eHealth Transforming TB Prevention and Control in Brazil, and Beyond

eHealth Transforming TB Prevention and Control in Brazil, and Beyond

Originally known as SITE-TB, Sistema TMBR is the official platform for drug resistant TB monitoring and treatment in Brazil.Originally known as SITE-TB, Sistema TMBR is the official platform for drug resistant TB monitoring and treatment in Brazil.

In the 1990s many Brazilian patients infected with tuberculosis (TB) were not being cured, despite starting treatment. Some patients stopped taking their medication, which led to the reemergence of TB. In 1993, the World Health Organization declared that TB was a global emergency. Eventually, a multi-resistant strain of TB surfaced, making it even more difficult to fight the disease.

These occurrences --- referred to as “chronic cases” --- became apparent in some Brazilian states, but health units lacked standardized management systems to treat these cases of TB.

Centro de Referência Professor Hélio Fraga (CRPHF), which is Brazil's National Tuberculosis Reference Laboratory, took control of TB surveillance in 1994. CRPHF defined a more effective treatment scheme and a national network to register and monitor the chronic cases in 1999. CRPHF builds human capacity through training and carries out operational and epidemiological studies. They also evaluate TB and other lung disease control activities and function as a Macro Regional Reference Lab.

Between 2000 and 2004, a national reference health unit network was gradually established in all Brazilian states where cases would be submitted for more detailed exams and adequate treatment. These cases would then be contacted and followed up with manually, using ordinary data sheets in regular personal computer programs. By that time, it was well known that the chronic cases were patients that developed resistance to the conventional treatment for TB, called multi-resistant TB or MDR-TB.

In 2004, Management Sciences for Health --- through the USAID-funded Rational Pharmaceutical Management Plus (RPM Plus) Program, and later the Strengthening Pharmaceutical Systems (SPS) program --- began working towards TB prevention and control in Brazil, in partnership with the Ministry of Health and CRPHF.

This cooperation yielded Sistema de Informação de Tratamentos Especiais para Tuberculose (SITE-TB or e-TB Manager Brazil), an electronic platform on the internet aimed at surveillance of drug resistant TB cases, previously monitored manually.

With this online tool, integration of the reference health units improved at all levels. The platform provided electronic management of notification, follow-up and closing of TB and MDR-TB cases; receipt, delivery, procurement, usage, waste, and demand of medicines; and operational and epidemiological reporting.

Besides strengthening treatment and monitoring of drug resistant TB, specific pharmaceutical management components were embodied in the same system. The analysis of indicators generated by the platform would now underpin decisions about more precise diagnosis and earlier introduction of adequate drug therapies, thus, optimizing the usage of resources for TB control.

In 2005, the online system, renamed Sistema TBMR or MDR-TB System, was adopted by the Ministry of Health as the official platform for drug resistant TB monitoring and treatment. MSH played a key role with partners in this accomplishment, by supporting and promoting the updating of theoretical and practical training courses in program operation and regional capacity building to deal with MDR-TB.

Through MSH partnerships globally, this new online system was implemented in Eastern European countries in 2006 as e-TB Manager (initially in Romania and Moldavia). As of 2011, four countries employ the e-TB Manager system: Ukraine, Uzbekistan, Indonesia and the Philippines. The system is in early stages of implementation in seven other countries, as well, supported by different partnerships.

With ongoing global implementation, the e-TB Manager is helping to lower TB and MDR-TB cases worldwide.


The global presence of MSH, through cross-cutting fertilization and country experience exchange, enabled a re-engineering of the system. e-TB-Manager has been further adapted in Brazil with new enhanced functionalities widening its scope by including cases with all kinds of resistance -- not only MDR-TB -- as well as those with adverse reactions and associations with other diseases such HIV & AIDS. In Brazil, e-TB Manager led to a significant increase of drug resistant TB case detection and offered a wider geographic coverage to treat and provide support to patients. Its internet basis was maintained, enabling decentralized management of cases, information sharing at all levels, and establishing a better control of supply chain with continued stock of medicines.

MSH’s Brazilian experience with Sistema TBMR not only addressed urgent concerns of rational use of medicines and effective TB case monitoring and control of patients; it also led to the wider, global implementation of a new electronic platform, improving other countries' supervision of patients and lowering TB and MDR-TB cases worldwide.

Joel Keravec, senior technical advisor, and Luis Gustavo do Valle Bastos, senior program associate for TB & malaria, work with MSH Brazil.