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

9. New developments - Average monthly consumption and estimated stock on hand Note: Simulation Data for Demo

11. E-TB Manager: Data from Brazil

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

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 In production In pilot phase In discussion Only Drug Mngt platform 5,000 cases 471 cases 8,000 cases 16,000 cases 1,700 cases

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.  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 …) Upcoming developments

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