Cambodia has made tremendous progress in reducing the Tuberculosis (TB) incidence. Though it is still on the global watchlist to monitor regularly, Cambodia is no longer in the top 30 countries with the highest TB burden. Yet according to the Center for Tuberculosis and Leprosy Control (CENAT) Annual Report 2021, despite these recent improvements, the number of undiagnosed cases remains high, with one-third of total incidence cases undetected. Reasons for this include accessibility challenges to World Health Organization (WHO) recommended diagnostics, reliance on chest X-ray (CXR) and low sensitivity diagnostic tests such as smear microscopy. Additionally, Cambodia relies on a paper-based reporting system which makes it difficult to monitor performance and ensure timely collection, analysis, and use of data for decision making. Though 107 GeneXpert (GX) instruments are installed at various laboratory levels for rapid TB and rifampicin resistance TB (RR-TB) diagnosis, without a connectivity solution, reporting and treatment delays persist, as does difficulties to monitor the equipment.
To address this reporting and data management issue, the United States Agency for International Development (USAID)-funded Infectious Disease Detection and Surveillance (IDDS) project supported the CENAT to initiate a pilot to connect GX instruments through a solution called DataToCare (DTC). DTC software is developed by Savics, Belgium, to connect GX or other diagnostic equipment for automated reporting, generate a dashboard to monitor the equipment functionality, and access real-time data.
The IDDS project worked closely with CENAT and Community Mobilization Initiative to End Tuberculosis (COMMIT) to identify 10 existing GX instruments sites to pilot the DTC solution. As of February 2022, the DTC software was successfully installed and connected to the 10 GX instruments which allows administrators at CENAT to access TB diagnostic data and instrument functionality over the web in real-time. This helps CENAT staff monitor and analyze routine results and standard performance quality indicators at all levels. Additionally, the logistic module of DTC and dashboard makes the management of GX cartridges logistics simple.
A series of trainings on the proper use of DTC were conducted in February for all laboratory technicians in the supported operational districts (ODs). To ensure a collaborative process, the provincial TB supervisors, OD TB supervisors, and referral hospital directors were engaged and trained. Additionally, 14 “super-users” from CENAT, IDDS, and COMMIT were identified and trained on the use of DTC, software installation, troubleshooting, and how to conduct further training for the end-users as necessary, even after the conclusion of the IDDS project.
While simple in practice, the DTC connectivity solution can greatly improve the capacity of provincial and national leaders to generate and use the data collected to monitor and respond to real-time TB diagnosis trends in Cambodia. With the initial success of the pilot, CENAT indicated the desire to expand this connectivity to all GX sites.
How does DataToCare work?
This content was produced with the support of the United States Agency for International Development (USAID), Global Health under the terms of the Infectious Disease Detection and Surveillance contract GS00Q14OADU119. Views expressed are not necessarily those of USAID or the United States government.
1 World Health Organization (WHO) Global Lists of High Burden Countries for TB, MDR/RR-TB and TB/HIV, 2021-2025; April 2021 (final version).