CONTROL AND PREVENTION OF LEPROSY IN DIFFICULT TO REACH AREAS OF AMAZONAS, BRAZIL THROUGH TELEHEALTH TECHNOLOGY
Luiz Claúdio Dias, Valderiza Pedrosa, Leila Brasil, Maria Leide Wand-Del-Rey, York Lunau, Carolina Talhari
Alfredo da Matta Foundation, Manaus, Amazonas, Brazil Federal University of Rio de Janeiro, Rio de Janeiro, Brazil Novartis Foundation for Sustainable Development, Basel, Switzerland Acknowledgments
Adriana Raposo Maria de Fátima Maroja Alexandra Costa Nádia Pimentel Andrezza Nunes Nádia Picanço Carlos Alberto Chirano Roger Assis Emília Pereira Rossilene Cruz Hanna Pereira Valdenora Rodrigues Ione Freire Valdelina Pereira Jamile Izan Júnior Leandro Fortes Leila Brasil Maria Anete Queiroz Maria Angêla Torrecila Maria da Graça Cunha Leprosy prevalence rates, data reported to WHO - 2012
http://gamapserver.who.int/mapLibrary/app/searchResults.aspx http://http://www.ezilon.com/maps/south-america/brazil-maps.html New leprosy case detection in Amazonas, Manaus and other municipalities, 1989-2012
CountrysideCountryside
SINANET/GEP/Subinfort/Fundação Alfredo da Matta, Manaus Detection of new leprosy cases in Humaitá, Amazonas, Brazil
Local general practitioners
SINANET/GEP/Subinfort/Fundação Alfredo da Matta, Manaus Detection of new leprosy cases in Humaitá, Amazonas, Brazil
Local general practitioners Alfredo da Matta’s staff
SINANET/GEP/Subinfort/Fundação Alfredo da Matta, Manaus Detection of new leprosy cases in Novo Aripuanã, Amazonas, Brazil
SINANET/GEP/Subinfort/Fundação Alfredo da Matta, Manaus Average cost of theoretical course on leprosy for health workers from other municipalities in Manaus
2013
People trained 37 2
Course’s duration (days) 5
Accommodation ($) 39.00 20.00
Transportation ($) 161.50 960.00
Personal expenses ($) 42.50 52.00
TOTAL ($) per participant 569.00 2.640,00 Average cost of monitoring leprosy in difficult to reach municipalities in Amazonas State
Lábrea
2012 2013 Visit frequency Every two years Every 6 months Staff 5-7 2 Visit’s duration 7 days 5 days Accommodation ($) 20.00 20.00 Transportation ($) 960.00 960.00 Personal expenses ($) 32.00 52.00 Patients attended 300-400 people 80 people New leprosy cases 7 (during the year) 7 TOTAL ($) 7,220.00 – 10,108.00 2.640,00 CONTROL AND PREVENTION OF LEPROSY IN DIFFICULT TO REACH AREAS OF AMAZONAS, BRAZIL THROUGH TELEHEALTH TECHNOLOGY
CONTROL AND PREVENTION OF LEPROSY IN DIFFICULT TO REACH AREAS OF AMAZONAS, BRAZIL THROUGH TELEHEALTH TECHNOLOGY
. General objective: to control and prevent leprosy in difficult
to reach areas of Amazonas through telehealth technology
CONTROL AND PREVENTION OF LEPROSY IN DIFFICULT TO REACH AREAS OF AMAZONAS, BRAZIL THROUGH TELEHEALTH TECHNOLOGY
. Specific objective: Train health workers from Parintins and Labrea in telehealth technology
Theoretical training in leprosy for local health workers through telehealth technology Establishment of a virtual clinic
Monitoring activities
Leprosy patients NGO units foundation outside Manaus http://www.v-brazil.com/tourism/amazonas/map-amazonas.html MANAUS PARINTINS
LÁBREA PAHO’s referral center for the diagnosis and treatment of leprosy
Referral center for the diagnosis and treatment of leprosy in Brazil Brazilian program for leprosy control and prevention – Amazonas State Training in telehealth tecnology at Alfredo da Matta Foundation
Telehealth center in Labrea before project initiation Telehealth center in Labrea after project initiation
20 Training in telehealth tecnology at Labrea’s telehealth center Telehealth center Paritins after project initiation Training in telehealth tecnology at Parintins’s telehealth center Total number of health workers trained in telehealth technology in Parintins and Labrea since April 2013
Health workers Lábrea Parintins
Physician 2 8 Nurse 8 19 Physiotherapist 5 Social worker 4 Dentist 1 8 Health technician 3 3 Nutritionist 1 Health care 1 TOTAL 16 47 Theoretical course on leprosy for Labrea health workers Theoretical course on leprosy for Parintins health workers Theoretical training in leprosy
LEPROSY Clinical aspects Classification Diagnosis and treatment Leprosy reaction management Differential diagnosis Physical disabilities prevention and self-care Active case finding Social aspects of the disease Theoretical training in leprosy
LEPROSY Skin examination Clinical aspects of leprosy Treatment administration Physical disabilities prevention and self-care Active case finding Total number of health workers trained in leprosy through telehealth in Parintins and Labrea since April 2013 Dermatological consultation through telehealth to difficult to reach municipialities – a much needed help
Adriana Raposo, dermatologist Carla Ribas, dermatologist Carlos Chirano, dermatologist Carolina Talhari, dermatologist Luiz Cláudio, dermatologist Mônica Santos, dermatologist Nádya Picanço, dermatologist Patricia Morais, dermatologist Carolina Cunha, physician Emilia Pereira, nurse Anete Queiroz, nurse
30 Synchronous telehealth
Asynchronous Telehealth - Virtual clinic Parintins and Labrea
Monitoring&Evaluation the project in Lábrea and Parintins - August 2013
• Visit to 9 local health units
• Interview with the health workers trained in leprosy through telehealth technology
• Visit to rural communities with local health workers
• Local MORHAN (leprosy patients NGO) unit was implemented
• Local Self-care group was implemented
Total number of patients examined by Alfredo da Matta’s staff in Labrea during monitoring - August 2013
Lábrea
City area Lábrea river Dermatological examination 148 152 New leprosy cases 5 2
3 children
Average cost of theoretical course on leprosy for health workers from other municipalities in Manaus
2013 2013 Telehealth
People trained 37
Course’s duration (days) 5
Accommodation ($) 39.00
Transportation ($) 161.50
Personal expenses ($) 42.50
136
TOTAL ($) per participant 569.00 Comparison between the average cost of theoretical course on leprosy for health workers from other municipalities in Manaus and through telehealth technology 2013 2013 Telehealth
People trained 37 488
Course’s duration (days) 5
Accommodation ($) 39.00 -
Transportation ($) 161.50 -
Personal expenses ($) 42.50 -
Telehealth project investment 136,800
TOTAL ($) per participant 569.00 280.33 Average cost of leprosy monitoring in difficult to reach municipalities in Amazonas State
Lábrea
2012 2013 Visit frequency Every two years Every 6 months Staff 5-7 2 Visit’s duration 7 days 5 days Accommodation ($) 20.00 20.00 Transportation ($) 960.00 960.00 Personal expenses ($) 32.00 52.00 Patients attended 300-400 people 80 people New leprosy cases 7 (during the year) 7 TOTAL ($) 7,220.00 – 10,108.00 2.640,00 Comparison between the average cost of leprosy monitoring in difficult to reach municipalities in Amazonas State before and after telehealth technology implementation Lábrea
2012 2013 (wtih telehelath) Visit frequency Every two years Every 6 months Staff 5-7 2 Visit’s duration 7 days 5 days Accommodation ($) 20.00 20.00 Transportation ($) 960.00 960.00 Personal expenses ($) 32.00 32.00 Patients attended 300-400 people 80 people New leprosy cases 7 (during the year) 7 (during one week) TOTAL ($) 7,220.00 – 10,108.00 2.640,00 Low costs of leprosy monitoring&evaluation in difficult to reach municipalities of Amazonas with telehealth technology
• Visit frequency – less people at low costs
• staff and visit’s duration: theoretical courses on leprosy are performed through telehealth Pre-screening of patients made by local health workers Monitoring of epidemiological aspects are made through telehealth Virtual clinic
Positive aspects of the project in Parintins and Lábrea
• Local health workers became more aware of leprosy after training
• Active case finding were conducted by local health workers after training
• All primary health units are performing skin examination on a routine basis
• Identification of new cases of leprosy Positive aspects of the project in Parintins and Lábrea
• All equipment provided for telehealth are in its own room and in good condition
• Self-care groups were created both in Parintins and Labrea
Negative aspects of the project in Parintins and Labrea
• Poor internet connection quality in some municipalities
• Necessity of printed material for the theoretical courses on leprosy
• Health personnel turn-over necessity of a permanent training in leprosy
What else is possible through telehealth technology?
Secondary benefits… http://www.v-brazil.com/tourism/amazonas/map-amazonas.html
Number of health workers from indigenous area trained in leprosy through telehealth - 2013
INDIGENOUS PROFESSIONAL NUMBER OF HEALTH MUNICIPALITIES CATEGORY PARTICIPANTS DISTRICT Anamã, Autazes,Itacoatiara, Nova Olinda, Nurse 20 MANAUS Manacapuru, Rio Preto da Eva, Manaus, Manicoré, Manaquiri, Novo Airão Health technician 6 Physician 1 ALTO RIO Nurse 9 NEGRO São Gabriel da Cachoeira DSEI - ARN Pharmacist 1 Health technician 8 Nurse 23 ALTO RIO Tabatinga, Benjamin Constant, São Paulo de Social worker 1 SOLIMÕES Olivença, Amaturá DSEI - ARS Health technician 13 Laboratorial technician 1 Nurse 02 PARINTINS Parintins Health technician TOTAL:03 88 Videoconferences with health workers from indigenous area in São Gabriel da Cachoeira through telehealth - 2013
Professional Municipiality Participants categories Physician 4 Nurse 12 São Gabriel da Pharmacist 1 Cachoeira Psicologist 1 Health technician 22 Laboratory technician 2 TOTAL: 42 Specials groups for discussion:
Dermatology Leprosy
Acknowledgments