Complex DR-TB Case Management

HAI is testing a tablet-based intervention that could help National Tuberculosis Programs curb drug-resistance, prevent adverse treatment effects, and build tuberculosis capacity among health providers nationwide.

Two common adverse effects of drug-resistant tuberculosis (DR-TB) treatment are irreversible hearing loss and sudden cardiac death.  Early identification of these adverse effects and subsequent changes to patient treatment plans are a critical aspect of curbing TB drug resistance.

In partnership with the Mozambican National Tuberculosis Program (NTP), HAI is supporting the implementation of internet connected tablets at high volume DR-TB health facilities equipped with SHOEBOX audiometers and SmartHeart ECGs. When hearing loss or heart rhythm changes are detected, these cases are presented by videoconference to a weekly national DR-TB expert clinical conference using the ECHO model

Through the roll-out of these devices at subnational levels, HAI and Mozambique’s NTP are helping frontline health workers 1) detect adverse side effects that stem from commonly-used DR-TB treatments; and 2) easily access national TB expertise to determine individualized treatment plans for these complex patient cases.

This novel method serves as an initial test to determine whether National Tuberculosis Programs in other countries could adopt the intervention and ensure that these life-saving services reach the most vulnerable DR-TB patients.

HAI-LIGHTS

In July 2018, the Mozambican National TB Program distributed 53 SHOEBOX enabled tablets to health facilities across all provinces of Mozambique.  Over a two year period, 1,331 audiology tests were performed and abnormal results were noted in 170 patients, resulting in medication change to reduce the impact of such adverse side effects.

Weekly DR-TB ECHO sessions over the two year implementation period covered 614 cases, and led to regimen changes for 510 patients, leading to the increased use of novel all-oral DR-TB medications, namely Bedaquiline and Delamanid, in Mozambique.  

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News/Media

Pilot of weekly ECHO model videoconferencing system in Mozambique to review complex drug-resistant TB cases Abstract, 50th World Conference on Lung Health, 2019, Hyderabad, India
Proof of concept: integrated tablet-based hearing and ECG testing for Mozambican patients with drug-resistant TB Abstract, 50th World Conference on Lung Health, 2019, Hyderabad, India
Harnessing systems integration: multi-device connectivity in Mozambique Abstract, 49th Union World Conference on Lung Health, 2018, The Hague, The Netherlands
The experience of developing an MDR-TB ECHO programme in the country of Mozambique Abstract, 49th Union World Conference on Lung Health, 2018, The Hague, The Netherlands

Funding

[2018-2020] Optimizing the safety of drug resistant-TB treatment with mobile audiometry and ECG testing to prevent complications.

This project receives funding support from the Stop TB Partnership.

[2017-2018] Improving Diagnostic, Linkage to Care, and Routing Reporting for TB, MDR/RR-TB and XDR-TB Patients in Mozambique.

This project received funding support from the Stop TB Partnership.

[2015-2018] Strengthening the HIV/MDR-TB Diagnostic and Care Cascade in Mozambique.

This project received funding support from the National Institute of Allergy and Infectious Disease of the National Institutes of Health under award number 30AI027757-28, via a subagreement from the University of Washington.

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