TT Tracker

Trachoma is the world’s leading infectious cause of blindness, and is part of a group of conditions known as neglected tropical diseases (often referred to as NTDs). The disease thrives where there are water shortages, poor sanitation and infestations of flies. Trachoma is caused by repeated infection with bacteria known as ‘chlamydia trachomatis’, and it spreads through contact with infected flies and via hands, clothes or bedding that have been in contact with an infected person.
Over time the infection causes scarring to the eyelid that pulls the eyelashes inward, so with every blink they scrape against the eye. This advanced form of trachoma is called trachomatous trichiasis (TT), and the pain can be so intense that many people resort to pulling out their eyelashes to reduce the agony of blinking. Over time, if left untreated, TT can lead to blindness.
The World Health Organization’s trachoma elimination strategy is summarized by the acronym SAFE, which means Surgery for advanced disease, Antibiotics to clear infection, Facial cleanliness and Environmental improvement to reduce transmission. The number of people requiring management for TT was estimated by the World Health Organization in 2019 to be 2.5 million. TT operations are generally conducted in remote areas, which can make it challenging to conduct follow-up visits and analyze surgical outcomes.
There are three major challenges in TT outreach which the TT Tracker addresses. The first is ensuring patient follow-up, especially at 3-6 months. Follow-up visits usually take place in villages where previously operated patients live, and not where the rural outreach camp was held. It has been historically challenging for country programs to know when each patient needs a follow-up visit and where they are, and to organize visits accordingly. The second challenge is understanding surgeon strengths and weaknesses. Audits are performed on some surgeons, but there is no consistently easy way to track their performance and know who needs additional supervision or training, or who should be promoted. Finally, paper data collection in very rural environments makes thorough and efficient reporting from field activities very challenging. The TT Tracker helps with data completeness and timeliness.

Surgical teams enter standardized patient information into electronic forms (mobile or tablet) at each stage in the patient’s journey:

Registration and evaluation.
Demographic information, diagnosis, intervention recommendations
Surgery. Details of operation, surgeon name, complications
Follow-up appointments (at 24-hours, 7-14 days, and 3-6 months). Full operation outcome assessment; recommended actions

The TT Tracker uses the information collected by surgeons and their assistants to generate useful real-time reports for supervisors at all levels:

Patient follow-up lists. All surgery patients are placed on follow-up lists based on the time period and these reports are electronically sent to supervisors detailing where and when follow-up must take place.
Surgical performance evaluation. Performance assessments for individual surgeons are compiled so supervisors understand their performance and can take action. Surgeons are also emailed personalised emailed performance reports.
Easy-to-access data visualizations. An online reporting tool, with data updated daily, allows programmes to use the data for decision making and to easily compile reports.

The application was built using CommCare, Metabase, Heroku and Mailgun technologies. The mobile app, online reports and training/support materials are available in English and French. All data are owned by Ministries of Health and the highest level of data privacy rules are put in place.
The TT Tracker is not just the technology but a full package including Data Manager support (configuration, data quality checks, reporting needs, preparation for outreach), the standard reports package (Surgery and Follow-up Completion, Outcome Assessments and Session Activities, Data Quality Assessment, Due for Follow-up Lists, Surgeon Performance Reports), data storage through a secure online platform, training, and user manuals.

Sightsavers has developed the application TT Tracker to help with these challenges. The TT Tracker is used as a reporting and programme management tool within already funded country trachoma elimination programs. This tool helps teams at national, regional, district and outreach level to collect, manage and use their program data.