How Dimagi Is Helping to Fight Tuberculosis Around the World

Facing the Issues

While tuberculosis (TB) incidence has decreased worldwide, low- and middle-income countries (LMICs) still bear the greatest burden of TB, accounting for 95% of deaths associated with the disease (WHO, 2014). At the same time, multidrug-resistant (MDR)-TB rates continue to rise. Programs such as DOTS (Directly Observed Therapy Support) assist countries in treating TB. However, ongoing supervision and support can be difficult to provide, resulting in limited success for otherwise effective programs.

These are several persistent challenges for TB programs in LMICs that prevent case detection and consistent follow-up services across all levels of the health system. For example, there is a shortage of health care personnel available to support TB care and for those providing care, there is often insufficient training. In addition, counterfeit medicines contribute significantly to the TB epidemic.

Finding an Answer

One solution that can aid in mitigating some of these challenges is the use of mobile or tablet-based case management software.

At Dimagi, we are using our expertise and resources to help support comprehensive TB elimination interventions. CommCare offers easy screening, registration, contact tracing, and follow-up of households and individuals for interventions. It has been used in TB programs for contact tracing, case finding interventions, appointment reminders, community-level case management, and follow-up programs. More advanced implementations have integrated CommCare with electronic medical records (EMRs) like OpenMRS and business intelligence (BI) solutions for reporting and analytics, including DHIS2. Dimagi has also been featured by the Stop TB Partnership’s Re-Imagining TB Care Pathway as a technology innovator supporting TB programs.

Our system is being used in three countries with a high TB burden. Here we are engaged with the government and implementing agencies who are continuing the fight against tuberculosis, each taking a different approach to tackling the disease:

Mozambique – Infomovel System

In collaboration with the Center for Disease Control, Friends in Global Health, Fundação Ariel Glaser, Elizabeth Glaser Pediatrics Aids Foundation (EGPAF), Centro de Colaboração em Saude, ICAP, Mothers2Mothers, and N’weti, Dimagi developed an integrated TB/HIV case management system called Infomovel. Infomovel is a patient tracking tool developed to support community health workers (CHWs) administer services across seven provinces in Mozambique. Focused on HIV/AIDS, tuberculosis, and prevention of mother-to-child transmission (PMTCT), the tool was originally piloted in 2015 with Ariel Glaser Foundation in Cabo Delgado. In 2019, the program expanded to national scale, supporting more than 1,750 workers across eight different implementing partners.

Infomovel supports linkages between community workers and health facility focal points by including case management support for HIV testing and counseling (HTC), care & treatment (C&T), PMTCT, and tuberculosis programmatic workflows. Infomovel consists of two applications, Health Facility and Community, which support patient registration, follow-up, defaulter tracking, and household testing. The digital solution facilitates services for individuals living with HIV and TB: mothers and pediatric patients of HIV and TB, individuals co-infected with HIV and TB, and TB contacts (requiring re-tracking and prophylaxis)

For more information on Infomovel, please see our case study. 

Nigeria – Case Finding Application for Private Sector Providers

Engaging the private sector in TB interventions is an important part of the puzzle of fighting the disease. The process is also very complex, given the fragmentation of services, providers, and mix of formal and informal networks required to engage. 

KNCV Nigeria uses CommCare to carry out active TB finding within the private sector providers of health services in Nigeria. Along with the support of InstratGHS, this program uses CommCare to complete the registration of probable cases, screening for TB and follow-up care, along with integrations to data visualizations platform for aggregating data. 

Lesotho – The Client Tracking Application 

The Client Tracking Application was developed in partnership with EGPAF. It is used to Track Clinic Appointments; send SMS reminders for patients; and facilitate Patient Tracing (HIV, TB) to reduce the  number of missed appointments, defaulting, and loss to follow-up (LTFU) patients in TB / HIV / ANC visits. The app is currently deployed in 8 districts. Dimagi is now partnering with the Baylor College of Medicine Children’s Foundation in Lesotho to deploy the app to the two final districts in Lesotho – bringing the app to national scale. 

Tools for Every Approach

CommCare offers critical functionality to support TB elimination, including:

• Clinical decision support modules: Tailor your tool to offer diagnosis and care recommendations specific to the patient’s clinical manifestations, such as comorbidities or health risks. Automation of clinical protocols through algorithms built into mobile applications can significantly improve diagnosis accuracy. 
• Case management: Longitudinal data collection can ensure that TB care providers take a patient-centered approach by tracking a person’s journey through the health system, including diagnosis, testing, and more. A patient-centric focus is a key principle of the End TB strategy, and a case management system allows providers to factor in the current and past needs and values of the person.
• Multimedia: Mobile applications can include quick reference guides and expert advice from lung specialists with audio visual prompts and tips. These can be accessed on demand during care provision or in between consultations to reinforce training and best practices for TB care.
• Case Sharing: Streamline the flow of data between community health workers and health facility workers securely. Allow authorized workers at each touchpoint to rapidly access test result and other health information information.
• Third-Party Integration: Integration with national health information systems is possible through a configurable interface that allows programs to map data collected or aggregated in CommCare applications with DHIS2. 

To learn more about how Dimagi and CommCare can help with disease treatment initiatives around the world, visit our sector summary on Disease Treatment.