Project Lead(s): Mubeezi Micah
Tuberculosis (TB) is one of the world’s major public health problems. In 2011, there were 8.7 million new TB cases and 1.4 million TB deaths worldwide.
Effective surveillance can improve TB case detection and treatment outcomes but, in many low- and middle-income countries, paper-based TB patient registers are employed that do not facilitate the timely reporting and efficient monitoring of TB patients.
The project was designed to determine if an electronic TB register (eTBr) would increase TB case notification and treatment, compared to a routine, paper-based system, in Uganda and South Sudan.
A research study was conducted adopting a quasi-experimental design, with two interventions at two control TB management sites (between-site comparisons) plus a pre- and post-intervention study period (within-site comparison).
In each of the two intervention sites, three TB high-volume sites were selected to participate in the study.
Each of these high-volume sites received one laptop on which an eTBr had been installed and individuals at each of the TB high-volume sites were trained on how to use eTBr to enter data, identify patients who missed scheduled appointments, send treatment adherence SMS reminders, generate quarterly TB reports, etc.
A consultant checked the quality of the TB data being entered into the eTBr and provided relevant feedback to the users. Existing staff in the health facility collected the data for the study.
In total, 7,656 TB patients were enrolled into the study. Of these, 5,478 were in the South Sudan study arm and 2,178 were in the Ugandan arm of the study.
Results of the study showed that the introduction and use of the eTBr had mixed effects on TB case notification rates, as notification rates improved in South Sudan but not Uganda.
However, there were other positive findings from the trial:
· Surveys showed that the use of the eTBr improved the timeliness, completeness and accuracy of reporting in both countries.
· TB treatment outcomes significantly improved, notably in Luwero District (Uganda) where the cure rate for bacteriologically confirmed TB (new cases) almost doubled.
· In South Sudan, the TB treatment success rate for all new forms of TB improved from 77% to 84%.
· In the control site (Torit, Uganda) where the electronic registry was not used, the TB treatment success rate dropped by 15%.
· It was also observed that, as treatment success rates improved, the proportion of TB patients who were lost to follow-up was also reduced in the intervention sites.
The South Sudan National TB Program, State TB-led Coordinator, Management Sciences for Health (MSH), has committed $42,000 to facilitate the roll-out of the electronic TB register to at least two of the 10 states in South Sudan.
The Global Fund has committed $26,000 to roll out the electronic TB register in South Sudan.
The project team intends to request about $600,000 from Grand Challenges Canada to complement the transition to scale efforts from MSH, the Global Fund and the Ministry of Health.
In late 2013, FIND diagnostics requested the redesign of the eTBr into a format that could be used on mobile phones and tablets, and this version is being used on about 60 phones across Uganda.