Building A Better Link From Diagnosis to Treatment
Working in partnership with a high-burden TB country to close the lab-clinic divide and confirm treatment for all positive TB cases
March 24, 2019 — In honor of World TB day, SystemOne is proud to announce a grant opportunity of in-kind services to help the Recipient connect positive TB diagnoses to treatment. The in-kind services will focus on connecting several diagnostic devices to Aspect, the multi-disease, multi-device digital data platform, and then connecting that data to a TB case management system. SystemOne will connect a GeneXpert point of care (POC) device and central laboratory diagnostics, such as MGIT and LPA, at 1 (one) central or national-level laboratory. This connectivity with multiple instruments, and use of Aspect to link positive cases to treatment, is designed to dramatically reduce loss to follow-up, account for every positive diagnosis, and enable rapid electronic results reporting via app, email or SMS.
Also included in the grant is a data deep-dive to immediately gain insight into how patients proceed through the cascade of diagnostics and then onto treatment. The deep dive will also analyze impact measurements on turnaround time, time to treatment initiation, and the gap between diagnosis and treatment -- and how the intervention has helped to narrow that gap.
The in-kind grant’s estimated value is $70,000 USD.
A person experiencing signs and symptoms of TB faces many challenges to timely diagnosis and appropriate treatment. Many of these bottlenecks can be characterized as delays.
Delays between ordering a diagnostic test and receiving the results;
Delays in initiating treatment due to the challenges of interpreting complex results and the unavailability of appropriate drugs for treatment; and
Delays in proactive longitudinal monitoring of patients to prevent drug resistance and negative patient outcomes.
These delays prolong illness, fuel the outbreak of drug resistant TB (DR TB), and constrain efforts to improve patient outcomes. They make it more difficult to identify where to put resources, to notify patients and clinicians, to confirm positive diagnoses are on treatment, and to ensure appropriate treatment. Reducing these delays requires a stronger link between laboratory and clinic. New diagnostics and drugs are critical, but if they do not connect into a patient-centered model of care—the right diagnostic or drug, for the right patient, at the right time—they will have limited impact.
This grant for connecting multiple devices, combined with the resulting information flow and interpretation, addresses these delays by connecting diagnostics, harnessing their data, and moving that data in real time to actors in the health system. Additionally, we seek to reduce time to identify and notify patients and clinicians and reduce the pretreatment Loss to Follow-up (LTFU) by confirming that all positive diagnoses are linked to appropriate treatment.
Successful Applicant will be Awarded:
Connection of 1 GeneXpert POC TB diagnostic instrument and up to two central laboratory DR TB diagnostic tests (ie MGIT, LPA) to Aspect. The central laboratory tests/devices will be limited to one central or national level laboratory.
Deployment of a mobile application to capture smear microscopy results and move them to Aspect.
Connection between Aspect and the currently used DR TB case management system.
Site visits by SystemOne staff (to be conducted within first 90 days of the grant).
Capacity building during site visits.
Data, SMS, and other running costs and remote support for one year.
The successful awardee will be invited to nominate 1 or 2 individuals to co-author a paper on the results of this initiative with SystemOne.
Eligibility for Award
Ministries of Health must submit an application by April 30, 2019 (see below for application instructions).
The successful awardee will need to provide a Ministry of Health-appointed point of contact to manage the project and provide all local logistical support and local travel costs for the SystemOne engineers. That person will remain the point of contact during the following 9 additional months of connectivity. Meals, lodging, incidentals and international travel costs for SystemOne engineers will be covered by SystemOne.
Must sign a Data Use Agreement to ensure compliance with international data usage regulations. The Data Use Agreement will be sent to applicant upon receipt of completed application.
We are looking for country applicants that can:
Submit a complete application.
Provide strong governmental leadership and management of laboratory diagnostics.
Collaborate on final data analysis report.
Nominate a responsible point of contact for the Project for one full year.
Demonstrate potential collaboration between HIV and TB programs.
How to Apply
To apply, complete the application below by April 30, 2019 by copying the questions and pasting them into a text editor of your choice. Save the Application as a PDF and submit to Dx2Tx@SystemOne.id. You may also submit any questions by emailing Dx2Tx@SystemOne.id.
Nothing contained in this call for proposal creates any express or implied obligation on the part of SystemOne, including, without limitation, obligation to fund any proposal, person or entity. SystemOne will make all award decisions in response to this call for proposals at its sole discretion and any award will be contingent upon an applicant entering into a written memorandum of understanding on terms acceptable to SystemOne.
Please copy and paste the following text into a text editor of your choice and submit the application as a PDF file to Dx2Tx@SystemOne.id.
1. General Information
1.1 Name of Country
1.2 Name and information for National TB Program Director:
1.3 Name, title, email, and phone number of person submitting application:
1.4 Do you have GeneXperts already connected to GxAlert (Y/N)?
1.5 Please list the types of drug sensitivity tests and devices used in 1 central/national lab:
1.6 Does your country already have a dedicated GxAlert server? (Y/N) (If No, then Aspect and/or GxAlert will be provisioned at no additional cost on SystemOne’s secure cloud platform).
2. Descriptions of Existing Connections
2.1 What is the average number of tests per day performed on the devices listed on #4 (below) at 1 central or national level laboratory?
2.2 Are the instruments at the central/national level lab connected to a laboratory information system (LIS)? If so, please name and describe the system. (200 words max.)
2.3 What electronic case management system is used to initiate and track DR TB patients on treatment (i.e. OpenMRS, eTB manager, etc)?
3. Existing Processes and Support
3.1 Describe briefly what happens after a result is generated from a diagnostic instrument? For example, does the result have to be manually approved by a clinician or lab manager before it is shown to the referring facility/patient? (400 words max.)
3.2 Describe briefly your laboratory workflow. How are results currently transferred from the instrument to both laboratory information systems and case management systems? (400 words max.)
4. Hardware and Connectivity
4.1 Are the instruments listed in the application already connected to a computer?
4.2 Does the central or national lab already have a reliable internet connection that can be utilised to move data for this project? Is this an Ethernet or WiFi connection (please specify)?
4.3 Is there a reliable wifi or 3G signal inside the lab?
4.4 Which mobile networks providers are known to work inside the lab?
4.5 Briefly describe any networks that are set up in the lab. For example, is there a router that instruments and/or computers connect to? Do those instruments/computers connect via Wifi or Ethernet? (200 words max.)
4.6 Is there a reliable source of electricity at the lab? Are there any backup sources of electricity and are they reliable?
Optional: Is there anything else you wish us to know about your landscape, and why your country would be a strong recipient and partner for the SystemOne Diagnostic-to-Treatment Grant? (200 words max)