Application of Biometrics / SmartCard Technology for A nti- R etroviral T herapy (ART) in South Africa John Wilson & Rovaro Bayard JSI South Africa S ecure T echnology A dvancing T reatment
THE OPERATIONAL PLAN FOR COMPREHENSIVE HIV AND AIDS CARE, MANAGEMENT AND TREATMENT FOR SOUTH AFRICA – November 2003 JSI requested by NDOH Chief Director to survey what systems are available in South Africa that can help with the ARV roll-out, especially in terms of Logistics, Patient Information Systems and Program Monitoring
CRITICAL REQUIREMENTS: Must be attractive to clinicians and healthcare workers Capable of tracking drug distribution to end user Will generate NDOH / Emergency Plan indicators (2-7-10) Confidentiality Authentication / Verification Data Security Responsive to the very high mobility of South Africans Can operate in an off-line environment (community outreach)
FINDINGS: Of the 9 systems reviewed that are currently in use in 6 Provinces of South Africa only 1 system is sufficiently responsive to the mobility issue, and can operate off-line in community outreach settings NET1 Biometrics / Smart Card system used for dispensing more than 4 million pensions and social grants in 6 Provinces (began 1999), which seemed to have applicability in an ART setting
NET1 UEPS system for pension payout More than 4 million pensions & social grants dispensed using SmartCard/ Biometrics in 6 South African Provinces since 1999; This indicated potential applicability to ART in overcoming challenges. Pensioners receiving payouts from mobile unit
STAT System Development Phase 1: Conceptual Framework Phase 2: Proof of Concept Phase 3: Systems Development in Clinical ART Settings Phase 4: Live Implementation in Diverse Field-Test Sites
JSI Partners Developing Biometric / Smartcard Solution for Patient Information and Drug Stock Control System
STAT System for ART Based on existing RSA Biometrics and Smartcard technology ART patients retain their cards Healthcare workers have their own cards Cards hold 64Kb of data in 255 data wallets.
Provider can print prescription, sign and store in patient folder How STAT works in practice: Patient ART Center Visit/Home Visit Script Rx Script Rx Providers STAT Card Coded data entry: Symptoms Weight Lab results Prescription Patients STAT Card Provider enters codes for drugs prescribed, gives drugs to patient and returns STAT Card Alternatively, if pharmacy available…
ARVs Dispensed in Pharmacy Pharmacists STAT Card Patients STAT Card Pharmacist dispenses drugs as prescribed and recorded on patient card Pharmacist gives drugs to patient, returns Patients STAT card Script Rx Script Rx OPTIONAL: Patient gives prescription to pharmacist
Data Batch Upload to STAT Reporting Database Encrypted Data on Service Provider STAT cards uploaded to Net1 Switch by dialup or broadband at end of day Providers & Pharmacists STAT Cards Data from Net 1 FTPd to JSI STAT Reporting database server
Features of the STAT System Patients can use their card at any STAT ART center; Ideal for home visits - Battery operated and portable STAT system functions off-line, with upload of data to central database at end of day; JSI STAT central database runs on Microsoft SQL relational database, hosted on a MS-SQL Server incorporating SQL Reporting Services; Able to accurately record facility-level ARV inventory.
Only the owner or proxy in exceptional circumstances of the STAT card can use it to obtain treatment; without = X Patients cannot receive more than the appropriate amount of drugs in any month; Potential ARV leakage at ART centers minimized due to higher level of accountability through use of provider STAT cards.
Electricity/phone line available availability: Since card readers powered by rechargeable batteries, no electricity required during home visiting; Battery pack allows estimated 320 patient interactions on single charge; Patient visits at ART centers can continue during power outages; No need for constant online connection – dialup and upload at end of day only.
ARV inventory control, security, & data management: Incoming drugs entered on pharmacists STAT card and deducted from inventory on hand as drugs dispensed to patients; ARV stock status uploaded daily to national STAT database; Precise consumption data generated to enable accurate forecasting; Supervisors can check physical inventories against up-to- date stock status data.
Verifying Private Provider Billing: Private practitioners can claim payment made through data uploaded through Net 1 switch; Eliminates need for paper billing.
STAT Implementation (FY 04 PEPFAR COP) Currently live field testing in Hospital, Static Clinic & Community outreach environments ( Target 2500 on ART, 4000 on Care and Support) Uplink to STAT central database went live April 8, 2005
By end FY 05 funding, 5,700 patients on ARV's plus 38,000 patients on care and support utilizing STAT in 23 CRS/SACBC sites in 8 of 9 provinces In addition, as appropriate, public sector sites in provinces (so far 4 provincial sites Testing of STAT Drug Inventory Module Development of TB, Pediatric, and Nutrition modules Planned Implementation of STAT per FY 05 COP
SmartCard/Biometrics Readers Portable, rechargeable battery operated card readers; Patient and provider cards inserted in card reader; Built-in fingerprint scanner; LED screen to guide provider through treatment protocol; Numeric keypad for data entry.
Potential New Partners? Broadreach Aid for Aids Absolute Recovery for Kids (ARK) } Malawi (Malswitch Reserve Bank) Nigeria (FHI?) Private GP Service Providers Billing / Verification potential!!
Long Term Vision ?? LOGO ADVERTISEMENT The Patient-Retained Record System of Choice ? Reduced Shrinkage in Supply Chain Management Systems ??