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

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