By Chris Macek, Jeff Takle and Kehinde Jimoh of SystemOne. Cracking the Nut Health Conference. July 2016.

1. Cost Effective Technology for
Effective and Rapid TB
Response in Nigeria
Cracking the Nut Health Conference
Kehinde Jimoh , Chris Macek, Jeff Takle
FHI 360 Conference Center in Washington, DC.

2. Abt Associates
Outline
 Session Objectives
 Background
 Approach and Process of Using GxAert
 Value of integrating the GxAlert application
 Implementation of Innovation
 Results
 Breakout session
 To share Lessons Learned

3. Abt Associates
Session Objectives
 To orient participants to the Cost effective
technology-supported GxAlert system in Nigeria.
 To present our we achieved an improvement in DR-
TB patient enrollment.
 To share lessons learned to date.

4. Abt Associates
Background
 Nigeria is a Country in W/Africa with a
population of 165 million
 Nigeria is ranked 13th among the 27 high
DR-TB burden countries in the world
 Prevalence of MDR-TB among New
Cases is 2.9%
 Prevalence of MDR-TB among
Retreatment Cases is 14.3%
 Number of GeneXpert Site is 210
presently
 Nigeria is implementing technology-
supported GxAlert system to improve
DRTB patients notification and enrollment
in about 200 Labs Presently.

5. Abt Associates
Challenges to Intervention
 Reporting TB testing results is a
lengthy process due to a
continued reliance on paper
records and slow data transit
systems.
 Quality of results data is often
poor and subsequent program
management decisions are not
always timely or focused on
priority needs.

6. Abt Associates
What is GxAlert?
GeneXpert
Health
Systems
Connects the device via
secure network. Allows
automatic real-time
reporting of test results.
Send GeneXpert MTB/RIF
diagnostic results in real time to a
secure web-based database in mere
seconds so it can become
“actionable” within the health
system.
Open-Source Software
Source Code Available for free
Any funded development
available to all users/countries

7. Abt Associates
Approach and Process of GxAert
 GxAlert is configured on GeneXpert
systems and by installing a
modem/Router from a telecom that
encryps and gives access to
internet to send out the results.
 Data can be analyzed and
aggregated by: Device, Facility,
LGA, or State in a Gxalert
Database (Dashboard)
 The system then sends the results
in an SMS alert to program decision
makers at the state and national TB
program, shortening the new-case
reporting period from months to
seconds.

8. Abt Associates
Why Connect GeneXperts?
Connected via GxAlert

9. Abt Associates
GxAlert Allows Data to Flow Across the
Health System
GH Kumo
Kwali GH
IDH Kano
Zankli Lab
NIMR Yaba
SMS
Email
Computer
App
Other Systems:
e-TB Manager
DHIS2
• Connects diagnostic devices
• Collects custom data
• Sends alerts, notifications and reports
to different level of care providers
• Monitors and manages
cartridge inventory
• Records service, warranty,
and maintenance events
• Integrates with other
health systems

10. Abt Associates
Development of government ownership,
strategies to encourage and engender ownership
 The government of Nigeria was involved in the design of the pilot right
from the beginning.
 Selection of facilities for the pilot was done by the government and they
were involved and supported the installation processes to all facilities.
 SMS notification was sent to the NTP director and his team for prompt
notification.
 Login and Access to the data collected from all the pilot facilities was first
created and shared with the government staffs (national/ state and facility
view).
 The analysis of the data was done in collaboration with the Government to
enable take policy decision and initiate quick enrolment of Rifampicin
Resistance patients that were reported into care and treatment..

11. Abt Associates
Results
 The proportion of DR-TB patients
enrolled for treatment based on
GxAlert messages received from 35
GeneXpert facilities jumped to 85%
in March, 2015 from only 50%
enrolled in April 2014.
 SMS or text message alerts are sent
to TB Local Government supervisor,
State program manager and National
Program DR-TB enrollment officer
upon GeneXpert confirmation of a
MTB+ Rif+ case to speed treatment
initiation.
 Weekly reports of all new TB+ cases
are both emailed and sent by SMS to
local health officials to ensure better
connection between diagnosis,
enrollment and treatment.

12. 74
110
181
122
194
180
232
143
-
50
100
150
200
250
Q1 2014 Q2 2014 Q3 2014 Q4 2014
Trend of DR-TB cases enrolled between Q1 2014 to Q4 2014
DR-TB cases enrolled RIF resistant cases detected
RIF Resistant
cases diagnosed
within 4
quarters report
directly from
Gxalert
Percentage of
Patient
enrolled on
treatment
increased in
Q4

13. Abt Associates
Lessons Learned
 This innovation has made it possible to get diagnostics
results immediately back to clinicians and patients.
 It identified $100k’s worth of commodities that would expire
before use; led to immediate reallocation and redesign of
NTP logistics unit approaches to GeneXpert supplies.
 We saw gains in supervisor capability, improved the focus of
training, enhanced site selection.
 Diagnostic machine utilization, and machine uptime and
improved adherence to maintenance regime (calibration and
module replacement).


14. Open-source
MOH-owned data
Appropriate treatment, faster
Value for Money
Secure, patient privacy
Proxy for disease burden
QUESTIONS?
www.GxAlert.com

15. Abt Associates
Breakout session
 Participants will be divided into four groups to look at
the following case studies, discuss and identify
solution to the problems in their various group before
rounding up with a plenary.
(Case studies will be shared to all participants)

16. Abt Associates
End of seesion
Session will be rounded
up with answers to the
Simple and Big questions
in the slides below:

17. Abt Associates
Can we get
better quality
data, faster?
Does it lead to
NTP action?
Do results get
to patients?
Many more
steps in here…
Are patients getting into
appropriate treatment
faster because of a data
connectivity solution?
Big QuestionsSimple Questions
1
"GxAlert has revolutionized the TB
control program in Nigeria with faster
diagnostic results (with better
accuracy) in real time. It has further
made patients’ enrollment in
treatment centers much easier."
— Elom Emeka
Director/Medical Laboratory Team
Lead , NTP/Nigerian Federal Ministry
of Health
“

18. Abt Associates
Are patients getting into
appropriate treatment
faster because of a data
connectivity solution?
Big Questions
Can we get
better quality
data, faster?
Does it lead to
NTP action?
Do results get
to patients?
Simple Questions
“We saw 3x the level of
MDR we expected!”
1

19. Abt Associates
Can a data connectivity
solution demonstrate
“Value for Money”?
Big Questions
Can errors be
better managed?
Simple Questions
Can stockouts
be prevented?
Can it optimize
Site Selection?
Build supervisor training
specifically around reducing
2008, 5006, and 5007 errors
Set up 5011 SMS text alert to
contact Cepheid tech support
2

20. Abt Associates
Can a data connectivity
solution demonstrate
“Value for Money”?
Big Questions
Can errors be
better managed?
Simple Questions
Can stockouts
be prevented?
Can it optimize
Site Selection?
Good news is that better training
leads to fewer errors!
2

21. Abt Associates
Can a data connectivity
solution demonstrate
“Value for Money”?
Big Questions
Can errors be
better managed?
Simple Questions
Can stockouts
be prevented?
Can it optimize
Site Selection?
Needs cartridges
Has more cartridges on
hand than they can use
before expiration
2

22. Abt Associates
Could a data connectivity
solution serve as a proxy
for measuring disease
burden?
Big Questions
Can we report
WHO indicators
automatically?
Simple Questions
Self-configure
new indicators
 By MTB
 By Rif
 By Age
 By Sex
 By DR Suspect
 By HIV status
 Custom…
4

23. Abt Associates
Recap: Take Home Messages
 GxAlert eliminates the need for human error in data
entry, reduces the lag time, and helped pinpoint
patients that should be place on care.
 GxAlert strengthened surveillance of DR-TB, TB in
children and TB in the HIV infected, speeding
response and improving programmatic decision
made for enrollment and placement of DR-TB patient
on treatment.
 The use of GxAlert SMS notification of GeneXpert
testing suggests a scalable model for sustainability:
Installation is done once and in-country.

24. Abt Associates
Recap: Take Home Messages
 GxAlert eliminates the need for human error in data
entry, reduces the lag time, and helped pinpoint
patients that should be place on care.
 GxAlert strengthened surveillance of DR-TB, TB in
children and TB in the HIV infected, speeding
response and improving programmatic decision
made for enrollment and placement of DR-TB patient
on treatment.
 The use of GxAlert SMS notification of GeneXpert
testing suggests a scalable model for sustainability:
Installation is done once and in-country.

25. Abt Associates
Recap: Take Home Messages
 GxAlert eliminates the need for human error in data
entry, reduces the lag time, and helped pinpoint
patients that should be place on care.
 GxAlert strengthened surveillance of DR-TB, TB in
children and TB in the HIV infected, speeding
response and improving programmatic decision
made for enrollment and placement of DR-TB patient
on treatment.
 The use of GxAlert SMS notification of GeneXpert
testing suggests a scalable model for sustainability:
Installation is done once and in-country.

26. QUESTIONS?
www.GxAlert.com
Contact:
Kehinde Jimoh Agbaiyero, Abt Associates
Kehinde_Agbaiyero@abtassoc.com
Chris Macek, SystemOne
chris@systemone.id
OR