Manivasagan Naicker

1
Implementing ETR.NET for TB and TB/HIV
Surveillance

• Manivasagan Naicker
• Centers for Disease Control and Prevention-South
  Africa

2
Outline

• Background
• System description
• System architecture
• Data model
• Main features/functionality
• Security and confidentiality
• Structure and information flow
• Status of implementation
• HIV Surveillance
• Adapting ETR.NET
• Summary

3
Background

• First Electronic TB Register (TBREG) was
  developed in Botswana, 1995
  
• Objective to provide timely and accurate TB
  management information
  
• Developed using Epi Info 6 (DOS)
• menu-driven, user friendly, requiring minimal
  previous computer exposure
  
• Provide National TB Programs simple way to
• Collect patient data in a systematic manner at
  district level from hand written paper based
  registers
  
• Perform automated analysis of data in a
  consistent, more accurate and less time-consuming
  way
  

4
Background

• Based on IUATLD/WHO recommended R R
  definitions
  
• Case Finding, Sputum Conversion, Treatment
  Outcome
  
• Allow TB program management at all levels
• Focus on district level
• Focus on usage of data
• Evolved to generic software adaptable to any
  country with a well functioning TB program, 1999
  
• Implemented in several countries in southern
  Africa
  
• Botswana, South Africa, Lesotho, Swaziland,
  Namibia, Tanzania, including Philippines and many
  unknown countries
  

5
System Description ETR.NET

• ETR.NET
• Successor to TBREG/ETR (BOTUSA)
• Developed in consultation with TB program
  managers
  
• Phased implementation in RSA
• Regional
• Botswana (Nov 2005)
• Tanzania scaling up quarterly since June 2006
• RSA based programming and support

6
System Architecture

• Development language Visual Basic.NET (updated
  to .NET v 2.0)
  
• Developed using an n-tier architecture, i.e.
  presentation, business, data access and DBMS
  layers
  
• Database MS Access and MS SQL Server (MSDE/SQL
  Server recommended at high volume levels)
  
• Designed using the Data Access Object Factory
  pattern (developing modules to access other
  database systems will not affect the rest of the
  functionality)

7
System Architecture

• ETR.NETs n-tier design also facilitates possible
  future extension to the web (for relevant
  features)
  
• ETR.NET Regional (Global) designed to be as
  flexible as possible (e.g. users can rename
  dropdown items and show/hide fields, etc.)
  customization for different countries (National
  Setup Wizard)

8
ETR.NET Data Model

• Can support a variety of functions, program
  monitoring and reporting
  
• Allows for data to be exported for OR in standard
  formats for further analysis in analytical and
  statistical packages
  
• Allows for, or can easily expand and support
  other languages (Fr, Port.)

9
ETR.NET Features

• Personalized access control (user/administrator)
• Data import from existing systems
• Add/edit/move facilities
• Enter/edit/search patient records
• Validations (data entry checks, listings)
• Data dispatch in XML

10
ETR.NET Features

• Archiving of data and cohort reports
• Sort and filter data
• Automatic report generation in HTML
• Graphs and Maps
• Secure and encrypted database
• Application Updater patch

11
Security and confidentiality

• Database
• MS Access security features (e.g. database
  password and workgroup administration security)
  
• Custom developed features on top of Access
  security include 256 bit Rijndael encryption
  algorithm
  
• GUID last user, date, time that recorded was
  edited  
  
• Software login
• Assigning user permissions (DEL, HL) and login
  functionality
  
• User types administrator, user, and user with
  HIV permissions
  
• Backups and dispatches
• Created in XML, compressed encrypted (Rijndael
  encryption)
  
• HIV data
• Various levels of access to either enter, view
  patient-level data vs aggregate reports only
  
• Other
• Data checks/listings which display patient
  identifiers are deleted when the application is
  closed

12
Structure and information flow
13
Status of implementation
South Africa- all nine provinces
200 installations (sub-districts, regional,
provinces, national) 1000 000 records in active
dataset (national) HIV components still in assess
ment phase in limited areas Botswana- 24 district
s Tanzania- 8 regions Philippines (MMC Phil C
AT), Swaziland, Namibia, Lesotho- Q1 2007
14
HIV surveillance in ETR.NET
Implementation of Comprehensive Plan offers
renewed impetus to accelerate VCT and access to
HIV services for TB patients ETR.NET process is o
pportune time to integrate HIV data elements into
software Challenge HIV test data has not been pa
rt of routine collection in many countries
TB/HIV surveillance module piloted in RSA, tools
for R R are being revised Implemented in Botswa
na (routine policy on HIV testing)
Implemented in Tanzania Co-developed in Philippin
es
15
TB/HIV Surveillance data elements
16
Adapting ETR.NET

• National Setup Wizard (v 1.0.6)
• Set-up Login Screen Details
• Set-up Lookup Items
• Set-up Available Fields/
• Features
• Set-up Facility Tree
• Set-up Captions

17
Set-up Login Screen Details

• Allows for customization of country logo
• Insert contact details of TB program manager
• Insert contact details of TB Data Manager
• Information for user support, technical
  enquiries, and development support

18
Set-up Lookup Items

• Allows in-country customization of a choice of
  data variables
  
• Allows customization of dropdown combo boxes

19
Set-up Available Fields/Features

• Allows country to select from a list, different
  options for TB/HIV collaborative activities (HIV
  testing, ART, CPT, IPT)
  
• Allows data entry screen to display selected data
  elements, password protected with user access

20
Set-up Facility Tree

• Allows country to set-up reporting hierarchy (5
  levels)
  
• Levels link by GUIDs instead of codes
• Validation for duplicate facility
• Facility level data includes contact details
  (useful when patient is transferred out)
  
• Facility can be decommissioned (data not deleted)

21
Set-up Caption

• Allows customization of 3 optional data
  variables
  
• Data labels are renamed according to user
  preference

22
Summary
E-systems such as ETR.Net can be valuable tools
to collect and analyze TB and TB/HIV surveillance
data to monitor basic program management performa
nce as well as the expansion of HIV services for
TB patients ETR.Net offer flexibility to enhance
analysis as TB and TB/HIV care evolves
ETR.Net is not a Gold Standard, require lots of
work (esp data analysis/use), but increase
accountability for full outcome reporting
Sufficient human resources at district level are
a prerequisite to realise the benefits of this
tool. Continuing and ongoing dialogue among int
l and country partners will be useful to guide
future developments
23
Acknowledgments

• CDC/GAP Atlanta
• (William Coggin, Charles Wells)
• South Africa NTP (Carina Idema )
• Wamtechnology (Paul Maree, Stefan Buys, Tom
  Welch)
  
• BOTUSA Project (CDC Botswana)
• MRC (Chris Seebregts)

24
For further enquiries

• ETR.NET_at_sa.cdc.gov

25
Thank you
26
Live Demonstration

• ETR.NET Overview of National Setup Wizard
• Date Saturday 4 November 2006
• Room 326/327 M
• Time 14H00-16H15