e-health

Ukraine has successfully implemented e-TB Manager nationwide as its mandatory national tuberculosis registry after first introducing it in 2009. Our objective was to perform an end-of-programme evaluation after formal handover of the registry administration to Ukraine's Centre for Disease Control in 2015. Of the 5.9 million transactions over a 4-year period, nine out of 24 oblasts (regions) and Kiev City accounted for 62.5% of all transactions, and corresponded to 59% of Ukraine's tuberculosis burden. There were 437 unique active users in 486 rayons (districts) of Ukraine, demonstrating extensive reach.

Users of e-TB Manager, a web-based eHealth system institutionalized in 10 resource-constrained countries that account for one-third of the world’s tuberculosis (TB) burden, reported that e-TB Manager helped to improve patient care and workplace productivity, and they found it reliable for case management. The users--especially those with more experience in TB programs and those who had used the system for more than two years--were generally satisfied with the system. Responses came from Armenia, Bangladesh, Brazil, Cambodia, Namibia, Nigeria, Indonesia, Ukraine, and Vietnam. The study concluded that younger users and those with less experience in TB programs need more training, and institutional capacity for managing e-TB Manager takes at least five years. The capacity  to manage e-TB Manager has been built in Brazil and Ukraine.

In this opinion paper, we discuss lessons learned from the global scale-up of these laboratory devices and the pathway to tapping the potential of laboratory-generated information in the field of TB by using connectivity. Responding to the demand for connectivity, innovative third-party players have proposed solutions that have been widely adopted by field users of the Xpert® MTB/RIF assay. The experience associated with the utilisation of these systems, which facilitate the monitoring of wide laboratory networks, stressed the need for a more global and comprehensive approach to diagnostic connectivity. In addition to facilitating the reporting of test results, the mobility of digital information allows the sharing of information generated in programme settings. When they become easily accessible, these data can be used to improve patient care, disease surveillance and drug discovery. We list several examples of initiatives that should allow data sources to be combined to improve the understanding of the epidemic, support the operational response and, finally, accelerate TB elimination.

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