miLINC(Novel Package of Integrated Mobile Applications Reduces Time to Treatment

Initiation for Patients with MDR-TB)

Mani Naicker18 September 2015

OBJECTIVE

“Improvement in identifying and curing drug-susceptible TB and early detection and effective treatment of all MDR-TB cases (reduce time from suspicion to starting standard second-line treatment –five working days)”

2

NATIONAL STRATEGIC PLAN ON HIV, STIs AND TB: 2012-2016

INTRODUCTION

• Implemented in 3 PHC, Ugu District

• Murchison Hospital, Gamalakhe CHC, Kwa Mbunde Clinic

• GeneXpert® testing done at NHLS: Murchison and Port Shepstone

• Application built on the emocha platform

• Custom designed for operation on an inexpensive 7” Fonetab

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THE APPLICATIONS

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To be used by clinicians at the

Primary Health Care clinics in

order to ENROLL potential MDR-

TB patients.

[Will also contain a Training Library

in the future.]

To be used by Linkage Officers in

order to receive MDR-TB results

from the NHLS and CONTACT

the patient to LINK them with an

MDR-TB unit

[Will also contain a Training

Library in the future.]

To be used by clinicians at MDR-

TB unit in order to REGISTER

MDR-TB patients and confirm

that they have been linked to

care.

[Will also include a Training

Library and Clinical Decision

Support modules in the future.]

USER ACCESS

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STRUCTURE

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CLOUD PROCESSES

System Monitors

Back ups NHLS

ENCRYPTED

DATABASESERVICES

WEB INTERFACE

PHC APP

L.O. APP

MDR-TB CLINIC APP

PATIENT

SMS GATEWAY

PROCESSES

DATA FLOW

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# ENROLLED

8

242

546

722

636

536

595

0

100

200

300

400

500

600

700

800

Mar Apr May Jun Jul Aug

ENROLLED SITES

9

0

50

100

150

200

250

300

350

Murchison Kwa Mbunde Gamalakhe

5036

156

240

80

226

314

106

302

272

103

261

234

64

238222

103

270

Mar Apr May Jun Jul Aug

TB STATUS (n=1781)

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85.3%

10.6%

1.4% 2.6%

TB- TB+ RR Inconclusive

RR+ = 13%

LINKAGE TO CARE

• 25 MTB+Rifampicin Resistant detected, 24-48hrs

• 20 Contacted/appointment by Linkage Officer

• 20 LTC between 2-5 days working days

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IMPLEMENTATION PLAN

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Province District JSA Programme ManagerJSA Clinical Nurse

PractionerJSA Linkage Officer 2015 2016

KZN Ugu Y Y Y Mar/Aug

KZN eThekweni Y Y Y Aug

EC NMB Y Y Y Sep

EC Buffalo City Y N Y Sep

EC OR Tambo N Y Y Nov

EC Chris Hani N Y N Jul

WC City of Cape Town Y Y Y Nov

WC West Coast Y Y Y Dec

WC Eden Y Y N Jul

GP City of Joburg Y Y Y Oct

GP City of Tshwane Y Y Y Oct

GP Ekhuruleni Y Y INTERVIEWED Jan

NC Upington Y Y N May

NC Kimberley Y Y N May

NC Kuruman Y Y N Aug

MP Witbank Y Y N Jun

MP Standerton Y Y N Jun

MP Barberton Y Y N Aug

LP Capricorn Y Y Y Dec

FS Mangaung Y Y INTERVIEWED Mar

FS Lejweleputswa Y Y INTERVIEWED Apr

FS Fezile Dabi Y Y Y Jan

NW Klerksdorp Y Y Y Feb

NW Rustenburg Y Y N Feb

DECENTRALISATION

• King Dinuzulu Hospital

• Charles James Hospital

• Don McKenzie Hospital

• Phoenix CHC

• Tongaat CHC

• KwaMashu CHC

• Inanda C CHC

• CDC

• Clairwood

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NEXT STEPS

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• Complete miLINC site readiness assessment at pre-selected sites.

• Ensure NHLS barcoded laboratory request forms available at Labs and facilities.

• Facilitate Training (1day) on NHLS form and miLINC App.

• Supervise implementation and on-site support.

• Provide feedback to stakeholders.

• Support further implementation.

DISCUSSIONS(1)

• Strengthen the capacity of clinicians and increase the quality of timeliness of delivery of health services

• Rapid linkage to MDR-TB care is feasible through a multi-sector approach

• TB transmission potentially reduced as treatment initiated sooner

• Expansion to other sites

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DISCUSSIONS(2)

• A systematic approach needed for scaling miLINCacross all 52 districts.

• SMS text messaging is now available.

• Interoperability with other applications, EDRWeb, TIER.Net, ETR.Net

• Data Exchange with NHLS TrakCare

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CONCLUSION

“Mobile health represents an innovative and exciting tool in the fight against TB, and it is in countries

where TB prevalence is highest that mHealth initiatives stand to make the greatest impact.”

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mHealth to Improve TB Care, IRD

ACKNOWLEDGEMENTS

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National Department of Health

• Norbert Ndjeka

• David Mametja

• Yogan Pillay

Johns Hopkins University School of Nursing

• Jason Farley

• Kelly Lowensen

• Ellie Bergen

Jhpiego-SA

• Ida Asia

• Douglas Mambera

• Annatjie Peters

• Mani Naicker

• Khaya Mlandu

• Matsie Mphalele

emocha health, inc.

• Sebastian Seiguer

• Jane McKenzie White

• Morad Elmi

• Amanda Allen

• Greg Chiasson

National Health Laboratory Services

• Wendy Stevens

• Leigh Berrie

• Lynsey Isherwood

• Floyd Olsen

• Portia Madumo

• Sue Candy

• Jaco Grobler