ROMANIAN EXPERIENCE IN ELECTRONIC TB RECORDING AND REPORTING

Cristian Popa, Elmira IbraimNational TB ProgrammeMarius Nasta Institute of PulmonologyBucharest - Romania

Geneva, April 27th 2011

ROMANIA

Total area: 238 391 km²41 counties + Bucharest (6 sectors)

Population: 21 431 298M: 48.8% F: 51.2%Urban: 53.3% Rural: 46.7%

TB endemic – 2010

• New cases + Relapses = 19 395• Notification rate = 90,5%ooo

• New cases = 16 021 • Pulmonary SS+ = 9 111 • MDR-TB: 2.9% of new cases

11% of retreatments• XDR-TB: 9.9% of new MDR-TB

11% of retreated MDR-TB• TB incidence rate in children =

27.2%ooo

• TB mortality rate (2009) = 7.1%ooo

• Success rate in new pulmonary SS+ cases (2009) = 81.4 %

History of TB recording and reporting

• 1881 – 1900: estimates of TB mortality from TB deaths reported

• Beginning of XX century: TB morbidity estimates from TB cases diagnosed in hospitals or ambulatories

• 1938: mortality and point prevalence (at the end of year)

• 1950: incidence rate of new cases

• 1965: global notification rate (including relapses)

• 1968: incidence rate of pulmonary smear positive cases and rate of bacteriological confirmed cases

• 1997: outcomes registered and reported

• 2001: all re-treatment cases (other than relapses) notified

• 2000: reporting of the TB cases in electronic format (epi info) in paralel with paper

• 2004-2005: development of the new electronic system for TB (SQLS database); use of the electronic system in parallel with paper (Global Fund support)

• 2005-2007 equipment of the TB units with computers & internet

• 2005 →→ trainings for the staff involved in electronic reporting and recording

• 2009: paper based system dropped

Steps in development of the electronic reporting and recording system for TB

- central servers- all (189) TB dispensaries- all penitentiary (3), army (1) and police (1) TB units- MDR-TB centres (2)- all (41) counties TB unit + 6 sectors of Bucharest + equivalent(3) of ministries - 68 of 165 TB laboratories

2006 – TB recording and reporting electronic system (RO-NTBSy) operational and functioning:

Purpose for the creation of the TB electronic recording and reporting system

• TB monitoring tool for central, county and facility level

• Surveillance of drug resistance

• Reports for the NIH, MOH, WHO …

• Data for drug management

• Individual data about TB patients for clinician

40000067%

8000013%

12000020%

software developmentequipmenttrainings

Costs (in USD) of TB electronic recording and reporting system

National TB Surveillance Unit

TB dispensary

County TB unit

MDR-TB centre

Architecture of electronic web based TB case reporting system

TB laboratory

Special units (police,army, prisons)

Access to electronic database limited to authorized staff -protected by password

“Search” module

“Search” module

Registration of TB cases in each TB ambulatory (189)

Bacteriological results registered in the laboratories; matching of data

Registration of TB cases

Recording of hospitalizations

List of hospitalizations

Registration of bacteriological exams results

List of bacteriological results

Recording the treatment

Recording the treatment

Recording the treatment – adverse reactions

Recording the treatment – adherence

Recording the treatment – surgical intervention

Treatment outcome

Registration of transfer

Registration of transfer

MDR-TB module

MDR-TB module

Matching of bacteriological results from dispensary and from laboratory

Validation of treatment outcome

Preformed reports

Custom defined reports

Examples of preformed reports

Examples of preformed reports - aggregate reports

Examples of preformed reports – graphs

Examples of preformed reports – aggregate data

Examples of preformed reports – line listings

Examples of preformed reports – MDR-TB

+ user friendly+ huge amount of information+ security of data+ validation of data+ use of automatic alerts+ avoid duplications+ no delays in data transmission + flexibility to allocate rights to

users+ cases from penitentiary, police,

army in the same database

- limited access to data at different levels (periphery)

- need of technical support inside and outside NTP

- financial sustainability of the system- sources of data only ambulatories &

MDR-TB centers & labs – no hospitals

- module for drug management functional, but not used

- need of good internet connection- maintenance - difficult upgrade (still version I -2005)

Characteristics of TB software application

and some Challenges

+ MDR-TB registry part of the general TB registry

+ double entry of bacteriological data (labs and ambulatories)

+ users have permanent contact each other and with staff in National Surveillance Unit

+ feed back from central level+ data entry at source + various reports (preformed or

custom)+ TB registry permanently updated

- MDR-TB data have to be redefined and updated (date of registration as MDR-TB case etc)

- need of periodic training- few preformed reports- delays in data entry- missing of links with other

databases (pharmacies, NIH, HIV etc)

- data collected to be used for the monitoring of the program performance

Characteristics of TB software application

…and other Challenges