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TIER.Net v1.12 updates: TB functionality

Comprehensive Trainings to support the National Integrated TB/HIV Information System Implementation. TIER.Net v1.12 updates: TB functionality. Purpose. To introduce participants to recent updates in DS-TB functionality in TIER.Net v1.12

theodorejohnson
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TIER.Net v1.12 updates: TB functionality

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  1. Comprehensive Trainings to support the National Integrated TB/HIV Information System Implementation TIER.Net v1.12 updates: TB functionality

  2. Purpose • To introduce participants to recent updates in DS-TB functionality in TIER.Net v1.12 • To discuss and demonstrate that identified challenges in TIER.Net v1.10.5 have been resolved • Excludes discussion on functionality that has not changed • To provide clarity and correction to critical processes following challenges that have emerged: missteps and inappropriate guidance provided by TKIs

  3. Background • To reiterate key guiding principles for DS-TB digitisation in TIER.Net • TB digitisation is framed in context of tracking the treatment cascade • TB identification and testing • Laboratory diagnosis and treatment initiation • Retention in care / treatment success

  4. Background (2) • TIER.Net maintains extensive reporting functionality that supports patient retention across 90-90-90 treatment cascade: • Line lists that alert clinicians of leakages in care from one pillar to the next (eg. TB identification results outstanding list, waiting to start TB treatment list) • Management reports at various levels: • Support patient management • Drive improved data quality

  5. DS-TB Cascade: TB identification and testing

  6. Line lists & reports for TB identification & testing

  7. TB Identification Module – Updates to Lists and Reports TB Identification Report

  8. Updates to TB Identification Report (1) Legible details in next slides

  9. Updates to TB Identification Report (2) • ‘TB headcount’ reworded to ‘TB symptomatic clients’ • ‘Under 5 yrs case Id’ reworded to ‘Symptomatic’

  10. Updates to TB Identification Report (3) • ‘Clients with sputum sent’ reworded to ‘Clients with specimen sent’ to include biopsies and aspirates

  11. Updates to TB Identification Report (4) • Added: outcome before Tx start: • TFO • RR/MDR

  12. Updates to TB Identification Report (5) • Changes to footnotes: • * Asymptomatic – this refers to contacts (children under 5 years) who are asymptomatic • ** Unique clients refer to non-duplicated clients; all clients are only counted once. In cases where multiple tests are conducted for a client, positive results trump negative results and if two results are positive, the most recent test result will be counted

  13. Updates to TB Identification Report (6) • DHIS indicators in improved order • ‘TB sputum (>=5) test’ changed to ‘TB bact test (>=5) • Removed: TB smear turnaround time (<48 hrs)

  14. TB Identification Module – Updates to User Interface Mantoux and LAM tests TB Identification outcomes

  15. User Interface: Mantoux and LAM test added

  16. Added to TB test types: Mantoux • Added Mantoux under test types (no longer stand-alone pane) • Rationale: • To identify children with presumptive TB based on a Mantoux test result (in conjunction with other clinical information) • Note: these cases are not TB contacts, but are presumptive TB cases • To include presumptive TB children with confirmed Mantoux tests under Waiting for TB Treatment List

  17. Added to TB test type: Lipoarabinomannal Lateral Flow Assay (LF LAM) • LF-LAM is generally used for hospitalised patients who are very sick and are non ambulatory • Helps to detect mycobacteria in human urine • Useful screening tool for early diagnosis and treatment of TB in HIV positive patients who are hospitalised and/or who are seriously ill and/or with low CD4 count • Given that it is screening tool, LF LAM must be used in conjunction with diagnostic tests such as GXP, culture or LPA

  18. TB Identification Module – Updates to User Interface Mantoux and LAM tests TB Identification outcomes

  19. User interface: more outcomes added to TB Identification Module

  20. User interface: more outcomes added to TB Identification Module (2) • Added Transferred/Moved Out, Rif Resistance Case and MDR Case to list of outcomes • These outcomes relate to patients diagnosed with TB but not started on TB treatment at same facility • Patients diagnosed with RR-TB / MDR-TB should be assigned outcome of “Rif Resistance Case” / “MDR Case” respectively • Such patients must be referred to DR-TB treatment initiation site to initiate DR-TB treatment

  21. User interface: more outcomes added to TB Identification Module (3) • For patients who are transferred out (TFO), admin clerk (AC) must capture “TFO” as well as the facility that the patient is transferred to • This must be copied from the “Remarks Column” in the TB Identification Register • Patients who are transferred out must be given a transfer letter to start DS-TB treatment at another facility

  22. User interface: more outcomes added to TB Identification Module (4) • DS-TB patients are transferred out to another facility to initiate DS-TB treatment • RR/MDR-TB patients are allocated these outcomes then referred to a DR-TB treatment initiation site to initiate MDR-TB treatment • HAST managers must ensure that patients reach their destination facilities and start treatment

  23. DS-TB Cascade: Laboratory Diagnosis & Treatment Initiation

  24. Line lists and reports for TB treatment initiation

  25. TB Confirmed Module – Updates to Lists and Reports Waiting for TB Treatment List DS-TB Treatment Initiation Report

  26. Updates to Waiting for TB treatment list

  27. Updates to Waiting for TB treatment list (2) • In TIER.Net v1.10.5 only cases with positive bacteriological test results appeared on the list • In v1.12 all TB cases with positive TB results / investigations appear on the list, including: • Clinical diagnosis of TB • X-ray suggestive of TB • LF LAM test and • Mantouxtest

  28. TB Confirmed Module – Updates to Lists and Reports Waiting for TB Treatment List DS-TB Treatment Initiation Report

  29. DS-TB treatment initiation report TIER.Net V1.10.5

  30. Updates to DS-TB Treatment Initiation Report (1) TIER.Net V1.12

  31. Updates to DS-TB Treatment Initiation Report (2) • Combined GXP report with the DS-TB treatment initiation report • Bacteriological coverage • Historically EPTB cases were diagnosed clinically only - not bacteriologically • Bacteriological coverage now includes EPTB cases diagnosed via GXP on an aspiration or biopsy specimen

  32. Update to DS-TB Treatment Initiation Report (3) • Bacteriological coverage may decline for one or two quarters until all EPTB cases are diagnosed bacteriologically Prescription: to test EPTB cases bacteriologically (GXP, smear or culture)

  33. TB Confirmed Module - Updates to User Interface Adding new TB episode Disease classification and ICD10 codes TB registration year Expanded TB treatment calendar TB regimen 2 “Receiving ART at another facility”

  34. Summary of updates to User Interface of Confirmed TB Module • Bug fix: adding of new TB episode • Corrected disease classification and ICD10 codes • Added TB registration year validation • Expanded TB treatment calendar for extended TB treatment • TB regimen 2 option disabledwith a dialogue box validation • Improved capturing of TB patient “receiving ART at another facility” Details in next slides

  35. TB Confirmed Module - Updates to User Interface Adding new TB episode Disease classification and ICD10 codes TB registration year Expanded TB treatment calendar TB regimen 2 “Receiving ART at another facility”

  36. User Interface: Improved adding of new TB episode (1) • Scenario: patient has a closed TB episode (an outcome was allocated), and now has a new TB episode • Bug: In v1.10.5 adding of new TB episode was not user-friendly • When opening patient record, system automatically opened the outcomed TB episode • User unable to start new episode within the patient record

  37. User Interface: Improved adding of new TB episode(2) • Guidance on an interim (but counter-intuitive) work-around was made available • Challenge: many users / TKIs did NOT reach out for guidance • ACs resorted to deleting / overwriting the previous episode’s data – this is incorrect practice • Now that bug has been fixed, ACs must re-capture the previous episode

  38. User Interface: Improved adding of new TB episode(3) • Fix: In v1.12 adding of a new TB episode is now logical and user-friendly • Double-click on row to open the patient record in the regular manner

  39. User Interface: Improved adding of new TB episode(4) • Dialogue box will open • Select ‘TB’ for type of record

  40. User Interface: Improved adding of new TB episode(5) • Dialogue box will open • Select ‘Add new’ to open a new TB episode • To open a closed case, double-click on it in the grid

  41. TB Confirmed Module - Updates to User Interface Adding new TB episode Disease classification and ICD10 codes TB registration year Expanded TB treatment calendar TB regimen 2 “Receiving ART at another facility”

  42. User interface: updates to Disease classification • Disease classification: option for ‘both’ has been removed • Now reflects only PTB and EPTB • Patients who were classified and captured under ‘both’ will be mapped to PTB

  43. Updates to ICD10 codes • ICD10 codes 19.0 to 19.9 (miliary TB) previously listed under PTB have been moved to EPTB

  44. User interface: updates to ICD10 codes (2)

  45. TB Confirmed Module - Updates to User Interface Adding new TB episode Disease classification and ICD10 codes TB registration year Expanded TB treatment calendar TB regimen 2 “Receiving ART at another facility”

  46. User interface: updates to TB reg year (1) • Bug: v1.10.5 erroneously allowed users to capture incorrect data as the registration year • E.g. 20188 vs 2018 – more than 4 digits captured in “year” field • Fix: in v1.12 a data entry validation was added to prevent ACs from capturing anything other than a year from the dropdown list

  47. User interface: updates to TB regyear (2)

  48. User interface: updates to TB regyear (3) • Impact of this v1.10.5 bug: any data set with incorrect data for registration year: • Unable to import the DES file into ETR.Net • Patient indexing failed in ETR.Net Historical data that has been incorrectly captured MUST BE corrected manually at facility level Run the Data Validation List to identify historical errors

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