E-DETECT partners have devised an app for use in the migrant screening process. 

Dr Lucia Barcellini of OSR and Valentina Marchese of UNIBS talk here about how the app was conceived and the results so far.

“One of the main challenges in TB screening activities among migrants is data recording and sharing.  As a part of D5.8- Development of an effective, digital recording tool for CPSA and CARA residents and in collaboration with Servizi Computerizzati srl (Catania), we realised a digital recording tool called the E-DETECT System. The use of a digital tool to perform active TB screening will allow for the standardisation of the TB screening practice, and the possibility to record and share all of the patients’ information using a common database.

“The E-DETECT App is a mHealth system which includes:

• A phone application: a touch screen icon-based application for Android smartphones designed and developed following the WHO guidelines for active TB and LTBI screening. The app is now available in English, and it is structured in five modules as follows:

1. A questionnaire including:
– Socio-demographic data, personal information, migration information
– Risk factors such as smoking, alcohol, intravenous drug use, diabetes and HIV
– TB symptoms (cough, fever, hemoptysis, night sweats, weight loss)
When one or more symptom is present, the application proposes the sputum collection, otherwise the operator can choose whether to continue for latent infection screening or to conclude the investigation.

2. Sputum collection: the data corresponding to each migrant can be retrieved by scanning the barcode or by searching the individual’s name. Once the sputum sample is collected and labelled it will be identifiable within the application by scanning the barcode. This procedure allows the retrieval of all data collected when the lab technicians process the sample.

3. Diagnostics:
– Xpert MTB/RIF ULTRA
– Xpert MTB/RIF
– Microscopy
– Culture
– Drug resistance
– X-Ray
This module allows one to registers the diagnostic tests performed in order to confirm or reject the diagnosis of TB disease.

4. Latent TB infection
– A questionnaire to confirm or change the screening location and to check for symptoms
– Tuberculin Skin Test
– QuantiFERON
– X-Ray

5. Treatment and follow-up
– Treatment (either active TB or LTBI)
– Treatment initiation and completion date
– Follow-up
– Outcome (treatment completed/failed or lost to follow-up)”

“At the end of the questionnaire all data collected is automatically wirelessly transmitted to the Medical Unit. In the absence of cellular network coverage, it is still possible to use the application and store the data locally until an area with network coverage is reached. The phone then automatically synchronizes and sends the details of the questionnaire to the medical unit within the referral hospital.

• The Medical Unit is a java-based software system hosted inside a referral hospital. The system receives all the information registered by the phone application during the visit and allows the clinical staff at the hospital to monitor the data collected.

• Data Exportation system. All data collected is directly exported into an excel database for scientific and epidemiological purposes.

“The mobile application was released at the end of December, whilst the Data Back-office was published in February.  Since March 2017, EDT staff have been using the EDT App during active TB screening activities. To date, almost 1000 visits have been performed and recorded using the EDT App.

“All planned data can be directly extracted from the data back office and exported into an Excel database”.

“UNIBS hosts the decrypted database, which will be used for data analysis.  Hosting centres and health officers are participating by performing defined roles and responsibilities following each step of the cascade of screening and treatment.  This has been implemented despite there being no link with the national surveillance system (currently not present in Italy).  We are now advocating for the adoption of the system through a continuous dialogue with regional and national authorities once the project is completed.”