The AmbiCal Assist App for safe and correct administration of AmBisome

Wednesday, 12 December, 2018

Example screen shots from AmbiCal app

Challenge

AmBisome (liposomal amphotericin, donated by Gilead) is the first line treatment for VL in South Asia. AmBisome preparation involves several critical calculations: what dosage of drug to be given in a 50Kg man, or 10K child? How many vials to be used? How many drops per minutes to be maintained while giving infusion? With fewer cases being seen, a risk is posed that trained healthcare providers knowledge on these critical steps will diminish, resulting in unsafe and potentially severe patient outcomes. Even at present, with reasonable number of VL caseloads, healthcare providers need to refer to dosage charts or technical materials, which have been provided during the KalaCORE training.

Therefore, the AmbiCal application (app) was designed by the KalaCORE Asia team to address some of the major following challenges seen in the field:

  • The need for a user friendly, handy tool
  • The need to keep a hard copy of technical materials- which may get lost or torn off
  • The need to provide updated information – replacing all outdated job aids and hard copies takes time and money, any changes in the treatment guidelines can be confirmed through, regular application updates, easily downloaded on the phone.
  • The need to show multiple treatment pathways in a single app- such as treatment pathway for HIV-VL co-infection, or VL relapse. Since treatment protocols for these could be complex and different from the standard protocols, equipping the healthcare workers with easily accessible information tool, could be helpful and importantly may reduce chances of errors due to mis-calculations.
  • The need for a training refresher prompt, so that any doubts the health care providers might experience, while preparing the infusion for AmBisome, can be clarified through a quick reference.

Result

The AmbiCal Assist is a simple yet useful and user friendly mobile application, developed to address the treatment challenges identified and to assist healthcare providers in charge of preparation and administration of single dose AmBisome, as well as in preparation of AmBisome for administration to HIV-VL co-infected patients. It can be used by all health care cadres across all settings. Compatible with android and iOs, it is freely available and is login based.

The main features include:

  • information on how to test a patient for VL and HIV-VL
  • suitable procedure based on whether the patient has VL or HIV-VL
  • calculation of the dosage
  • materials needed for administration

Currently, 164 health facilities in India are providing AmBisome treatment. To date, in the piloting phase, the AmbiCal app been was shared with a group of 22 professionals which includes doctors administering AmBisome treatment, nurses in health facilities, monitors and state representatives for the purpose of pre-testing. Feedback from the pilot was incorporated into the app and has been submitted to the National Vector Borne Disease Control Programme for approval. Upon approval, the app will be provided to the health staff in all these facilities.

Nepal and Bangladesh are eager to have their own AmbiCal app in order to address the similar challenges their healthcare providers experience so KalaCORE is looking at how to finance and roll those out.

Field staff using the app in Patna, Bihar.