Case study: Developing an app to improve efficiencies in TB data collection in Nigeria
Nigeria is a high-burden country for TB, multidrug-resistant TB, and TB-HIV co-infection. In 2017, Nigeria was estimated to have an incidence of 418,000 cases. The country also has one of the lowest case detection rates among high-TB-burden countries with just 25 percent of cases detected.15 The private sector is an important source of overall care in the country but is underused for TB; treatment is largely restricted to the public sector.
There are many reasons for low detection rates. Patients who go to private facilities are often not adequately screened and their samples and referrals are not tracked, leading to loss to follow-up. Further, the entire process is paper-based, which makes the collection and use of data more time-consuming. It delays both clinical and programmatic decision making, follow-up, and care. Improvements in TB case notification in Nigeria would prevent the further spread of TB there.
SHOPS Plus support
SHOPS Plus developed a mobile application to replace paper forms with a more efficient digital platform that supports the reporting needs of clinical providers such as doctors and nurses, laboratory scientists, pharmacists, and patent and proprietary drug vendors. TB Screening and Tracking for Accelerated Referral and Reporting (TB STARR) displays workflows specific to provider types and includes functionalities such as TB case referral tracking and sputum sample tracking. The app has the potential to reduce delays, improve data for program decision making, and ultimately improve the patient experience. All of the data collected through the app are aggregated and visualized through a web-based data portal. This information can be used by the national, state, and donor-funded TB programs to improve decision making and follow-up. The app is unique in that it can be adapted for other health areas. Given the impact of COVID-19, in late 2020 SHOPS Plus added a screening tool to help distinguish between the two respiratory diseases.
SHOPS Plus partnered with Every1Mobile, a digital solutions design firm with experience designing tools for drug shops in Nigeria. Together, they worked with the National Tuberculosis and Leprosy Control Program, private providers, and other stakeholders to develop the app using a user-centered approach. This ensured that the final product would meet the needs of the providers who would use the app to enter, use, and submit data. The project convened workshops with various providers and stakeholders to outline challenges and visualize patient pathways. The development of the app was an iterative process that involved piloting, revising, and problem solving.
TB STARR was originally created for providers who participated in SHOPS Plus’s network of patent and proprietary medicine vendors, pharmacies, labs, and clinicians. Eventually, the app was modified to include non-networked providers, which required enhancements to the app’s user capacity, design interface, and data security. The project developed a streamlined user type for these providers, is simpler to use, and has less risk for data sharing.
Since TB STARR’s launch in August 2019, users have downloaded the app over 1,000 times, which has resulted in 680 registered users and several cases reported. SHOPS Plus will transition the app to the National Tuberculosis and Leprosy Control Program. To achieve this, the project is working to integrate TB STARR into the existing digital ecosystem, and is planning to make it interoperable with GxAlert, which reports Xpert MTB/Rif test results in real time, and the e-TB manager system in Nigeria.