Remote monitoring of Xpert® MTB/RIF testing in Mozambique: results of programmatic implementation of GxAlert

SETTING: Electronic diagnostic tests, such as the Xpert (R) MTB/RIF assay, are being implemented in low- and middle-income countries (LMICs). However, timely information from these tests available via remote monitoring is underutilized. The failure to transmit real-time, actionable data to key individuals such as clinicians, patients, and national monitoring and evaluation teams may negatively impact patient care. OBJECTIVE: To describe recently developed applications that allow for real-time, remote monitoring of Xpert results, and initial implementation of one of these products in central Mozambique. DESIGN: In partnership with the Mozambican National Tuberculosis Program, we compared three different remote monitoring tools for Xpert and selected one, GxAlert, to pilot and evaluate at five public health centers in Mozambique. RESULTS: GxAlert software was successfully installed on all five Xpert computers, and test results are now uploaded daily via a USB internet modem to a secure online database. A password-protected web-based interface allows real-time analysis of test results, and 1200 positive tests for tuberculosis generated 8000 SMS result notifications to key individuals. CONCLUSION: Remote monitoring of diagnostic platforms is feasible in LMICs. While promising, this effort needs to address issues around patient data ownership, confidentiality, interoperability, unique patient identifiers, and data security.