientific Day – 20th May 2017

6. Round 3 – Intervention Participants 24 prescribers Training
1 day + 1 h on-job supervision
Supervisors trained to support
app utilisation
Material
1 tablet
1 solar panel & power bank
©Pierre-Yves Bernard/MSF
C. Rambaud-Althaus – MSFeCARE Vacci– MSFUK-Scientific Day – 20th May 2017

7. Round 3 – Evaluation Appropriateness of vaccination prescriptions
1106 exit interviews (50 per prescriber, 22 prescribers)
Proportions of children appropriately vaccinated compared to 610 exit interviews with paper (338) & vacci app (272) during 2nd round feasibility
Completeness of data collection
Comparison of electronic data to paper-based attendance registry
Users’ perception (ease of use, integration in activities, added value)
Focus group discussion (9 prescribers)
C. Rambaud-Althaus – MSFeCARE Vacci– MSFUK-Scientific Day – 20th May 2017

8. Results Implementation From April 24 -June 7 2016:
consultations
vaccines prescribed
Median number of consultations/day/prescriber: (range: 6-234)
©Anna Righetti/MSF
C. Rambaud-Althaus – MSFeCARE Vacci– MSFUK-Scientific Day – 20th May 2017

9. Results Impact on prescriptions
Initially: difficulties due to differences with previous prescription rules
Then: increased confidence
Correct mistakes on vacci cards
Easy update of prescriptions rules to adapt to vaccine availability
©Pierre-Yves Bernard/MSF
“Entering the vaccination history in the tablet allowed me to identify mistakes in the vaccination cards and invalid doses, allowing me to provide better vaccination to the child”
C. Rambaud-Althaus – MSFeCARE Vacci– MSFUK-Scientific Day – 20th May 2017

10. 2nd round feasibility study
Results
Exit interviews: Assessment of prescriptions
2nd round feasibility study
Round 3
(N 1106)
Vacci app
(N 272)
Paper-based
(N 338)
Appropriate vaccine prescription
98% (1081)
96% (260)
91% (307)
≥ 1 missed opportunity
1% (14)
3% (9)
6% (19)
≥ 1 unnecessary vaccine
1% (11)
1% (3)
2% (8)
≥ 1 vaccine with CI
0.1% (1)
0 (0)
1% (4)
p = 0.049
C. Rambaud-Althaus – MSFeCARE Vacci– MSFUK-Scientific Day – 20th May 2017

11. Results Operational feasibility No technical problem
Apart from 1 implementer: No additional HR (-1 Data entry clerk)
Consultations duration prolonged during first days
> Tablet use
> Difference in prescriptions rules (vs round 2 simplified rules)
> More complex vaccination cards presented
Data collection process facilitated
©Pierre-Yves Bernard/MSF
C. Rambaud-Althaus – MSFeCARE Vacci– MSFUK-Scientific Day – 20th May 2017

12. Limitations No patient file
No possibility to follow children over 3 rounds
C. Rambaud-Althaus – MSFeCARE Vacci– MSFUK-Scientific Day – 20th May 2017

13. Conclusion & perspective
In selective multi-antigen vaccination campaign
Facilitate implementation of complex rules by lay health workers
Facilitate and improve data collection
Perspective
Application & system made available for other campaigns
Selective, multi-antigen, mass campaigns
Vaccination calculator integrated into MSFeCARE-Ped
C. Rambaud-Althaus – MSFeCARE Vacci– MSFUK-Scientific Day – 20th May 2017

14. THANK YOU FOR YOU ATTENTION
Acknowledgement
THANK YOU FOR YOU ATTENTION
©Pierre-Yves Bernard/MSF
Special Thanks to All the Vaccination Teams in CAR
C. Rambaud-Althaus – MSFeCARE Vacci– MSFUK-Scientific Day – 20th May 2017