1. 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 Associates
2nd African Regional Training Workshop on Xpert MTB/RIF
July 24, 2013
(C) Abt Associates, Inc.

2. 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

3. 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

4. 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

5. A Look Inside…GxAlert

6. HIV Devices (PIMA) Can Report Directly into GxAlert

7. Tracking Co-Infection Indicators at the Patient Level

8. 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

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

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

11. A Look Inside…XpertSMS

12. A Look Inside…XpertSMS

13. A Look Inside…TBGxMonitor

14. 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

15. 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

16. Challenges Stable nationwide connectivity Security
Stakeholder coordination

17. 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

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

19. Better patient treatment Faster response to MDR-TB
More efficient TB logistics
Prepared by:
Martha Benezet
Jeff Takle
Download slide