TB Module

Motivation

Tuberculosis has affected millions of people across the globe and is now classified as the most lethal infectious disease. Different regions counter the challenge using different techniques and often struggle with managing the data and program workflow which results in putting additional effort that could have been utilized in maximizing coverage. The OpenSRP TB application aims to provide a generic solution meeting the basic data needs of a TB program while allowing groups make basic customizations to suit local context specific needs without the backing of large and experienced technology teams.

Background

Access to data is a key bottleneck for teams running TB programs. Data collected on paper is error-prone and not readily available to analyse or generate reports. Paper forms need to be transported to a single place before being entered into an electronic form. By this time, it is usually too late to correct errors and by the time analysis is done, problems have persisted for a long time. Often at national scale such analysis is done quarterly at best, which means that a problem persists for at least three months before it is identified, and then further time is spent on resolution. For example, knowing that screening targets are being met is particularly important to TB REACH projects. Similarly at a national level, understanding loss to follow-up or primary default rates is critical to programs that are focused on starting patients on treatment. Given that an untreated pulmonary TB patient will go on to infect several others during his/her lifetime, this has an impact on treatment success rates and on slowing the spread of TB. But the absence of reliable data means that project managers do not have immediate visibility into the care they are providing to patients, and about their project indicators.

Mobile and electronic data collection tools are one way in which program managers, field staff, and clinicians can get access to clean data quickly. A range of mobile tools is available for TB data, but the tools are either too general to use; lacking in functionality; difficult to use, install, and configure; or so specific that they can only be used for the project that they were developed for. This means that programs must either choose a general and easy-to-use tool that is lacking in functionality (and work around the limitations of such a tool) or a more powerful tool that makes the project team dependent on a dedicated technology team to make even the smallest change to the system, at significant cost and time. Such complex systems often require significant time and money to be invested in the customization of the application to the project or country context, a process which has to be repeated for every implementation setting. With only either of these choices available, it often means that the tools that end up being used in the field are not sustainable for use over time or at scale. This scenario often creates more problems than benefit and takes away from the intended goal of improved TB patient care and outcomes

Focus

Screening: Verbally screen individuals to identify presumptive TB patients
Diagnosis: Allow entry to diagnostic data to report TB diagnoses
Treatment enrollment: Enroll diagnosed TB patients into program on prescribed regimen and monitor the treatment throughout.
Follow-up: Track monthly follow-up visits, patient health progress and further lab tests to comprehend the treatment impact.
End of Treatment: Record treatment outcomes
Contact Tracing: Screen people in close contact with patients and track them actively to minimize the contagious effect of TB.

System Description

The system provides a user-configurable system that can be implemented by various TB screening and treatment programs worldwide. The application is built to include the following registers:

Presumptive cases
Positive TB Cases
In-Treatment Patients

These registers are meant to replicate the minimum workflow items of current TB management programs but can be tailored according to the specific needs and requirements of individualized TB programs. Since workflows may vary across different settings and different registers in different settings may have different variables and different data-entry points, the aim is to build a ready-to-use yet flexible application that fulfills the basic needs of a TB app and can be adapted to a majority of existing TB programs, while minimizing the dependency on developers for minor changes.

Replacing paper forms with digital, synchronized TB registries using the OpenSRP platform will improve operational efficiencies and management of the TB programs, enable prompt and systematic treatment of patients and allow for routine audits and analysis of data, contrary to the inefficient process of maintaining hardcopy paper-based registries for patient records.

Key Features

Three Registers to record and track data	Presumptive cases Positive TB cases In-Treatment cases
Contact Tracing	Close contacts of identified TB patients are also tracked and screened for possible TB. These contacts are referred for lab tests and then enrolled into treatment if found positive
Diagnostic Data Entry	The application allows entry of diagnostic test data at different points in the case cascade. The available tests are GeneXpert, Smear, Culture, and Chest X-ray
Ability to add a patient to system at any point in the TB care cascade	A TB program cannot run in isolation. Different institutions in a country run different programs to counter TB and individuals can come via different channels and at different points in TB workflow. The application allows users to add these patients into the system and continue the treatment from any point
User configurable forms	Every program and region collects different data and phrase questions differently based on users` and patients` literacy level and prevailing TB control practices. The data collection forms use an excel based standard template and are manageable via a user interface. This allows users make modifications, and add different data constraints based on program needs
User configurable register content	The mobile client logos, colors, and labelling can also be modified to some extent via UI. The application also allows users to choose which columns appear in each register to meet individual program and project needs
Configurable schedules	The follow-up schedule is usually monthly for most programs, however, the schedule can be easily modified through an Excel sheet
Easy Installer	The application does not require developers to setup and can be easily installed and tested by following few instructions
Internationalizable	The application can easily be translated into other languages using the same Excel based template used for form content
Offline Capable	The application works offline can be used for data collection even without an Internet connection. Data can then be uploaded whenever a connection is available
Dashboard	The application features a web-based dashboard for project and program managers to keep track of key program indicators

Screenshots

Find screenshots of a basic implementation here.

Mobile App

Mobile client app is available on Google playstore here. The app is compatible with Android Lollipop (5.0) and above versions.

Web Server

Production server specs recommended can be found here.

Server setup instructions can be found here.

Source Code

The source code can be found here.

Reference materials

Link 1
Link 2
Link 3

Documentation