The Ambical App - safe and correct administration of AmBisome

Wednesday, 3 October, 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  • The need to provide updated information – replacing all outdated job aids and hard copies takes time and money, any changes in the treatment guidelines can be confirmed through, regular application updates, easily downloaded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 very 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. A simple and yet very useful application, 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; the suitable procedure based on whether the patient has VL or HIV-VL; calculation of the dosage; and the materials needed for administration.

To date in the piloting phase, the Ambical app has been 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. 

154 health facilities in India are providing Ambisome treatment, so following the pretesting and pilot, 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.