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Castaño RA, Granados MA, Trujillo N, Bernal JP, Trujillo JF, Trasmondi P, Maestre AF, Cardona JS, Gonzalez R, Larrarte MA, Hernandez DC, Barengo NC, Reynales H. Does performing a Point-Of-Care HbA1c test increase the chances of undertaking an OGTT among individuals at risk of diabetes? A randomized controlled trial. Prim Care Diabetes 2024:S1751-9918(24)00188-8. [PMID: 39313407 DOI: 10.1016/j.pcd.2024.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Revised: 08/20/2024] [Accepted: 09/12/2024] [Indexed: 09/25/2024]
Abstract
AIMS Early detection of type 2 diabetes mellitus is key to reducing micro and macrovascular complications associated with this disease. However, a lab-based process for diagnosis entails the risk of loss-to-follow-up. The objective of this study was to demonstrate if performing a point-of-care test of HbA1c immediately after a screening questionnaire will increase the proportion of individuals showing up for a lab-based confirmatory test as Point-of-care (POC) provides immediate availability, which is expected to reduce loss-to-follow-up. RESEARCH DESIGN AND METHODS This trial was a two-arm, randomized controlled, open-label study. Participants were recruited using the FINDRISC Score in a primary care and community setting. All 902 eligible participants were randomized into the intervention (n=511) and control (n=391) group. The intervention group was given information on healthy lifestyles, and a Point-of-care POC-HbA1c test was performed during the same visit. The control group was only given information on healthy lifestyles. Participants in both groups received a written prescription to have an oral glucose tolerance test (OGTT) performed within the next 30 days. Follow-up phone calls were made at 30 and 90 days to check if participant had undergone the test. The total duration of the intervention was 8 months. The posterior data analysis was made by using the Kolmogorov-Smirnoff test for the quantitative variables, and the descriptive statistics were expressed as means and standard deviation, or median and interquartile range 25 %-75 %, as appropriate. RESULTS At 30 days, 28 % of participants in the intervention group and 26.1 % in the control group undertook the OGTT (RD 1.90 %; 95 % CI -3.94; 7.73). At 90 days, 35.8 % of participants in the intervention group and 37.1 % in the control group undertook the OGTT. There was no statistically significant difference (RD - 3.17 %; 95 % CI -7.04; 0.70) between both groups. CONCLUSIONS The data suggest that performing a POC-HbA1c test after the FINDRISC did not increase the percentage of individuals showing up for the OGTT.
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Affiliation(s)
- Ramón A Castaño
- [UEB] Universidad El Bosque, Faculty of Medicine, Bogotá. Colombia
| | - Maria A Granados
- [CAIMED] Centro de Atención e Investigación Médica, Chía, Colombia
| | - Natalia Trujillo
- [CAIMED] Centro de Atención e Investigación Médica, Chía, Colombia
| | - Juan P Bernal
- [CAIMED] Centro de Atención e Investigación Médica, Chía, Colombia
| | - Juan F Trujillo
- [CAIMED] Centro de Atención e Investigación Médica, Chía, Colombia
| | | | - Angel F Maestre
- [CAIMED] Centro de Atención e Investigación Médica, Chía, Colombia.
| | - Juan S Cardona
- [CAIMED] Centro de Atención e Investigación Médica, Chía, Colombia
| | | | - María A Larrarte
- [CAIMED] Centro de Atención e Investigación Médica, Chía, Colombia
| | | | - Noël C Barengo
- [HWCM] Department of Medical Education, Herbert Wertheim College of Medicine, Florida International University, Miami, FL, USA; [UNMdP] Escuela Superior de Medicina, Universidad Nacional de Mar del Plata, Mar del Plata, Argentina
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Ofori B, Twum S, Nkansah Yeboah S, Ansah F, Amofa Nketia Sarpong K. Towards the development of cost-effective point-of-care diagnostic tools for poverty-related infectious diseases in sub-Saharan Africa. PeerJ 2024; 12:e17198. [PMID: 38915381 PMCID: PMC11195550 DOI: 10.7717/peerj.17198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Accepted: 03/14/2024] [Indexed: 06/26/2024] Open
Abstract
In this review, we examine the current landscape of point-of-care testing (POCT) diagnostic tools designed for poverty-related infectious diseases (PRIDs) in sub-Saharan Africa (sSA) while delineating key avenues for future advancements. Our analysis encompasses both established and emerging diagnostic methods for PRIDs, addressing the persistent challenges in POCT tool development and deployment, such as cost, accessibility, and reliability. We emphasize recent advancements in POCT diagnostic tools as well as platforms poised to enhance diagnostic testing in sSA. Recognizing the urgency for affordable and widely accessible POCT diagnostic tools to detect PRIDs in sSA, we advocate for a multidisciplinary approach. This approach integrates current and emerging diagnostic methods, explicitly addressing challenges hindering point-of-care (POC) tool development. Furthermore, it recognizes the profound impact of misdiagnosis on public and global health, emphasizing the need for effective tools. To facilitate the successful development and implementation of POCT diagnostic tools in sSA, we propose strategies including the creation of multi-analyte detection POCT tools, the implementation of education and training programs, community engagement initiatives, fostering public-private collaborations, and the establishment of reliable supply chains. Through these concerted efforts, we aim to accelerate the development of POCT in the sSA region, ensuring its effectiveness and accessibility in addressing the diagnostic challenges associated with PRIDs.
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Affiliation(s)
- Benedict Ofori
- West African Centre for Cell Biology of Infectious Pathogens, University of Ghana, Legon, Accra, Ghana
- Department of Biochemistry, Cell and Molecular Biology, College of Basic and Applied Sciences, University of Ghana, Legon, Accra, Ghana
| | - Seth Twum
- Department of Biochemistry, Cell and Molecular Biology, College of Basic and Applied Sciences, University of Ghana, Legon, Accra, Ghana
| | - Silas Nkansah Yeboah
- West African Centre for Cell Biology of Infectious Pathogens, University of Ghana, Legon, Accra, Ghana
- Department of Biochemistry, Cell and Molecular Biology, College of Basic and Applied Sciences, University of Ghana, Legon, Accra, Ghana
| | - Felix Ansah
- West African Centre for Cell Biology of Infectious Pathogens, University of Ghana, Legon, Accra, Ghana
- Department of Biochemistry, Cell and Molecular Biology, College of Basic and Applied Sciences, University of Ghana, Legon, Accra, Ghana
| | - Kwabena Amofa Nketia Sarpong
- West African Centre for Cell Biology of Infectious Pathogens, University of Ghana, Legon, Accra, Ghana
- Department of Biochemistry, Cell and Molecular Biology, College of Basic and Applied Sciences, University of Ghana, Legon, Accra, Ghana
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Chen J, Li Y, Chen J, Wang R, Lu M, Yu C. Miniature mass spectrometer-based point-of-care assay for quantification of metformin and sitagliptin in human blood and urine. Anal Bioanal Chem 2024; 416:3305-3312. [PMID: 38642098 DOI: 10.1007/s00216-024-05281-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Revised: 03/12/2024] [Accepted: 03/25/2024] [Indexed: 04/22/2024]
Abstract
Metformin (MET) and sitagliptin (STG) are widely used as the first-line and long-term oral hypoglycemic agents for managing type 2 diabetes mellitus (T2DM). However, the current lack of convenient and rapid measurement methods poses a challenge for individualized management. This study developed a point-of-care (POC) assay method utilizing a miniature mass spectrometer, enabling rapid and accurate quantification of MET and STG concentrations in human blood and urine. By combining the miniature mass spectrometer with paper spray ionization, this method simplifies the process into three to four steps, requires minimal amounts of bodily fluids (50 μL of blood and 2 μL of urine), and is able to obtain quantification results within approximately 2 min. Stable isotope-labeled internal standards were employed to enhance the accuracy and stability of measurement. The MS/MS responses exhibited good linear relationship with concentration, with relative standard deviations (RSDs) below 25%. It has the potential to provide immediate treatment feedback and decision support for patients and healthcare professionals in clinical practice.
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Affiliation(s)
- Jingying Chen
- Central Hospital Affiliated to Shandong First Medical University, Jinan, 250000, Shandong Province, China
| | - Yaohan Li
- Central Hospital Affiliated to Shandong First Medical University, Jinan, 250000, Shandong Province, China
| | - Jingjing Chen
- Central Hospital Affiliated to Shandong First Medical University, Jinan, 250000, Shandong Province, China
| | - Ruimin Wang
- Central Hospital Affiliated to Shandong First Medical University, Jinan, 250000, Shandong Province, China
| | - Miaoshan Lu
- Central Hospital Affiliated to Shandong First Medical University, Jinan, 250000, Shandong Province, China
| | - Changbin Yu
- Central Hospital Affiliated to Shandong First Medical University, Jinan, 250000, Shandong Province, China.
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Hauner A, Onwuchekwa C, Ariën KK. Sample-to-result molecular diagnostic platforms and their suitability for infectious disease testing in low- and middle-income countries. Expert Rev Mol Diagn 2024; 24:423-438. [PMID: 38747017 DOI: 10.1080/14737159.2024.2353690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Accepted: 05/07/2024] [Indexed: 05/22/2024]
Abstract
INTRODUCTION Diagnostics are an essential, undervalued part of the health-care system. For many diseases, molecular diagnostics are the gold standard, but are not easy to implement in Low- and Middle-Income Countries (LMIC). Sample-to-result (S2R) platforms combining all procedures in a closed system could offer a solution. In this paper, we investigated their suitability for implementation in LMIC. AREAS COVERED A scorecard was used to evaluate different platforms on a range of parameters. Most platforms scored fairly on the platform itself, ease-of-use and test consumables; however, shortcomings were identified in cost, distribution and test panels tailored to LMIC needs. The diagnostic coverage for common infectious diseases was found to have a wider coverage in high-income countries (HIC) than LMIC. A literature study showed that in LMIC, these platforms are mainly used as diagnostic tools or evaluation of diagnostic performance, with a minority assessing the operational characteristics or the clinical utility. In this narrative review, we identified various points for adaptation of S2R platforms to LMIC conditions. EXPERT OPINION For S2R platforms to be suitable for implementation in LMIC some modifications by the manufacturers could be considered. Furthermore, strengthening health systems and digitalization are vital; as are smaller, cheaper, faster, and sustainable technologies.
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Affiliation(s)
- Anne Hauner
- Virology Unit, Department of Biomedical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | | | - Kevin K Ariën
- Virology Unit, Department of Biomedical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
- Department of Biomedical Sciences, University of Antwerp, Antwerp, Belgium
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Stavelin A, Sandberg S. Analytical performance specifications and quality assurance of point-of-care testing in primary healthcare. Crit Rev Clin Lab Sci 2024; 61:164-177. [PMID: 37779370 DOI: 10.1080/10408363.2023.2262029] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 09/19/2023] [Indexed: 10/03/2023]
Abstract
Point-of-care testing (POCT) is the fastest-growing segment of laboratory medicine. This review focuses on the essential aspects of setting analytical performance specifications (APS) and performing quality assurance for POCT in primary healthcare. In-vitro diagnostic medical devices for POCT are typically small and easy to operate. Users often have little to no laboratory experience and may not necessarily see the value of conducting quality assurance on their devices. Therefore, training, guidance, and motivation should be integral parts of the total quality management system, as they are vital for managing errors and ensuring reliable results. It is common to believe that the analytical quality of POCT should be comparable to that of laboratory testing, and as a result, APS should be the same. This paper challenges this concept. The APS for POCT can often be less stringent compared to those used in a central laboratory because the requester is closer to both the analytical and clinical situation. Point-of-care instruments should be selected based on clinical needs, the required analytical quality and user-friendliness in the intended usage setting.Quality assurance should include both internal quality control (IQC) and external quality assessment (EQA). It is recommended that IQC protocols should be dependent on the complexity of the POCT device. A scoring system to determine how frequent IQC should be analyzed in primary healthcare on different types of POCT devices has been suggested. The main challenge in EQA for POCT involves using suitable control materials that reflect instrument performance on patient samples. Obtaining commutable control materials for POCT is difficult since the matrix often is whole blood. An essential aspect of EQA for POCT is that feedback reports should be easily interpretable. Users should receive advice from the EQA organizer regarding the root causes of deviating results. Quality assurance for POCT is not an easy task and presents numerous challenges. However, there is evidence that quality assurance improves the quality of POCT measurements and, consequently, can enhance patient outcomes.
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Affiliation(s)
- Anne Stavelin
- The Norwegian Organization for Quality Improvement of Laboratory Examinations (Noklus), Haraldsplass Diaconess Hospital, Bergen, Norway
| | - Sverre Sandberg
- The Norwegian Organization for Quality Improvement of Laboratory Examinations (Noklus), Haraldsplass Diaconess Hospital, Bergen, Norway
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
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Luttikhuis N, Wiebe KS. Analyzing SDG interlinkages: identifying trade-offs and synergies for a responsible innovation. SUSTAINABILITY SCIENCE 2023; 18:1-19. [PMID: 37363308 PMCID: PMC10214325 DOI: 10.1007/s11625-023-01336-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Accepted: 04/17/2023] [Indexed: 06/28/2023]
Abstract
This paper responds to recent calls to address the indivisible nature of the Sustainable Development Goal (SDG) framework and the related knowledge gap on how SDG targets interlink with each other. It examines how SDG targets interact in the context of a specific technology, point of care (PoC) microfluidics, and how this relates to the concept of responsible innovation (RI). The novel SDG interlinkages methodology developed here involves several steps to filter the relevant interlinkages and a focus group of experts for discussing these interlinkages. The main findings indicate that several social synergies occur when deploying PoC microfluidics, but that the environmental trade-offs may jeopardize the total progress toward the SDGs. More specifically, the environmental sacrifices (use of plastics and lack of recyclability) resulted in the product being cheaper and, thus, better accessible. This work suggests that attention should be given (and prioritized) to the use of renewable and recyclable materials without jeopardizing the accessibility of the product. This should minimize the identified trade-offs. These findings inform how analyzing SDG interlinkages relates to the responsibilities and dimensions of RI in several ways. First, analyzing SDG interlinkages helps to execute the governance responsibility by using the RI dimensions (anticipation, reflexivity, inclusion and responsiveness). Second, analyzing SDG interlinkages gives insights into if and how a technology relates to the do-good and avoid-harm responsibility. This is important to assess the responsiveness of the technology to ensure that the technology can become truly sustainable and leaves no one behind.
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Affiliation(s)
- Nikki Luttikhuis
- Sustainable Energy Technology, SINTEF, Torgarden, P.O. Box 4760, 7465 Trondheim, Norway
- Department of Industrial Economics and Technology Management, Norwegian University of Science and Technology (NTNU), 7491 Trondheim, Norway
| | - Kirsten S. Wiebe
- Sustainable Energy Technology, SINTEF, Torgarden, P.O. Box 4760, 7465 Trondheim, Norway
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Dally M, Amador JJ, Butler-Dawson J, Lopez-Pilarte D, Gero A, Krisher L, Cruz A, Pilloni D, Kupferman J, Friedman DJ, Griffin BR, Newman LS, Brooks DR. Point-of-Care Testing in Chronic Kidney Disease of Non-Traditional Origin: Considerations for Clinical, Epidemiological, and Health Surveillance Research and Practice. Ann Glob Health 2023; 89:7. [PMID: 36789382 PMCID: PMC9896998 DOI: 10.5334/aogh.3884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Accepted: 12/29/2022] [Indexed: 02/04/2023] Open
Abstract
Purpose As the prevalence of chronic kidney disease of non-traditional origin (CKDnt) rises in low-resource settings, there is a need for reliable point-of-care creatinine testing. The purpose of this analysis was to assess the accuracy of two commonly used point-of-care creatinine devices, the i-STAT handheld (Abbott, Princeton, NJ, USA) and the StatSensor Creatinine (Nova Biomedical, Waltham, MA, USA) in comparison to venipuncture serum creatinine measures. The affordability, sensitivity, specificity, ease of use, and other considerations for each device are also presented. Methods Three paired data sets were compared. We collected 213 paired i-STAT and venipuncture samples from a community study in Nicaragua in 2015-2016. We also collected 267 paired StatSensor Creatinine and venipuncture samples, including 158 from a community setting in Nicaragua in 2014-2015 and 109 from a Guatemala sugarcane worker cohort in 2017-2018. Pearson correlation coefficients, Bland-Altman plots, and no intercept linear regression models were used to assess agreement between point-of-care devices and blood samples. Results The i-STAT performed the most accurately, overestimating creatinine by 0.07 mg/dL (95% CI: 0.02, 0.12) with no evidence of proportional bias. The StatSensor Creatinine performed well at low levels of creatinine (Mean (SD): 0.87 (0.19)). Due to proportional bias, the StatSensor Creatinine performed worse in the Nicaragua community setting where creatinine values ranged from 0.31 to 7.04 mg/dL. Discussion Both devices provide acceptable sensitivity and specificity. Although adequate for routine surveillance, StatSensor Creatinine is less accurate as the values of measured creatinine increase, a consideration when using the point-of-care device for screening individuals at risk for CKDnt. Research, clinical, and screening objectives, cost, ease of use, and background prevalence of disease must all be carefully considered when selecting a point-of-care creatinine device. Conclusion POC testing can be more accessible in resource-limited settings. The selection of the appropriate device will depend on the use-case.
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Affiliation(s)
- Miranda Dally
- Center for Health, Work, & Environment, Colorado School of Public Health, University of Colorado, Aurora, CO
- Department of Environmental and Occupational Health, Colorado School of Public Health, University of Colorado, Aurora, CO
| | - Juan José Amador
- Department of Epidemiology, Boston University School of Public Health, Boston, MA
| | - Jaime Butler-Dawson
- Center for Health, Work, & Environment, Colorado School of Public Health, University of Colorado, Aurora, CO
- Department of Environmental and Occupational Health, Colorado School of Public Health, University of Colorado, Aurora, CO
| | | | - Alexandra Gero
- Department of Epidemiology, Boston University School of Public Health, Boston, MA
| | - Lyndsay Krisher
- Center for Health, Work, & Environment, Colorado School of Public Health, University of Colorado, Aurora, CO
- Department of Environmental and Occupational Health, Colorado School of Public Health, University of Colorado, Aurora, CO
| | - Alex Cruz
- Pantaleon, Guatemala City, Guatemala
| | | | - Joseph Kupferman
- Division of Nephrology, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
- Center for Vascular Biology Research, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - David J. Friedman
- Division of Nephrology, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
- Center for Vascular Biology Research, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | | | - Lee S. Newman
- Center for Health, Work, & Environment, Colorado School of Public Health, University of Colorado, Aurora, CO
- Department of Environmental and Occupational Health, Colorado School of Public Health, University of Colorado, Aurora, CO
- Division of Pulmonary Sciences and Critical Care Medicine, Department of Medicine, School of Medicine, University of Colorado, Aurora, CO
- Department of Epidemiology, Colorado School of Public Health, University of Colorado, Aurora, CO
| | - Daniel R. Brooks
- Department of Epidemiology, Boston University School of Public Health, Boston, MA
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McCloskey D, Semeere A, Ayanga R, Laker-Oketta M, Lukande R, Semakadde M, Kanyesigye M, Wenger M, LeBoit P, McCalmont T, Maurer T, Gardner A, Boza J, Cesarman E, Martin J, Erickson D. LAMP-enabled diagnosis of Kaposi's sarcoma for sub-Saharan Africa. SCIENCE ADVANCES 2023; 9:eadc8913. [PMID: 36638178 PMCID: PMC11318663 DOI: 10.1126/sciadv.adc8913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Accepted: 12/12/2022] [Indexed: 06/17/2023]
Abstract
Kaposi's sarcoma (KS) is an endothelial cancer caused by the Kaposi's sarcoma-associated herpesvirus (KSHV) and is one of the most common cancers in sub-Saharan Africa. In limited-resource settings, traditional pathology infrastructure is often insufficient for timely diagnosis, leading to frequent diagnoses at advanced-stage disease where survival is poor. In this study, we investigate molecular diagnosis of KS performed in a point-of-care device to circumvent the limited infrastructure for traditional diagnosis. Using 506 mucocutaneous biopsies collected from patients at three HIV clinics in Uganda, we achieved 97% sensitivity, 92% specificity, and 96% accuracy compared to gold standard U.S.-based pathology. The results presented in this manuscript show that LAMP-based quantification of KSHV DNA extracted from KS-suspected biopsies has the potential to serve as a successful diagnostic for the disease and that diagnosis may be accurately achieved using a point-of-care device, reducing the barriers to obtaining KS diagnosis while increasing diagnostic accuracy.
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Affiliation(s)
- Duncan McCloskey
- Meinig School of Biomedical Engineering, Cornell University, Ithaca, NY 14850, USA
| | - Aggrey Semeere
- Infectious Diseases Institute, Makerere University College of Health Sciences, Kampala, Uganda
| | - Racheal Ayanga
- Infectious Diseases Institute, Makerere University College of Health Sciences, Kampala, Uganda
| | - Miriam Laker-Oketta
- Infectious Diseases Institute, Makerere University College of Health Sciences, Kampala, Uganda
| | - Robert Lukande
- Pathology Department, Makerere University College of Health Sciences, Kampala, Uganda
| | | | - Micheal Kanyesigye
- Immune Suppression Syndrome Clinic, Mbarara Regional Referral Hospital, Mbarara, Uganda
| | - Megan Wenger
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA 94143, USA
| | - Philip LeBoit
- Pathology and Laboratory Medicine, University of California, San Francisco, San Francisco, CA 94143, USA
| | - Timothy McCalmont
- Pathology and Laboratory Medicine, University of California, San Francisco, San Francisco, CA 94143, USA
- Golden State Dermatology Dermatopathology, Walnut Creek, CA 94598, USA
| | - Toby Maurer
- Department of Dermatology, Indiana University School of Medicine, Indianapolis, IN 46202, USA
| | - Andrea Gardner
- Pathology and Laboratory Medicine, Weill Cornell Medical College; New York, NY, 10021, USA
| | - Juan Boza
- Meinig School of Biomedical Engineering, Cornell University, Ithaca, NY 14850, USA
| | - Ethel Cesarman
- Pathology and Laboratory Medicine, Weill Cornell Medical College; New York, NY, 10021, USA
| | - Jeffrey Martin
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA 94143, USA
| | - David Erickson
- Sibley School of Mechanical and Aerospace Engineering, Cornell University; Ithaca, NY, 14850, USA
- Division of Nutritional Science, Cornell University, Ithaca, NY 14850, USA
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Sreenan B, Lee B, Wan L, Zeng R, Zhao J, Zhu X. Review of Mn-Doped Semiconductor Nanocrystals for Time-Resolved Luminescence Biosensing/Imaging. ACS APPLIED NANO MATERIALS 2022; 5:17413-17435. [PMID: 36874078 PMCID: PMC9980291 DOI: 10.1021/acsanm.2c04337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
Colloidal semiconductor nanocrystals (NCs) have been developed for decades and are widely applied in biosensing/imaging. However, their biosensing/imaging applications are mainly based on luminescence-intensity measurement, which suffers from autofluorescence in complex biological samples and thus limits the biosensing/imaging sensitivities. It is expected for these NCs to be further developed to gain luminescence features that can overcome sample autofluorescence. On the other hand, time-resolved luminescence measurement utilizing long-lived-luminescence probes is an efficient technique to eliminate short-lived autofluorescence of samples while recording time-resolved luminescence of the probes for signal measurement after pulsed excitation from a light source. Despite time-resolved measurement being very sensitive, the optical limitations of many of the current long-lived-luminescence probes cause time-resolved measurement to be generally performed in laboratories with bulky and costly instruments. In order to apply highly sensitive time-resolved measurement for in-field or point-of-care (POC) testing, it is essential to develop probes possessing high brightness, low-energy (visible-light) excitation, and long lifetimes of up to milliseconds. Such desired optical features can significantly simplify the design criteria of time-resolved measurement instruments and facilitate the development of low-cost, compact, sensitive instruments for in-field or POC testing. Mn-doped NCs have recently been in rapid development and provide a strategy to solve the challenges faced by both colloidal semiconductor NCs and time-resolved luminescence measurement. In this review, we outline the major achievements in the development of Mn-doped binary and multinary NCs, with emphasis on their synthesis approaches and luminescence mechanisms. Specifically, we demonstrate how researchers approached these obstacles to achieve the aforementioned desired optical properties on the basis of the progressive understanding of Mn emission mechanisms. Afterward, we review representative applications of Mn-doped NCs in time-resolved luminescence biosensing/imaging and present the potential of Mn-doped NCs in advancing time-resolved luminescence biosensing/imaging for in-field or POC testing.
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Affiliation(s)
- Benjamin Sreenan
- Department of Electrical and Biomedical Engineering, University of Nevada-Reno, Reno, Nevada 89557, United States
| | - Bryan Lee
- Department of Electrical and Biomedical Engineering, University of Nevada-Reno, Reno, Nevada 89557, United States
| | - Li Wan
- Department of Physics, Wenzhou University, Wenzhou 325035, China
| | - Ruosheng Zeng
- School of Physical Science and Technology, Guangxi University, Nanning 530004, China
| | - Jialong Zhao
- School of Physical Science and Technology, Guangxi University, Nanning 530004, China
| | - Xiaoshan Zhu
- Department of Electrical and Biomedical Engineering, University of Nevada-Reno, Reno, Nevada 89557, United States
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Erasmus RT. Point-of-care testing: Connecting communities in Africa and ensuring equity in access to health and diagnostics. Afr J Lab Med 2022; 11:2072. [PMID: 36569336 PMCID: PMC9772737 DOI: 10.4102/ajlm.v11i1.2072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Affiliation(s)
- Rajiv T. Erasmus
- Department of Chemical Pathology, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
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Lingervelder D, Koffijberg H, Emery JD, Fennessy P, Price CP, van Marwijk H, Eide TB, Sandberg S, Cals JW, Derksen JT, Kusters R, IJzerman MJ. How to Realize the Benefits of Point-of-Care Testing at the General Practice: A Comparison of Four High-Income Countries. Int J Health Policy Manag 2022; 11:2248-2260. [PMID: 34814677 PMCID: PMC9808289 DOI: 10.34172/ijhpm.2021.143] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Accepted: 10/12/2021] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND In some countries, such as the Netherlands and Norway, point-of-care testing (POCT) is more widely implemented in general practice compared to countries such as England and Australia. To comprehend what is necessary to realize the benefits of POCT, regarding its integration in primary care, it would be beneficial to have an overview of the structure of healthcare operations and the transactions between stakeholders (also referred to as value networks). The aim of this paper is to identify the current value networks in place applying to POCT implementation at general practices in England, Australia, Norway and the Netherlands and to compare these networks in terms of seven previously published factors that support the successful implementation, sustainability and scale-up of innovations. METHODS The value networks were described based on formal guidelines and standards published by the respective governments, organizational bodies and affiliates. The value network of each country was validated by at least two relevant stakeholders from the respective country. RESULTS The analysis revealed that the biggest challenge for countries with low POCT uptake was the lack of effective communication between the several organizations involved with POCT as well as the high workload for general practitioners (GPs) aiming to implement POCT. It is observed that countries with a single national authority responsible for POCT have a better uptake as they can govern the task of POCT roll-out and management and reduce the workload for GPs by assisting with set-up, quality control, training and support. CONCLUSION Setting up a single national authority may be an effective step towards realizing the full benefits of POCT. Although it is possible for day-to-day operations to fall under the responsibility of the GP, this is only feasible if support and guidance are readily available to ensure that the workload associated with POCT is limited and as low as possible.
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Affiliation(s)
- Deon Lingervelder
- Health Technology and Services Research Department, Technical Medical Centre, University of Twente, Enschede, The Netherlands
| | - Hendrik Koffijberg
- Health Technology and Services Research Department, Technical Medical Centre, University of Twente, Enschede, The Netherlands
| | - Jon D. Emery
- Department of General Practice and Centre for Cancer Research, University of Melbourne, Melbourne, VIC, Australia
| | - Paul Fennessy
- Department of Health & Human Services, State Government of Victoria, Melbourne, VIC, Australia
| | - Christopher P. Price
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Harm van Marwijk
- Department of Primary Care and Public Health, Brighton and Sussex Medical School, University of Sussex, Falmer, UK
| | - Torunn B. Eide
- Department of General Practice, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Sverre Sandberg
- The Norwegian Organisation for Quality Improvement of Laboratory Examinations (NOKLUS), Haraldsplass Deaconess Hospital, Bergen, Norway
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
- Norwegian Porphyria Centre, Department of Medical Biochemistry and Pharmacology, Haukeland University Hospital, Bergen, Norway
| | - Jochen W.L. Cals
- Department of Family Medicine, CAPHRI School for Public Health and Primary Care, Maastricht University, Maastricht, The Netherlands
| | | | - Ron Kusters
- Health Technology and Services Research Department, Technical Medical Centre, University of Twente, Enschede, The Netherlands
- Laboratory for Clinical Chemistry and Haematology, Jeroen Bosch Hospital, ‘s-Hertogenbosch, The Netherlands
| | - Maarten J. IJzerman
- Health Technology and Services Research Department, Technical Medical Centre, University of Twente, Enschede, The Netherlands
- Cancer Health Services Research, School of Population and Global Health, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, VIC, Australia
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12
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Miniature mass spectrometer-based point-of-care assay for cabotegravir and rilpivirine in whole blood. Anal Bioanal Chem 2022; 414:3387-3395. [PMID: 35169905 PMCID: PMC9018536 DOI: 10.1007/s00216-022-03954-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Revised: 01/07/2022] [Accepted: 02/01/2022] [Indexed: 11/01/2022]
Abstract
HIV prevention and treatment with injectable cabotegravir and/or rilpivirine administered once every 4 to 8 weeks is an attractive alternative to daily therapy. Prescribed dosage and drug concentrations in plasma are based on patient data collected in clinical trials, but actual patients are expected to exhibit more variability in drug concentrations, which is important to quantify. Here, we demonstrate the first quantitative point-of-care assay with a miniature mass spectrometer to assess these drug concentrations in whole blood. Quantitative performance is obtained using paper spray ionization in combination with tandem mass spectrometry (MS/MS) in the clinically relevant concentration range of both drugs. Limits of quantitation (LoQs) of cabotegravir and rilpivirine are measured to be 750 ng/mL and 20 ng/mL, respectively. The assay turnaround time is < 4 min, and strong linear relationships are established between MS/MS responses and concentration, with percentage of relative standard deviations (RSDs) that are <15% at concentrations above the LoQs. The speed, portability, low power consumption, and specificity offered by the miniature instrument should make it an appropriate platform for measuring drug concentrations in a walk-in clinic using small volumes of patient blood.
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13
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Cao Y, Mo F, Liu Y, Liu Y, Li G, Yu W, Liu X. Portable and sensitive detection of non-glucose target by enzyme-encapsulated metal-organic-framework using personal glucose meter. Biosens Bioelectron 2022; 198:113819. [PMID: 34836711 DOI: 10.1016/j.bios.2021.113819] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Revised: 10/16/2021] [Accepted: 11/16/2021] [Indexed: 11/02/2022]
Abstract
Personal glucose meter (PGM) is one of the most commercially available POC (point-of-care) devices for monitoring the level of glucose reliably, yet its non-glucose quantification ability is limited since such strategy needs ingenious interface design and tedious enzyme conjugation. Herein, we constructed a portable and sensitive platform that can detect non-glucose target by combining enzyme-encapsulated zeolitic imidazole framework-90 (ZIF-90) with personal glucose meter. ZIF-90 is an ideal carrier and susceptor due to the extraordinary capability of packaging enzyme and stimuli-responsiveness. We selected adenosine-5'-triphosphate (ATP) as the target model of non-glucose analytes. Upon ATP-induced decomposition of MOF, the released enzyme (glucose oxidase or invertase) catalyzed substrate and gave rise to the change of the glucose concentration for PGM assay. This method determined ATP with a remarkably sensitivity of 233 nM and effective recovery in real serum samples. Our strategy provides a facile and practical approach for measuring the non-glucose target using PGM, and could potentially be applied in bimolecular detection in point-of-care diagnosis.
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Affiliation(s)
- Yunzhe Cao
- College of Chemistry and Molecular Sciences, Wuhan University, Wuhan, 430072, PR China
| | - Fengye Mo
- College of Chemistry and Molecular Sciences, Wuhan University, Wuhan, 430072, PR China
| | - Yahua Liu
- College of Chemistry and Molecular Sciences, Wuhan University, Wuhan, 430072, PR China; Animal, Plant and Foodstuffs Inspection Center of Tianjin Customs, Tianjin, 300461, PR China
| | - Yu Liu
- College of Chemistry and Molecular Sciences, Wuhan University, Wuhan, 430072, PR China
| | - Gaiping Li
- College of Chemistry and Molecular Sciences, Wuhan University, Wuhan, 430072, PR China; Department of Chemistry, Zhengzhou University, Zhengzhou, 450001, PR China
| | - Wenqian Yu
- College of Chemistry and Molecular Sciences, Wuhan University, Wuhan, 430072, PR China
| | - Xiaoqing Liu
- College of Chemistry and Molecular Sciences, Wuhan University, Wuhan, 430072, PR China.
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14
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Han GR, Jang H, Ki H, Lee H, Kim MG. Reagent Filming for Universal Point-of-Care Diagnostics. SMALL METHODS 2021; 5:e2100645. [PMID: 34928024 DOI: 10.1002/smtd.202100645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Revised: 09/14/2021] [Indexed: 06/14/2023]
Abstract
Simplifying assays while maintaining the robustness of reagents is a challenge in diagnostics. This problem is exacerbated when translating quality diagnostic assays to developing countries that lack resources and infrastructure such as trained health workers, high-end equipment, and cold-chain systems. To solve this problem, in this study, a simple solution that films assay reagents to simplify the operation of diagnostic assays and preserve the stability of diagnostic reagents without using cold chains is presented. A polyvinyl-alcohol-based water-soluble film is used to encapsulate premeasured and premixed reagents. The reagent film, produced through a simple and scalable cast-drying process, provides a glassy inner matrix with abundant hydroxyl groups that can stabilize various reagents (ranging from chemicals to biological materials) by restricting molecular mobility and generating hydrogen bonds. The reagent film is applied to an enzymatic glucose assay, a high-sensitivity immunoassay for cardiac troponin, and a molecular assay for viral RNA detection, to test its practicability and universal applicability. The film-based assays result in excellent analytical/diagnostic performance and stable long-term reagent storage at elevated temperatures (at 25 or 37 °C, for six months), demonstrating clinical readiness. This technology advances the development and distribution of affordable high-quality diagnostics to resource-limited regions.
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Affiliation(s)
- Gyeo-Re Han
- Department of Chemistry, School of Physics and Chemistry, Gwangju Institute of Science and Technology, 123 Cheomdangwagi-ro, Buk-gu, Gwangju, 61005, Republic of Korea
| | - Hyungjun Jang
- Department of Chemistry, School of Physics and Chemistry, Gwangju Institute of Science and Technology, 123 Cheomdangwagi-ro, Buk-gu, Gwangju, 61005, Republic of Korea
| | - Hangil Ki
- Department of Chemistry, School of Physics and Chemistry, Gwangju Institute of Science and Technology, 123 Cheomdangwagi-ro, Buk-gu, Gwangju, 61005, Republic of Korea
| | - Hoyeon Lee
- Department of Chemistry, School of Physics and Chemistry, Gwangju Institute of Science and Technology, 123 Cheomdangwagi-ro, Buk-gu, Gwangju, 61005, Republic of Korea
| | - Min-Gon Kim
- Department of Chemistry, School of Physics and Chemistry, Gwangju Institute of Science and Technology, 123 Cheomdangwagi-ro, Buk-gu, Gwangju, 61005, Republic of Korea
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15
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Lafferty L, Smith K, Causer L, Andrewartha K, Whiley D, Badman SG, Donovan B, Anderson L, Tangey A, Mak D, Maher L, Shephard M, Guy R. Scaling up sexually transmissible infections point-of-care testing in remote Aboriginal and Torres Strait Islander communities: healthcare workers' perceptions of the barriers and facilitators. Implement Sci Commun 2021; 2:127. [PMID: 34743760 PMCID: PMC8572571 DOI: 10.1186/s43058-021-00232-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Accepted: 10/26/2021] [Indexed: 11/30/2022] Open
Abstract
Background Sexually transmissible infections (STIs), such as gonorrhoea and chlamydia, are highly prevalent, particularly in remote Aboriginal and Torres Strait Islander communities in Australia. In these settings, due to distance to centralised laboratories, the return of laboratory test results can take a week or longer, and many young people do not receive treatment, or it is considerably delayed. Point-of-care testing (POCT) provides an opportunity for same day diagnosis and treatment. Molecular POC testing for STIs was available at 31 regional or remote primary health care clinic sites through the Test-Treat-And-GO (TANGO2) program. This qualitative study sought to identify barriers and facilitators to further scaling up STI POCT in remote Aboriginal communities within Australia. Methods A total of 15 healthcare workers (including nurses and Aboriginal health practitioners) and five managers (including clinic coordinators and practice managers) were recruited from remote health services involved in the TTANGO2 program to participate in semi-structured in-depth interviews. Health services’ clinics were purposively selected to include those with high or low STI POCT uptake. Personnel participants were selected via a hybrid approach including nomination by clinic managers and purposive sampling to include those in roles relevant to STI testing and treatment and those who had received TTANGO2 training for POCT technology. Milat’s scaling up guide informed the coding framework and analysis. Results Acceptability of STI POCT technology among healthcare workers and managers was predominantly influenced by self-efficacy and perceived effectiveness of POCT technology as well as perceptions of additional workload burden associated with POCT. Barriers to integration of STI POCT included retention of trained staff to conduct POCT. Patient reach (including strategies for patient engagement) was broadly considered an enabler for STI testing scale up using POCT technology. Conclusions Remote healthcare clinics should be supported by both program and clinic management throughout scaling up efforts to ensure broad acceptability of STI POCT as well as addressing local health systems’ issues and identifying and enhancing opportunities for patient engagement. Supplementary Information The online version contains supplementary material available at 10.1186/s43058-021-00232-8.
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Affiliation(s)
- Lise Lafferty
- The Kirby Institute, UNSW Sydney, Sydney, NSW, 2052, Australia. .,Centre for Social Research in Health, UNSW Sydney, Sydney, NSW, 2052, Australia.
| | - Kirsty Smith
- The Kirby Institute, UNSW Sydney, Sydney, NSW, 2052, Australia
| | - Louise Causer
- The Kirby Institute, UNSW Sydney, Sydney, NSW, 2052, Australia
| | - Kelly Andrewartha
- Flinders University International Centre for Point-of-Care Testing, Flinders University, Adelaide, SA, 5042, Australia
| | - David Whiley
- University of Queensland, Brisbane, QLD 4006, Australia
| | - Steven G Badman
- The Kirby Institute, UNSW Sydney, Sydney, NSW, 2052, Australia
| | - Basil Donovan
- The Kirby Institute, UNSW Sydney, Sydney, NSW, 2052, Australia
| | | | - Annie Tangey
- The Kirby Institute, UNSW Sydney, Sydney, NSW, 2052, Australia.,Ngaanyatjarra Health Service, Alice Springs, NT, 0870, Australia
| | - Donna Mak
- Department of Health, Western Australia, East Perth, WA, 6004, Australia.,School of Medicine, University of Notre Dame Australia, Fremantle, WA, 6160, Australia
| | - Lisa Maher
- The Kirby Institute, UNSW Sydney, Sydney, NSW, 2052, Australia.,Burnet Institute, Melbourne, VIC, 3004, Australia
| | - Mark Shephard
- Flinders University International Centre for Point-of-Care Testing, Flinders University, Adelaide, SA, 5042, Australia
| | - Rebecca Guy
- The Kirby Institute, UNSW Sydney, Sydney, NSW, 2052, Australia
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16
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Moore KJM, Cahill J, Aidelberg G, Aronoff R, Bektaş A, Bezdan D, Butler DJ, Chittur SV, Codyre M, Federici F, Tanner NA, Tighe SW, True R, Ware SB, Wyllie AL, Afshin EE, Bendesky A, Chang CB, Dela Rosa R, Elhaik E, Erickson D, Goldsborough AS, Grills G, Hadasch K, Hayden A, Her SY, Karl JA, Kim CH, Kriegel AJ, Kunstman T, Landau Z, Land K, Langhorst BW, Lindner AB, Mayer BE, McLaughlin LA, McLaughlin MT, Molloy J, Mozsary C, Nadler JL, D'Silva M, Ng D, O'Connor DH, Ongerth JE, Osuolale O, Pinharanda A, Plenker D, Ranjan R, Rosbash M, Rotem A, Segarra J, Schürer S, Sherrill-Mix S, Solo-Gabriele H, To S, Vogt MC, Yu AD, Mason CE. Loop-Mediated Isothermal Amplification Detection of SARS-CoV-2 and Myriad Other Applications. J Biomol Tech 2021; 32:228-275. [PMID: 35136384 PMCID: PMC8802757 DOI: 10.7171/jbt.21-3203-017] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
As the second year of the COVID-19 pandemic begins, it remains clear that a massive increase in the ability to test for SARS-CoV-2 infections in a myriad of settings is critical to controlling the pandemic and to preparing for future outbreaks. The current gold standard for molecular diagnostics is the polymerase chain reaction (PCR), but the extraordinary and unmet demand for testing in a variety of environments means that both complementary and supplementary testing solutions are still needed. This review highlights the role that loop-mediated isothermal amplification (LAMP) has had in filling this global testing need, providing a faster and easier means of testing, and what it can do for future applications, pathogens, and the preparation for future outbreaks. This review describes the current state of the art for research of LAMP-based SARS-CoV-2 testing, as well as its implications for other pathogens and testing. The authors represent the global LAMP (gLAMP) Consortium, an international research collective, which has regularly met to share their experiences on LAMP deployment and best practices; sections are devoted to all aspects of LAMP testing, including preanalytic sample processing, target amplification, and amplicon detection, then the hardware and software required for deployment are discussed, and finally, a summary of the current regulatory landscape is provided. Included as well are a series of first-person accounts of LAMP method development and deployment. The final discussion section provides the reader with a distillation of the most validated testing methods and their paths to implementation. This review also aims to provide practical information and insight for a range of audiences: for a research audience, to help accelerate research through sharing of best practices; for an implementation audience, to help get testing up and running quickly; and for a public health, clinical, and policy audience, to help convey the breadth of the effect that LAMP methods have to offer.
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Affiliation(s)
- Keith J M Moore
- School of Science and Engineering, Ateneo de Manila University, Quezon City 1108, Philippines
| | | | - Guy Aidelberg
- Université de Paris, INSERM U1284, Center for Research and Interdisciplinarity (CRI), 75006 Paris, France
- Just One Giant Lab, Centre de Recherches Interdisciplinaires (CRI), 75004 Paris, France
| | - Rachel Aronoff
- Just One Giant Lab, Centre de Recherches Interdisciplinaires (CRI), 75004 Paris, France
- Action for Genomic Integrity Through Research! (AGiR!), Lausanne, Switzerland
- Association Hackuarium, Lausanne, Switzerland
| | - Ali Bektaş
- Oakland Genomics Center, Oakland, CA 94609, USA
| | - Daniela Bezdan
- Institute of Medical Genetics and Applied Genomics, University of Tübingen, 72076 Tübingen, Germany
- NGS Competence Center Tübingen (NCCT), University of Tübingen, 72076 Tübingen, Germany
- Poppy Health, Inc, San Francisco, CA 94158, USA
- Institute of Medical Virology and Epidemiology of Viral Diseases, University Hospital, 72076 Tübingen, Germany
| | - Daniel J Butler
- Department of Physiology and Biophysics, Weill Cornell Medicine, New York, NY 10065, USA
- The HRH Prince Alwaleed Bin Talal Bin Abdulaziz Alsaud Institute for Computational Biomedicine, Weill Cornell Medicine, New York, NY 10065, USA
| | - Sridar V Chittur
- Center for Functional Genomics, Department of Biomedical Sciences, School of Public Health, University at Albany, State University of New York, Rensselaer, 12222, USA
| | - Martin Codyre
- GiantLeap Biotechnology Ltd, Wicklow A63 Kv91, Ireland
| | - Fernan Federici
- ANID, Millennium Science Initiative Program, Millennium Institute for Integrative Biology (iBio), Institute for Biological and Medical Engineering, Schools of Engineering, Biology and Medicine, Pontificia Universidad Católica de Chile, Santiago 8331150, Chile
| | | | | | - Randy True
- FloodLAMP Biotechnologies, San Carlos, CA 94070, USA
| | - Sarah B Ware
- Just One Giant Lab, Centre de Recherches Interdisciplinaires (CRI), 75004 Paris, France
- BioBlaze Community Bio Lab, 1800 W Hawthorne Ln, Ste J-1, West Chicago, IL 60185, USA
- Blossom Bio Lab, 1800 W Hawthorne Ln, Ste K-2, West Chicago, IL 60185, USA
| | - Anne L Wyllie
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT 06510, USA
| | - Evan E Afshin
- Department of Physiology and Biophysics, Weill Cornell Medicine, New York, NY 10065, USA
- The HRH Prince Alwaleed Bin Talal Bin Abdulaziz Alsaud Institute for Computational Biomedicine, Weill Cornell Medicine, New York, NY 10065, USA
- The WorldQuant Initiative for Quantitative Prediction, Weill Cornell Medicine, New York, NY 10065, USA
| | - Andres Bendesky
- Department of Ecology, Evolution and Environmental Biology, Columbia University, New York, NY 10027, USA
- Zuckerman Mind Brain Behavior Institute, Columbia University, New York, NY 10027, USA
| | - Connie B Chang
- Department of Chemical and Biological Engineering, Montana State University, Bozeman, 59717, USA
- Center for Biofilm Engineering, Montana State University, Bozeman, 59717, USA
| | - Richard Dela Rosa
- School of Science and Engineering, Ateneo de Manila University, Quezon City 1108, Philippines
| | - Eran Elhaik
- Department of Biology, Lund University, Sölvegatan 35, Lund, Sweden
| | - David Erickson
- Sibley School of Mechanical and Aerospace Engineering, Cornell University, Ithaca, NY 14850, USA
| | | | - George Grills
- Department of Microbiology, University of Pennsylvania, Philadelphia, 19104, USA
| | - Kathrin Hadasch
- Université de Paris, INSERM U1284, Center for Research and Interdisciplinarity (CRI), 75006 Paris, France
- Department of Biology, Membrane Biophysics, Technische Universität Darmstadt, 64289 Darmstadt, Germany
- Lab3 eV, Labspace Darmstadt, 64295 Darmstadt, Germany
- IANUS Verein für Friedensorientierte Technikgestaltung eV, 64289 Darmstadt, Germany
| | - Andrew Hayden
- Center for Functional Genomics, Department of Biomedical Sciences, School of Public Health, University at Albany, State University of New York, Rensselaer, 12222, USA
| | | | - Julie A Karl
- Department of Pathology and Laboratory Medicine, School of Medicine and Public Health, University of Wisconsin, Madison, Madison 53705, USA
| | | | | | | | - Zeph Landau
- Department of Computer Science, University of California, Berkeley, Berkeley, 94720, USA
| | - Kevin Land
- Mologic, Centre for Advanced Rapid Diagnostics, (CARD), Bedford Technology Park, Thurleigh MK44 2YA, England
- Department of Electrical, Electronic and Computer Engineering, University of Pretoria, 0028 Pretoria, South Africa
| | | | - Ariel B Lindner
- Université de Paris, INSERM U1284, Center for Research and Interdisciplinarity (CRI), 75006 Paris, France
| | - Benjamin E Mayer
- Department of Biology, Membrane Biophysics, Technische Universität Darmstadt, 64289 Darmstadt, Germany
- Lab3 eV, Labspace Darmstadt, 64295 Darmstadt, Germany
| | | | - Matthew T McLaughlin
- Department of Pathology and Laboratory Medicine, School of Medicine and Public Health, University of Wisconsin, Madison, Madison 53705, USA
| | - Jenny Molloy
- Department of Chemical Engineering and Biotechnology, University of Cambridge, Cambridge CB3 0AS, England
| | - Christopher Mozsary
- Department of Physiology and Biophysics, Weill Cornell Medicine, New York, NY 10065, USA
- The HRH Prince Alwaleed Bin Talal Bin Abdulaziz Alsaud Institute for Computational Biomedicine, Weill Cornell Medicine, New York, NY 10065, USA
| | - Jerry L Nadler
- Department of Pharmacology, New York Medical College, Valhalla, 10595, USA
| | - Melinee D'Silva
- Department of Pharmacology, New York Medical College, Valhalla, 10595, USA
| | - David Ng
- Zuckerman Mind Brain Behavior Institute, Columbia University, New York, NY 10027, USA
| | - David H O'Connor
- Department of Pathology and Laboratory Medicine, School of Medicine and Public Health, University of Wisconsin, Madison, Madison 53705, USA
| | - Jerry E Ongerth
- University of Wollongong, Environmental Engineering, Wollongong NSW 2522, Australia
| | - Olayinka Osuolale
- Applied Environmental Metagenomics and Infectious Diseases Research (AEMIDR), Department of Biological Sciences, Elizade University, Ilara Mokin, Nigeria
| | - Ana Pinharanda
- Department of Biological Sciences, Columbia University, New York, NY 10027, USA
| | - Dennis Plenker
- Cold Spring Harbor Laboratory, Cold Spring Harbor, NY 11724, USA
| | - Ravi Ranjan
- Genomics Resource Laboratory, Institute for Applied Life Sciences, University of Massachusetts, Amherst, 01003, USA
| | - Michael Rosbash
- Howard Hughes Medical Institute and Department of Biology, Brandeis University, Waltham, MA 02453, USA
| | | | | | | | - Scott Sherrill-Mix
- Department of Microbiology, University of Pennsylvania, Philadelphia, 19104, USA
| | | | - Shaina To
- School of Science and Engineering, Ateneo de Manila University, Quezon City 1108, Philippines
| | - Merly C Vogt
- Department of Biological Sciences, Columbia University, New York, NY 10027, USA
| | - Albert D Yu
- Howard Hughes Medical Institute and Department of Biology, Brandeis University, Waltham, MA 02453, USA
| | - Christopher E Mason
- Department of Physiology and Biophysics, Weill Cornell Medicine, New York, NY 10065, USA
- The HRH Prince Alwaleed Bin Talal Bin Abdulaziz Alsaud Institute for Computational Biomedicine, Weill Cornell Medicine, New York, NY 10065, USA
- The WorldQuant Initiative for Quantitative Prediction, Weill Cornell Medicine, New York, NY 10065, USA
- The Feil Family Brain and Mind Research Institute, Weill Cornell Medicine, New York, NY 10065, USA
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17
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Zhang K, Wang J, Liu T, Luo Y, Loh XJ, Chen X. Machine Learning-Reinforced Noninvasive Biosensors for Healthcare. Adv Healthc Mater 2021; 10:e2100734. [PMID: 34165240 DOI: 10.1002/adhm.202100734] [Citation(s) in RCA: 44] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Revised: 06/06/2021] [Indexed: 12/12/2022]
Abstract
The emergence and development of noninvasive biosensors largely facilitate the collection of physiological signals and the processing of health-related data. The utilization of appropriate machine learning algorithms improves the accuracy and efficiency of biosensors. Machine learning-reinforced biosensors are started to use in clinical practice, health monitoring, and food safety, bringing a digital revolution in healthcare. Herein, the recent advances in machine learning-reinforced noninvasive biosensors applied in healthcare are summarized. First, different types of noninvasive biosensors and physiological signals collected are categorized and summarized. Then machine learning algorithms adopted in subsequent data processing are introduced and their practical applications in biosensors are reviewed. Finally, the challenges faced by machine learning-reinforced biosensors are raised, including data privacy and adaptive learning capability, and their prospects in real-time monitoring, out-of-clinic diagnosis, and onsite food safety detection are proposed.
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Affiliation(s)
- Kaiyi Zhang
- Innovative Center for Flexible Devices (iFLEX) Max Planck – NTU Joint Lab for Artificial Senses School of Materials Science and Engineering Nanyang Technological University 50 Nanyang Avenue Singapore 639798 Singapore
| | - Jianwu Wang
- Innovative Center for Flexible Devices (iFLEX) Max Planck – NTU Joint Lab for Artificial Senses School of Materials Science and Engineering Nanyang Technological University 50 Nanyang Avenue Singapore 639798 Singapore
| | - Tianyi Liu
- Innovative Center for Flexible Devices (iFLEX) Max Planck – NTU Joint Lab for Artificial Senses School of Materials Science and Engineering Nanyang Technological University 50 Nanyang Avenue Singapore 639798 Singapore
| | - Yifei Luo
- Innovative Center for Flexible Devices (iFLEX) Max Planck – NTU Joint Lab for Artificial Senses School of Materials Science and Engineering Nanyang Technological University 50 Nanyang Avenue Singapore 639798 Singapore
- Institute of Materials Research and Engineering Agency for Science, Technology and Research (A*STAR) 2 Fusionopolis Way, Innovis, #08‐03 Singapore 138634 Singapore
| | - Xian Jun Loh
- Institute of Materials Research and Engineering Agency for Science, Technology and Research (A*STAR) 2 Fusionopolis Way, Innovis, #08‐03 Singapore 138634 Singapore
| | - Xiaodong Chen
- Innovative Center for Flexible Devices (iFLEX) Max Planck – NTU Joint Lab for Artificial Senses School of Materials Science and Engineering Nanyang Technological University 50 Nanyang Avenue Singapore 639798 Singapore
- Institute of Materials Research and Engineering Agency for Science, Technology and Research (A*STAR) 2 Fusionopolis Way, Innovis, #08‐03 Singapore 138634 Singapore
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18
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Osaigbovo II, Bongomin F. Point of care tests for invasive fungal infections: a blueprint for increasing availability in Africa. Ther Adv Infect Dis 2021; 8:20499361211034266. [PMID: 34422265 PMCID: PMC8371725 DOI: 10.1177/20499361211034266] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Accepted: 07/05/2021] [Indexed: 01/17/2023] Open
Abstract
Invasive fungal infections (IFIs) such as cryptococcosis, disseminated histoplasmosis, and chronic pulmonary aspergillosis are significant causes of morbidity and mortality in Africa. Lack of laboratory infrastructure and laboratory personnel trained in diagnostic mycology hamper prompt detection and management of IFIs on the continent. Point-of-care tests (POCT) obviate the need for complex infrastructure, skilled technicians, and stable electricity and have had major impacts on the diagnosis of bacterial, viral, and parasitic infections in low- and middle-income countries. Over the last 10 years, POCTs for IFIs have become increasingly available and they have the potential to revolutionize the management of these infections if scaled up in Africa. At the beginning of 2021, the World Health Organization (WHO) Essential Diagnostic List (EDL) included a cryptococcal antigen test for the diagnosis of cryptococcosis, Histoplasma antigen test for the diagnosis of disseminated histoplasmosis, and Aspergillus-specific test for the diagnosis of chronic pulmonary aspergillosis. All of these are available in formats that may be used as POCTs and it is hoped that this will improve the diagnosis of these life-threatening IFIs, especially in low- and middle-income countries. This perspective review discusses commercially available POCTs and outlines strategies of a blueprint to achieve their roll-out in Africa. The strategies include raising awareness, conducting research that uncovers the exact burden of IFIs, increasing advocacy, integrating diagnosis of IFIs into existing public health programs, adoption of the WHO EDL at country levels, and improving logistics and supply chains.
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Affiliation(s)
- Iriagbonse Iyabo Osaigbovo
- Department of Medical Microbiology, School of Medicine, College of Medical Sciences, University of Benin, Benin City, Nigeria, Department of Medical Microbiology, University of Benin Teaching Hospital, Benin City, Nigeria
| | - Felix Bongomin
- Department of Medical Microbiology and Immunology, Faculty of Medicine, Gulu University, Gulu, Uganda
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Yadav S, Sharma NN, Akhtar J. Nucleic acid analysis on paper substrates (NAAPs): an innovative tool for Point of Care (POC) infectious disease diagnosis. Analyst 2021; 146:3422-3439. [PMID: 33904559 DOI: 10.1039/d1an00214g] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
The cost-effective rapid diagnosis of infectious diseases is an essential and important factor for curing such diseases in the global public health care picture. Owing to poor infrastructure and lack of sanitation, these diseases have an extreme impact on remote and rural areas, especially in developing countries, and there are unresolved challenges. Molecular diagnosis, such as nucleic acid analysis, plays a key role in the significant treatment of numerous infectious diseases. Current molecular diagnostic assays require a sophisticated laboratory setup with expensive components. Molecular diagnosis on a microfluidic point-of-care (POC) platform is attractive to researchers for disease detection with proper prevention. Compared to various microfluidic substrate materials, paper-based POC technologies offer significant cost-effective solutions over high-cost clinical instruments to fill the gap between the needs of users and affordability. Low-cost paper-based microfluidic POC technologies provide portable and disposable diagnostic systems for multiple disease detection that may be extremely useful in remote areas. This article presents a critical review of paper-based microfluidic device technology which has become an imminent platform to adjust the current health scenario for the detection of diseases using different stages of nucleic acid analysis, such as extraction, amplification and detection of nucleic acid, with future perspectives for paper substrates.
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Affiliation(s)
- Supriya Yadav
- Department of Biosciences, Manipal University Jaipur, 303007, Rajasthan, India.
| | - Niti Nipun Sharma
- Department of Mechanical Engineering, Manipal University Jaipur, 303007, Rajasthan, India.
| | - Jamil Akhtar
- Department of Electronics & Communication Engineering, Manipal University Jaipur, 303007, Rajasthan, India.
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20
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Stulens S, De Boeck K, Vandaele N. HIV supply chains in low- and middle-income countries: overview and research opportunities. JOURNAL OF HUMANITARIAN LOGISTICS AND SUPPLY CHAIN MANAGEMENT 2021. [DOI: 10.1108/jhlscm-08-2020-0072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PurposeDespite HIV being reported as one of the major global health issues, availability and accessibility of HIV services and supplies remain limited, especially in low- and middle-income countries. The effective and efficient operation of HIV supply chains is critical to tackle this problem. The purpose of this paper is to give an introduction to HIV supply chains in low- and middle-income countries and identify research opportunities for the operations research/operations management (OR/OM) community.Design/methodology/approachFirst, the authors review a combination of the scientific and grey literature, including both qualitative and quantitative papers, to give an overview of HIV supply chain operations in low- and middle-income countries and the challenges that are faced by organizing such supply chains. The authors then classify and discuss the relevant OR/OM literature based on seven classification criteria: decision level, methodology, type of HIV service modeled, challenges, performance measures, real-life applicability and countries covered. Because research on HIV supply chains in low- and middle-income countries is limited in the OR/OM field, this part also includes papers focusing on HIV supply chain modeling in high-income countries.FindingsThe authors conclude this study by identifying several tendencies and gaps and by proposing future research directions for OR/OM research.Originality/valueTo the best of the authors’ knowledge, this paper is the first literature review addressing this specific topic from an OR/OM perspective.
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21
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An innovative and user-friendly smartphone-assisted molecular diagnostic approach for rapid detection of canine vector-borne diseases. Parasitol Res 2021; 120:1799-1809. [PMID: 33649963 PMCID: PMC7920752 DOI: 10.1007/s00436-021-07077-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Accepted: 02/01/2021] [Indexed: 11/17/2022]
Abstract
Present-day diagnostic tools and technologies for canine diseases and other vector-borne parasitic diseases hardly meet the requirements of an efficient and rapid diagnostic tool, which can be suitable for use at the point-of-care in resource-limited settings. Loop-mediated isothermal amplification (LAMP) technique has been always a method of choice in the development and validation of quick, precise, and sensitive diagnostic assays for pathogen detection and to reorganize point-of-care (POC) molecular diagnostics. In this study, we have demonstrated an efficient detection system for parasitic vector-borne pathogens like Ehrlichia canis and Hepatozoon canis by linking the LAMP assay to a smartphone via a simple, inexpensive, and a portable “LAMP box,” All the components of the LAMP box were connected to each other wirelessly. This LAMP box was made up of an isothermal heating pad mounted below an aluminum base which served as a platform for the reaction tubes and LAMP assay. The entire setup could be connected to a smartphone via an inbuilt Wi-Fi that allowed the user to establish the connection to control the LAMP box. A 5 V USB power source was used as a power supply. The sensitivity of the LAMP assay was estimated to be up to 10−6 dilution limit using the amplified, purified, and quantified specific DNA templates. It can also serve as an efficient diagnostic platform for many other veterinary infectious or parasitic diseases of zoonotic origin majorly towards field-based diagnostics.
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22
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Dorward J, Sookrajh Y, Ngobese H, Lessells R, Sayed F, Bulo E, Moodley P, Samsunder N, Lewis L, Tonkin-Crine S, Drain PK, Hayward G, Butler CC, Garrett N. Protocol for a randomised feasibility study of Point-Of-care HIV viral load testing to Enhance Re-suppression in South Africa: the POwER study. BMJ Open 2021; 11:e045373. [PMID: 33593788 PMCID: PMC7888322 DOI: 10.1136/bmjopen-2020-045373] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Revised: 01/21/2021] [Accepted: 02/02/2021] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Access to HIV viral load testing remains difficult for many people on antiretroviral therapy (ART) in low-income and middle-income countries. Weak laboratory and clinic systems often delay the detection and management of viraemia, which can lead to morbidity, drug resistance and HIV transmission. Point-of-care testing could overcome these challenges. We aim to assess whether it is feasible to conduct a randomised trial of point-of-care viral load testing to manage viraemia. METHODS AND ANALYSIS We will conduct an open-label, single-site, individually randomised, feasibility study of Point-Of-care HIV viral load testing to Enhance Re-suppression, in Durban, South Africa. We will enrol approximately 100 people living with HIV who are aged ≥18 years, receiving first-line ART but with recent viraemia ≥1000 copies/mL, and randomise them 1:1 to receive point-of-care viral load or standard laboratory viral load monitoring, after 12 weeks. All participants will continue to receive care from public sector healthcare workers following South African HIV management guidelines. Participants with persistent viraemia ≥1000 copies/mL will be considered for switching to second-line ART. We will compare the proportion in each study arm who achieve the primary outcome of viral suppression <50 copies/mL at 24 weeks after enrolment. Additional outcomes include proportions retained in the study, proportions with HIV drug resistance, time to viral load results and time to switching to second-line ART. We will assess implementation of point-of-care viral load testing using process evaluation data, and through interviews and focus groups with healthcare workers. ETHICS AND DISSEMINATION University of Oxford Tropical Research Ethics Committee and the Biomedical Research Ethics Committee of the University of KwaZulu-Natal have approved the study. We will present results to stakeholders, and through conferences and open-access, peer-reviewed journals. TRIAL REGISTRATION NUMBER PACTR202001785886049.
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Affiliation(s)
- Jienchi Dorward
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
- Centre for the Aids Programme of Research in South Africa, University of KwaZulu-Natal, Durban, South Africa
| | | | - Hope Ngobese
- eThekwini Municipality Health Unit, Durban, South Africa
| | - Richard Lessells
- Centre for the Aids Programme of Research in South Africa, University of KwaZulu-Natal, Durban, South Africa
- KwaZulu-Natal Research and Innovation Sequencing Platform (KRISP), University of KwaZulu-Natal, Durban, South Africa
| | - Fathima Sayed
- Centre for the Aids Programme of Research in South Africa, University of KwaZulu-Natal, Durban, South Africa
| | - Elliot Bulo
- eThekwini Municipality Health Unit, Durban, South Africa
| | - P Moodley
- Department of Virology, University of KwaZulu-Natal, Durban, South Africa
- National Health Laboratory Service, Inkosi Albert Luthuli Central Hospital, Durban, South Africa
| | - Natasha Samsunder
- Centre for the Aids Programme of Research in South Africa, University of KwaZulu-Natal, Durban, South Africa
| | - Lara Lewis
- Centre for the Aids Programme of Research in South Africa, University of KwaZulu-Natal, Durban, South Africa
| | - Sarah Tonkin-Crine
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
- NIHR Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, University of Oxford, Oxford, UK
| | - Paul K Drain
- Department of Global Health, Schools of Medicine and Public Health, University of Washington, Seattle, Washington, USA
- Department of Medicine, School of Medicine, University of Washington, Seattle, Washington, USA
- Department of Epidemiology, School of Public Health, University of Washington, Seattle, Washington, USA
| | - Gail Hayward
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Christopher C Butler
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Nigel Garrett
- Centre for the Aids Programme of Research in South Africa, University of KwaZulu-Natal, Durban, South Africa
- Discipline of Public Health Medicine, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
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Alam N, Tong L, He Z, Tang R, Ahsan L, Ni Y. Improving the sensitivity of cellulose fiber-based lateral flow assay by incorporating a water-dissolvable polyvinyl alcohol dam. CELLULOSE (LONDON, ENGLAND) 2021; 28:8641-8651. [PMID: 34305338 PMCID: PMC8286161 DOI: 10.1007/s10570-021-04083-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Accepted: 07/12/2021] [Indexed: 05/09/2023]
Abstract
UNLABELLED Lateral flow assay (LFA) is an important point-of-care (POC) test platform due to the associated portability, on-site testing, and low cost for diagnosis of pathogen infections and disease biomarkers. However, compared to high-end analyzers in hospitals, LFA devices, in particular, paper- based LFA tests, fall short in accuracy. This study focuses on two ways to improve LFAs: (1) using cellulose fibers, rather than glass fibers for a sample pad, and (2) incorporating a one-step simple, facile, and low cost PVA dam into the LFA. Both strategies (cellulose fiber as a sample pad and water dissolvable PVA dam) contributed to delaying the controlled biomolecule's flow through the nitrocellulose membrane's capillary channels resulting in increased bio-recognition time, thus contributing to the enhancement of LFA sensitivity. PVA modified cellulose fiber-based LFA demonstrated 10 times higher sensitivity than the cellulose fiber-based unmodified LFA, whereas 2 times enhancement was obtained in the cellulose fiber-based sample pad LFA compared to the glass fiber-based sample pad LFA. Ultimately, 20 times increase in sensitivity was achieved in the modified LFA device. This study shows that PVA and eco-friendly cellulose fibers could be incorporated into other paper based POC testing devices for future development. SUPPLEMENTARY INFORMATION The online version contains supplementary material available at 10.1007/s10570-021-04083-3.
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Affiliation(s)
- Nur Alam
- Department of Chemical Engineering, University of New Brunswick, Fredericton, NB E3B 5A3 Canada
| | - Li Tong
- Department of Chemical Engineering, University of New Brunswick, Fredericton, NB E3B 5A3 Canada
| | - Zhibin He
- Department of Chemical Engineering, University of New Brunswick, Fredericton, NB E3B 5A3 Canada
| | - Ruihua Tang
- Department of Chemical Engineering, University of New Brunswick, Fredericton, NB E3B 5A3 Canada
- College of Bioresources Chemical and Materials Engineering, Shaanxi University of Science & Technology, Xi’an, 710021 People’s Republic of China
| | - Laboni Ahsan
- Labaid Ltd (Diagonestic and Reference Lab), Dhanmondi, Dhaka, Bangladesh
| | - Yonghao Ni
- Department of Chemical Engineering, University of New Brunswick, Fredericton, NB E3B 5A3 Canada
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Singh S, Dhawan A, Karhana S, Bhat M, Dinda AK. Quantum Dots: An Emerging Tool for Point-of-Care Testing. MICROMACHINES 2020; 11:E1058. [PMID: 33260478 PMCID: PMC7761335 DOI: 10.3390/mi11121058] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Revised: 10/09/2020] [Accepted: 10/13/2020] [Indexed: 01/03/2023]
Abstract
Quantum dots (QDs) are semiconductor crystals in the nanodimension having unique optical and electronic properties that differ from bulk material due to quantum mechanics. The QDs have a narrow emission peak, size-dependent emission wavelength, and broad excitation range which can be utilized for diverse biomedical applications such as molecular imaging, biosensing, and diagnostic systems. This article reviews the current developments of biomedical applications of QDs with special reference to point-of-care testing.
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Affiliation(s)
| | | | | | | | - Amit Kumar Dinda
- Department of Pathology, All India Institute of Medical Sciences, New Delhi 110029, India; (S.S.); (A.D.); (S.K.); (M.B.)
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Abstract
Biological signaling pathways are underpinned by protein switches that sense and respond to molecular inputs. Inspired by nature, engineered protein switches have been designed to directly transduce analyte binding into a quantitative signal in a simple, wash-free, homogeneous assay format. As such, they offer great potential to underpin point-of-need diagnostics that are needed across broad sectors to improve access, costs, and speed compared to laboratory assays. Despite this, protein switch assays are not yet in routine diagnostic use, and a number of barriers to uptake must be overcome to realize this potential. Here, we review the opportunities and challenges in engineering protein switches for rapid diagnostic tests. We evaluate how their design, comprising a recognition element, reporter, and switching mechanism, relates to performance and identify areas for improvement to guide further optimization. Recent modular switches that enable new analytes to be targeted without redesign are crucial to ensure robust and efficient development processes. The importance of translational steps toward practical implementation, including integration into a user-friendly device and thorough assay validation, is also discussed.
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Affiliation(s)
- Hope Adamson
- School of Biomedical Sciences, University of Leeds, Leeds LS2 9JT, United Kingdom
| | - Lars J. C. Jeuken
- School of Biomedical Sciences, University of Leeds, Leeds LS2 9JT, United Kingdom
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26
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Han GR, Koo HJ, Ki H, Kim MG. Paper/Soluble Polymer Hybrid-Based Lateral Flow Biosensing Platform for High-Performance Point-of-Care Testing. ACS APPLIED MATERIALS & INTERFACES 2020; 12:34564-34575. [PMID: 32666783 DOI: 10.1021/acsami.0c07893] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/20/2023]
Abstract
As a global shift continues to occur in high burden diseases toward developing countries, the importance of medical diagnostics based on point-of-care testing (POCT) is rapidly increasing. However, most diagnostic tests that meet clinical standards rely on high-end analyzers in central hospitals. Here, we report the development of a simple, low-cost, mass-producible, highly sensitive/quantitative, automated, and robust paper/soluble polymer hybrid-based lateral flow biosensing platform, paired with a smartphone-based reader, for high-performance POCT. The testing architecture incorporates a polymeric barrier that programs/automates sequential reactions via a polymer dissolving mechanism. The smartphone-based reader with simple opto-mechanical parts offers a stable framework for accurate quantification. Analytical performance of this platform was evaluated by testing human cardiac troponin I (cTnI), a preferred biomarker for the diagnosis of myocardial infarction, in serum/plasma samples. Coupled with catalytic/colorimetric gold-ion amplification, this platform produced results within 20 min with a detection limit of 0.92 pg mL-1 and a coefficient of variation <10%, which is equivalent to the performance of a high-sensitivity standard analyzer, and operated within acceptable levels stipulated by clinical guidelines. Moreover, cTnI clinical sample tests indicate a high correlation (r = 0.981) with the contemporary analyzers, demonstrating the clinical utility of this platform in high-performance POCT.
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Affiliation(s)
- Gyeo-Re Han
- Department of Chemistry, School of Physics and Chemistry, Gwangju Institute of Science and Technology (GIST), 123 Cheomdangwagi-ro, Buk-gu, Gwangju 61005, Republic of Korea
| | - Hee Joon Koo
- Department of Chemistry, School of Physics and Chemistry, Gwangju Institute of Science and Technology (GIST), 123 Cheomdangwagi-ro, Buk-gu, Gwangju 61005, Republic of Korea
| | - Hangil Ki
- Department of Chemistry, School of Physics and Chemistry, Gwangju Institute of Science and Technology (GIST), 123 Cheomdangwagi-ro, Buk-gu, Gwangju 61005, Republic of Korea
| | - Min-Gon Kim
- Department of Chemistry, School of Physics and Chemistry, Gwangju Institute of Science and Technology (GIST), 123 Cheomdangwagi-ro, Buk-gu, Gwangju 61005, Republic of Korea
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27
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Rositch AF, Loffredo C, Bourlon MT, Pearlman PC, Adebamowo C. Creative Approaches to Global Cancer Research and Control. JCO Glob Oncol 2020; 6:4-7. [PMID: 32716656 PMCID: PMC7846070 DOI: 10.1200/go.20.00237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Anne F Rositch
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Christopher Loffredo
- Department of Oncology, Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC
| | - Maria T Bourlon
- Hemato-Oncology Department, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Paul C Pearlman
- National Cancer Institute Center for Global Health, Rockville, MD
| | - Clement Adebamowo
- Institute of Human Virology, Department of Epidemiology and Public Health, Marlene and Stewart Greenebaum Comprehensive Cancer Center, University of Maryland School of Medicine, Baltimore, MD.,Institute of Human Virology, Abuja, Nigeria.,Center for Bioethics and Research, Ibadan, Nigeria
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Noble L, Scott L, Stewart-Isherwood L, Molifi SJ, Sanne I, Da Silva P, Stevens W. Continuous quality monitoring in the field: an evaluation of the performance of the Fio Deki Reader™ for rapid HIV testing in South Africa. BMC Infect Dis 2020; 20:320. [PMID: 32366227 PMCID: PMC7199324 DOI: 10.1186/s12879-020-4932-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Accepted: 02/28/2020] [Indexed: 12/18/2022] Open
Abstract
Background Rapid diagnostic tests (RDTs) are a cornerstone of HIV diagnosis and rely on good quality processing and interpretation, particularly in the era of test and treat. The Deki Reader (Fio Corporation®, Toronto, Ontario, Canada) is a portable device designed specifically for analysing RDTs and was selected for evaluation in South Africa in the context of HIV RDT analysis. Methods This study consisted of a laboratory evaluation and two-part field evaluation of the Deki Reader v100, covering two RDT testing algorithms, and an evaluation of the continuous quality monitoring through the Fionet™ web portal. Based on user feedback from the field evaluation, the device underwent hardware and software redesign, and the Deki Reader v200 was evaluated in the laboratory. Ethics approval for this evaluation was obtained from the University of the Witwatersrand Human Research Ethics Committee: M150160. Results The intra- and inter-device laboratory precision of the Deki Reader v100 were 98.3 and 99.2% respectively, and 99.3 and 100% for the Deki Reader v200. The laboratory concordances compared to standard-of-care reporting were 99.5 and 98.0% for the two respective models, while sensitivity and specificity were 99.5 and 99.4% for the Deki Reader V100 and 100 and 93.1% for the Deki Reader V200 respectively. Screening and confirmatory concordances in the field were 99.3 and 96.5% under algorithm 1 and 99.7 and 100% under algorithm 2. Sensitivity and specificity for the field evaluation were 99.8 and 97.7%. Overall robustness of the device was acceptable and continuous quality monitoring through Fionet™ was feasible. Conclusions The Deki Reader provides an option for improved and reliable quality assessment for rapid diagnosis of HIV using RDTs to enhance the quality of healthcare at the point-of-care. However, the introduction of new RDTs and modification of current algorithms necessitates ongoing and agile RDT reader adjustments, which will require cost modelling to ensure sustainability of devices implemented into national HIV programs.
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Affiliation(s)
- Lara Noble
- Department of Molecular Medicine and Haematology, School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, Gauteng, South Africa.
| | - Lesley Scott
- Department of Molecular Medicine and Haematology, School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, Gauteng, South Africa
| | - Lynsey Stewart-Isherwood
- Department of Molecular Medicine and Haematology, School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, Gauteng, South Africa.,National Priority Programme, National Health Laboratory Service, Johannesburg, Gauteng, South Africa.,BroadReach Consulting, Johannesburg, Gauteng, South Africa
| | - Seponono John Molifi
- National Priority Programme, National Health Laboratory Service, Johannesburg, Gauteng, South Africa.,Strategic Evaluation Advisory and Development Consulting, Johannesburg, Gauteng, South Africa
| | - Ian Sanne
- Right to Care, Johannesburg, Gauteng, South Africa
| | - Pedro Da Silva
- National Priority Programme, National Health Laboratory Service, Johannesburg, Gauteng, South Africa
| | - Wendy Stevens
- Department of Molecular Medicine and Haematology, School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, Gauteng, South Africa.,National Priority Programme, National Health Laboratory Service, Johannesburg, Gauteng, South Africa
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Reddy S, Gibbs A, Spooner E, Ngomane N, Reddy T, |Luthuli N, Ramjee G, Coutsoudis A, Kiepiela P. Assessment of the Impact of Rapid Point-of-Care CD4 Testing in Primary Healthcare Clinic Settings: A Survey Study of Client and Provider Perspectives. Diagnostics (Basel) 2020; 10:E81. [PMID: 32024166 PMCID: PMC7168920 DOI: 10.3390/diagnostics10020081] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Revised: 12/05/2019] [Accepted: 12/07/2019] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND The high burden of disease in South Africa presents challenges to public health services. Point-of-care (POC) technologies have the potential to address these gaps and improve healthcare systems. This study ascertained the acceptability and impact of POC CD4 testing on patients' health and clinical management. METHODS We conducted a qualitative survey study with patients (n = 642) and healthcare providers (n = 13) at the Lancers Road (experienced POC) and Chesterville (non-experienced POC) primary healthcare (PHC) clinics from September 2015 to June 2016. RESULTS Patients (99%) at Lancers and Chesterville PHCs were positive about POC CD4 testing, identifying benefits: No loss/delay of test results (6.4%), cost/time saving (19.5%), and no anxiety (5.1%), and 58.2% were ready to initiate treatment. Significantly more patients at Chesterville than Lancers Road PHC felt POC would provide rapid clinical decision making (64.7% vs. 48.1%; p < 0.0001) and better clinic accessibility (40.4% vs. 24.7%; p < 0.0001) respectively. Healthcare providers thought same-day CD4 results would impact: Clinical management (46.2%), patient readiness (46.2%), and adherence (23.0%), and would reduce follow-up visits (7.7%), while 38.5% were concerned that further tests and training (15.4%) were required before antiretroviral therapy (ART) initiation. CONCLUSION The high acceptability of POC CD4 testing and the immediate health, structural, and clinical management benefits necessitates POC implementation studies.
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Affiliation(s)
- Shabashini Reddy
- South African Medical Research Council, Durban 4000, South Africa;
- Wits Health Consortium, Parktown, Johannesburg 2091, South Africa
| | - Andrew Gibbs
- South African Medical Research Council, Gender and Health Research Unit, Durban Centre for Rural Health, University of KwaZulu Natal, Durban 4000, South Africa;
| | - Elizabeth Spooner
- South African Medical Research Council, HIV Prevention Research Unit, Durban 3600, South Africa; (E.S.); (G.R.)
| | | | - Tarylee Reddy
- South African Medical Research Council, Biostatistics Unit, Durban 4000, South Africa;
| | | | - Gita Ramjee
- South African Medical Research Council, HIV Prevention Research Unit, Durban 3600, South Africa; (E.S.); (G.R.)
| | - Anna Coutsoudis
- School of Clinical Medicine, University of KwaZulu Natal, Durban 4000, South Africa;
| | - Photini Kiepiela
- South African Medical Research Council, Durban 4000, South Africa;
- Wits Health Consortium, Parktown, Johannesburg 2091, South Africa
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30
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Oshin O, Kireev D, Akinwande D, Adetiba E, Idachaba F, Atayero A. Advancing PoC Devices for Early Disease Detection using Graphene-based Sensors. ACTA ACUST UNITED AC 2019. [DOI: 10.1088/1742-6596/1378/3/032031] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
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31
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Adamson H, Ajayi MO, Campbell E, Brachi E, Tiede C, Tang AA, Adams TL, Ford R, Davidson A, Johnson M, McPherson MJ, Tomlinson DC, Jeuken LJC. Affimer-Enzyme-Inhibitor Switch Sensor for Rapid Wash-free Assays of Multimeric Proteins. ACS Sens 2019; 4:3014-3022. [PMID: 31578863 DOI: 10.1021/acssensors.9b01574] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Robust technology is required to underpin rapid point-of-care and in-field diagnostics to improve timely decision making across broad sectors. An attractive strategy combines target recognition and signal generating elements into an "active" enzyme-switch that directly transduces target-binding into a signal. However, approaches that are broadly applicable to diverse targets remain elusive. Here, an enzyme-inhibitor switch sensor was developed by insertion of non-immunoglobulin Affimer binding proteins, between TEM1-β-lactamase and its inhibitor protein, such that target binding disrupts the enzyme-inhibitor complex. Design principles for a successful switch architecture are illustrated by the rapid (min), simple (wash-free), and sensitive (pM) quantification of multimeric target analytes in biological samples (serum, plasma, leaf extracts), across three application areas. A therapeutic antibody (Herceptin), protein biomarker (human C-reactive protein), and plant virus (cow pea mosaic virus) were targeted, demonstrating assays for therapeutic drug monitoring, health diagnostics, and plant pathogen detection, respectively. Batch-to-batch reproducibility, shelf-life stability, and consistency with validated enzyme-linked immunosorbent assay analysis confirm that the principle of an Affimer-enzyme-inhibitor switch provides a platform for point-of-care and in-field diagnostics.
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Affiliation(s)
| | | | | | | | | | | | | | - Robert Ford
- Avacta Life Sciences Limited, Unit 20, Ash Way, Thorp Arch Estate, Wetherby LS23 7FA, U.K
| | - Alex Davidson
- Avacta Life Sciences Limited, Unit 20, Ash Way, Thorp Arch Estate, Wetherby LS23 7FA, U.K
| | - Matt Johnson
- Avacta Life Sciences Limited, Unit 20, Ash Way, Thorp Arch Estate, Wetherby LS23 7FA, U.K
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Sacks JA, Fong Y, Gonzalez MP, Andreotti M, Baliga S, Garrett N, Jordan J, Karita E, Kulkarni S, Mor O, Mosha F, Ndlovu Z, Plantier JC, Saravanan S, Scott L, Peter T, Doherty M, Alexander H, Vojnov L. Performance of Cepheid Xpert HIV-1 viral load plasma assay to accurately detect treatment failure. AIDS 2019; 33:1881-1889. [PMID: 31274537 PMCID: PMC7024604 DOI: 10.1097/qad.0000000000002303] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND Coverage of viral load testing remains low with only half of the patients in need having adequate access. Alternative technologies to high throughput centralized machines can be used to support viral load scale-up; however, clinical performance data are lacking. We conducted a meta-analysis comparing the Cepheid Xpert HIV-1 viral load plasma assay to traditional laboratory-based technologies. METHODS Cepheid Xpert HIV-1 and comparator laboratory technology plasma viral load results were provided from 13 of the 19 eligible studies, which accounted for a total of 3790 paired data points. We used random effects models to determine the accuracy and misclassification at various treatment failure thresholds (detectable, 200, 400, 500, 600, 800 and 1000 copies/ml). RESULTS Thirty percent of viral load test results were undetectable, while 45% were between detectable and 10 000 copies/ml and the remaining 25% were above 10 000 copies/ml. The median Xpert viral load was 119 copies/ml and the median comparator viral load was 157 copies/ml, while the log10 bias was 0.04 (0.02-0.07). The sensitivity and specificity to detect treatment failure were above 95% at all treatment failure thresholds, except for detectable, at which the sensitivity was 93.33% (95% confidence interval: 88.2-96.3) and specificity was 80.56% (95% CI: 64.6-90.4). CONCLUSION The Cepheid Xpert HIV-1 viral load plasma assay results were highly comparable to laboratory-based technologies with limited bias and high sensitivity and specificity to detect treatment failure. Alternative specimen types and technologies that enable decentralized testing services can be considered to expand access to viral load.
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Affiliation(s)
| | - Youyi Fong
- Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | | | - Mauro Andreotti
- National Center for Global Health, Istituto Superiore di Sanita, Viale Regina Elena, Rome, Italy
| | - Shrikala Baliga
- Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, India
| | - Nigel Garrett
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), University of KwaZulu-Natal, Durban, South Africa
| | | | - Etienne Karita
- Project San Francisco/Rwanda-Zambia HIV Research Group, Kigali, Rwanda
| | | | - Orna Mor
- Central Virology Laboratory, Public Health Services, Israel Ministry of Health, Tel – Hashomer, Israel
| | - Fausta Mosha
- National Health Laboratory Quality Assurance and Training Centre, Dar es Salaam, Tanzania
| | - Zibusiso Ndlovu
- Medecins Sans Frontieres, Southern Medical Unit, Cape Town, South Africa
| | - Jean-Christophe Plantier
- Normandie University, Unirouen, Rouen University Hospital, Laboratory of Virology, Rouen, France
| | - Shanmugam Saravanan
- Y. R. Gaitonde Centre for AIDS Research and Education, Taramani, Chennai, India
| | - Lesley Scott
- Department of Molecular Medicine and Haemotology, School of Pathology, Faculty of Health Science, University of Witwatersrand, Johannesburg, South Africa
| | - Trevor Peter
- Clinton Health Access Initiative, Boston, MA, USA
| | - Meg Doherty
- World Health Organization, Geneva, Switzerland
| | - Heather Alexander
- Center for Global Health, Division of Global HIV/TB, US Centers for Disease Control, Atlanta, GA, USA
| | - Lara Vojnov
- World Health Organization, Geneva, Switzerland
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Cotton fiber-based assay with time-based microfluidic absorption sampling for point-of-care applications. Bioanalysis 2019; 11:855-873. [PMID: 31084195 DOI: 10.4155/bio-2018-0190] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
Aim: Time-based microfluidic absorption sampling was proposed using cotton fiber-based device made in swab stick. The assay was optimized and compared with conventional pipetted drop sampling using the same device. Materials & methods: Reagents were integrated into cotton fiber device for assessing concentration of analytes by the colorimetric detection method through time-based absorption sampling microfluidic system. All assay parameters were first optimized using conventional pipette-based drop sampling. Results: The color intensity is linear in the relevant concentration range of the analytes. The LOD are 0.189 mM for glucose and 6.56 μM for nitrite, respectively. These values are better than conventional drop sampling. The fiber-containing swab itself functions as sampling, assay and calibration device. Conclusion: Microfluidic cotton fiber-based assay device was fabricated and can determine analyte concentration in artificial salivary samples, colorimetrically, by time-based absorption sampling without the need of complex equipments.
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Vojnov L, Taegtmeyer M, Boeke C, Markby J, Harris L, Doherty M, Peter T, Ford N. Performance of non-laboratory staff for diagnostic testing and specimen collection in HIV programs: A systematic review and meta-analysis. PLoS One 2019; 14:e0216277. [PMID: 31048881 PMCID: PMC6497381 DOI: 10.1371/journal.pone.0216277] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2018] [Accepted: 04/17/2019] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND In most high HIV burden countries, many HIV patients do not have reliable access to required diagnostic laboratory tests. Task shifting of clinical tasks to lower cadres of health care workers and lay counselors has been successful in scaling up treatment for HIV and may also be an effective strategy in expanding access to essential diagnostic testing. METHODS We screened major electronic databases between 1 January 2005 to 26 August 2018 to identify studies assessing ease of use and accuracy of task shifting of HIV-related diagnostic testing and/or specimen collection to non-laboratory health staff. Two independent reviewers screened all titles and abstracts for studies that analyzed diagnostic accuracy, patient impact, ease-of-use, or cost-effectiveness. Studies were assessed for quality, bias, and applicability following the QUADAS-2 framework. We generated summary estimates using random-effects meta-analyses. RESULTS We identified 42 relevant studies. Overall, point-of-care CD4 testing performed by non-laboratory staff had a mean bias of -54.44 (95% CI: -72.40 --36.48) compared to conventional laboratory-based. Though studies were limited, the diagnostic accuracy of point-of-care alanine transaminase enzyme (ALT) and hemoglobin testing performed by non-laboratory staff was comparable to conventional laboratory-based testing by laboratory professionals. Point-of-care testing and/or specimen collection were generally found to be acceptable and easy to use for non-laboratory staff. CONCLUSIONS Task shifting of testing using point-of-care technologies to non-laboratory staff was comparable to laboratory professionals operating the same technology in the laboratory. Some variability was observed comparing the performance of point-of-care CD4 testing by non-laboratory staff to conventional laboratory-based technologies by laboratory professionals indicating potential lower performance was likely technological rather than operator caused. The benefits of task shifting of testing may outweigh any possible harms as task shifting allows for increased decentralization, access of specific diagnostics, and faster result delivery.
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Affiliation(s)
- Lara Vojnov
- Clinton Health Access Initiative, Boston, Massachusetts, United States of America
| | - Miriam Taegtmeyer
- Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, United Kingdom
| | - Caroline Boeke
- Clinton Health Access Initiative, Boston, Massachusetts, United States of America
| | - Jessica Markby
- Clinton Health Access Initiative, Boston, Massachusetts, United States of America
| | - Lindsay Harris
- Clinton Health Access Initiative, Boston, Massachusetts, United States of America
| | - Meg Doherty
- World Health Organization, Geneva, Switzerland
| | - Trevor Peter
- Clinton Health Access Initiative, Boston, Massachusetts, United States of America
| | - Nathan Ford
- World Health Organization, Geneva, Switzerland
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Plebani M, Laposata M, Lippi G. Driving the route of laboratory medicine: a manifesto for the future. Intern Emerg Med 2019; 14:337-340. [PMID: 30783946 DOI: 10.1007/s11739-019-02053-z] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2019] [Accepted: 02/11/2019] [Indexed: 12/19/2022]
Abstract
The role of laboratory medicine is essential in healthcare, since in vitro diagnostic testing represents now an unavoidable part of reasoning and clinical decision making. Laboratory tests are an essential part of most care pathways, aimed at optimizing resource utilization and improving patient outcome. The activity of laboratory professionals is interconnected with all medical disciplines, and provides a crucial support for ordering the right test, for the right patient and at the right time, but also helps interpreting and using laboratory data. Although recent advancement in laboratory medicine, catalyzed by technical innovations and development of innovative tests, have promoted a substantial revolution in the organization of clinical laboratories, the future of this profession seems still ambiguous. We have hence developed a "manifesto" of laboratory medicine, meant to promote an innovative prospect of our discipline and encouraging the establishment of a new generation of laboratory professionals and managers.
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Affiliation(s)
- Mario Plebani
- Department of Laboratory Medicine, University Hospital of Padova, Via Giustiniani, 2, 35128, Padua, Italy.
| | - Michael Laposata
- Department of Pathology, University of Texas Medical Branch, Galveston, TX, USA
| | - Giuseppe Lippi
- Section of Clinical Biochemistry, University of Verona, Verona, Italy
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Gug IT, Tertis M, Hosu O, Cristea C. Salivary biomarkers detection: Analytical and immunological methods overview. Trends Analyt Chem 2019. [DOI: 10.1016/j.trac.2019.02.020] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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Toward Improving Accessibility of Point-of-Care Diagnostic Services for Maternal and Child Health in Low- and Middle-Income Countries. POINT OF CARE 2019; 18:17-25. [PMID: 30886544 PMCID: PMC6407818 DOI: 10.1097/poc.0000000000000180] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Point-of-care (POC) testing can improve health care provision in settings with limited access to health care services. Access to POC diagnostic services has shown potential to alleviate some diagnostic challenges and delays associated with laboratory-based methods in low- and middle-income countries. Improving accessibility to POC testing (POCT) services during antenatal and perinatal care is among the global health priorities to improve maternal and child health. This review provides insights on the availability of POC testing designed for diagnosing HIV, syphilis, and malaria in pregnancy to improve maternal and child health. In addition, factors such as accessibility of POC testing, training of health work force, and the efficiency of POC testing services delivery in low- and middle-income countries are discussed. A framework to help increase access to POC diagnostic services and improve maternal and child health outcomes in low- and middle-income countries is proposed.
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Abstract
Implementation science uses methods to promote the scaling up and use of evidence-based practices by health systems to improve quality and outcomes. Its use is vital to maximise the efficiency of limited resources for health care in tropical settings. HIV and tuberculosis (TB) are two of the major causes of morbidity and mortality in sub-Saharan Africa, and globally. Although effective treatments are widely available, lack of diagnosis remains a large barrier to accessing treatment, particularly in resource-limited settings. We explore HIV and TB diagnostics that can be used at point-of-care in any settings, and outline some important principles and applications of implementation science to aid their application and use. Despite robust evidence of diagnostic accuracy and efficacy in improving patient-centred outcomes, such interventions cannot be fully utilised without addressing operational barriers and knowledge gaps.
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Affiliation(s)
- Ankur Gupta-Wright
- Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK
- Department of Infection, St Thomas' Hospital, London, UK
| | - Yukari C Manabe
- Division of Infectious Diseases, Department of Medicine Johns Hopkins School of Medicine, Baltimore, USA
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Kuupiel D, Tlou B, Bawontuo V, Drain PK, Mashamba-Thompson TP. Poor supply chain management and stock-outs of point-of-care diagnostic tests in Upper East Region's primary healthcare clinics, Ghana. PLoS One 2019; 14:e0211498. [PMID: 30811407 PMCID: PMC6392218 DOI: 10.1371/journal.pone.0211498] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2018] [Accepted: 01/15/2019] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Several supply chain components are important to sustain point-of-care (POC) testing services in rural settings. To evaluate the availability of POC diagnostic tests in rural Ghana's primary healthcare (PHC) clinics, we conducted an audit of the supply chain management for POC diagnostic services in rural Upper East Region's (UER) PHC clinics, Ghana to determine the reasons/causes of POC tests deficiencies. MATERIAL AND METHODS We conducted a review of accessible POC diagnostics in 100 PHC clinics in UER, Ghana from February to March 2018. We used a monitoring audit tool adopted from the World Health Organization and Management Science for Health guidelines for supply chain management of diagnostics for compliance. We determined a clinic's compliance with the stipulated guidelines, and a composite compliant score was defined as a percentage rating of 90 to 100%. We used univariate logistic regression analysis in Stata 14 to determine the level of association between supply chain management and the audit variables. RESULTS Overall, the composite compliant score of supply chain management for existing POC tests was at 81% (95%CI: 79%-82%). The mean compliance with distribution guidelines was at 93.8% (95%CI: 91.9%-95.6%) the highest score, whilst inventory management scored the lowest, at 53.5% (95%CI: 49.5%-57.5%) compliance. Of the 13 districts in the region, the results showed complete stock-out of blood glucose test in all selected PHC clinics in seven (53.8%) districts, haemoglobin and hepatitis B virus test in three (23.1%), and urine protein test in two (15.4%) districts. Based on our univariate logistics regression models, stock-out of tests at the Regional Medical and District Health Directorates stores in the region, high clinic attendance, lack of documentation of expiry date/expired tests, poor documentation of inventory level, poor monitoring of monthly consumption level, and failure to document unexplained losses of the various POC tests were significant predictors of complete test stock-out in most of the clinics in the Upper East Region. DISCUSSION There is poor supply chain management of POC diagnostic tests in UER's PHC clinics. Improvement in inventory management and human resource capacity for POC testing is critical to ensure accessibility and sustainability of POC diagnostic services in resource-limited settings PHC clinics.
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Affiliation(s)
- Desmond Kuupiel
- Department of Public Health Medicine, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
| | - Boikhutso Tlou
- Department of Public Health Medicine, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
| | - Vitalis Bawontuo
- Faculty of Health and Allied Sciences, Catholic University College of Ghana, Fiapre, Sunyani, Ghana
| | - Paul K. Drain
- International Clinical Research Centre, Department of Global Health, University of Washington, Seattle, Washington, United States of America
- Division of Infectious Diseases, Department of Medicine, University of Washington, Seattle, Washington, United States of America
- Department of Epidemiology, University of Washington, Seattle, Washington, United States of America
| | - Tivani P. Mashamba-Thompson
- Department of Public Health Medicine, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
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Verboom DM, Koster-Brouwer ME, Varkila MRJ, Bonten MJM, Cremer OL. Profile of the SeptiCyte™ LAB gene expression assay to diagnose infection in critically ill patients. Expert Rev Mol Diagn 2019; 19:95-108. [PMID: 30623693 DOI: 10.1080/14737159.2019.1567333] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Sepsis is a severe and frequently occurring clinical syndrome, caused by the inflammatory response to infections. Recent studies on the human transcriptome during sepsis have yielded several gene-expression assays that might assist physicians during clinical assessment of patients suspected of sepsis. SeptiCyte™ LAB (Immunexpress, Seattle, WA) is the first gene expression assay that was cleared by the FDA in the United States to distinguish infectious from non-infectious causes of systemic inflammation in critically ill patients. The test consists of the simultaneous amplification of four RNA transcripts (CEACAM4, LAMP1, PLAC8, and PLA2G7) in whole blood using a quantitative real-time PCR reaction. This review provides an overview of the challenges in the diagnosis of sepsis, the development of gene expression signatures, and a detailed description of available clinical performance studies evaluating SeptiCyte™ LAB.
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Affiliation(s)
- D M Verboom
- a Julius Center for Health Sciences and Primary Care , University Medical Center Utrecht , Utrecht , The Netherlands.,b Department of Intensive Care , University Medical Center Utrecht , Utrecht , The Netherlands
| | - M E Koster-Brouwer
- a Julius Center for Health Sciences and Primary Care , University Medical Center Utrecht , Utrecht , The Netherlands.,b Department of Intensive Care , University Medical Center Utrecht , Utrecht , The Netherlands
| | - M R J Varkila
- a Julius Center for Health Sciences and Primary Care , University Medical Center Utrecht , Utrecht , The Netherlands.,b Department of Intensive Care , University Medical Center Utrecht , Utrecht , The Netherlands
| | - M J M Bonten
- a Julius Center for Health Sciences and Primary Care , University Medical Center Utrecht , Utrecht , The Netherlands.,c Department of Medical Microbiology , University Medical Center Utrecht , Utrecht , The Netherlands
| | - O L Cremer
- b Department of Intensive Care , University Medical Center Utrecht , Utrecht , The Netherlands
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Plebani M, Laposata M, Lippi G. A manifesto for the future of laboratory medicine professionals. Clin Chim Acta 2019; 489:49-52. [DOI: 10.1016/j.cca.2018.11.021] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2018] [Accepted: 11/12/2018] [Indexed: 10/27/2022]
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Wieringa G. Teaching the pony new tricks: competences for specialists in laboratory medicine to meet the challenges of disruptive innovation. ACTA ACUST UNITED AC 2018; 57:398-402. [DOI: 10.1515/cclm-2018-0609] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Accepted: 11/14/2018] [Indexed: 11/15/2022]
Abstract
Abstract
The 20th century digital revolution has already seen the introduction of faster, more diverse, easier to use technologies with extended capacity and capability that has enhanced productivity in Laboratory Medicine and allowed more effective use of human resource. With increasing demands for better health and best care the challenge to future healthcare systems is to deploy technology, facilities and human resources more effectively. For the 21st century the digital age heralds opportunities for information-led technology providers to become healthcare providers when algorithm driven care can support patients’ needs at the point of care close to or in their homes. For Specialists in Laboratory Medicine the opportunity arises for working beyond the laboratory in partnership with the emerging providers. The challenge to specialists is to extend their skill and competence to leadership roles that (a) determine clinical need and strategic direction for local environments, (b) ensure technology solutions are cost-effective, safe and reliable, (c) assume the business acumen to market, negotiate and manage change in services, (d) expect understanding of the clinical bioinformatics that underpin genomics, health information science (data mining and health economics) and physical sciences (e) expect knowledge and skills in the provision of direct clinical care in the face of staffing shortfalls experienced by many healthcare systems and (f) enhance their communication and interactive skills. In growing their leadership contribution a partnership approach in education and training across healthcare divides, in conjunction with the diagnostics and/or information technology industries, through integrated professional organisation approaches, joint approaches with academia and policy related healthcare organisations is recommended.
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Affiliation(s)
- Gijsbert Wieringa
- Department of Laboratory Medicine, Bolton NHS Foundation Trust , Minerva Road , Bolton BL4 0JR , UK
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Chevaliez S, Pawlotsky JM. New virological tools for screening, diagnosis and monitoring of hepatitis B and C in resource-limited settings. J Hepatol 2018; 69:916-926. [PMID: 29800630 DOI: 10.1016/j.jhep.2018.05.017] [Citation(s) in RCA: 63] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Revised: 05/11/2018] [Accepted: 05/14/2018] [Indexed: 02/07/2023]
Abstract
Worldwide, the increasingly dominant model of laboratory testing is the centralised laboratory, in which automation of analytical processes increases, enabling the analysis of large numbers of samples at a relatively low cost. However, this trend does not fulfil the requirements for care of patients with chronic hepatitis B and C in resource-limited settings. Alternative models using point-of-care (POC) tests and dried blood spots (DBSs) are increasingly being considered for viral hepatitis screening, diagnosis and monitoring. POC tests are small devices providing qualitative and/or quantitative determination of viral antibodies and/or antigens. They can use original specimen matrices, such as oral fluid or blood collected from a fingerstick. POC tests are particularly useful for large-scale screening, and to improve access to care in regions where laboratory access is limited. New POC devices that detect and quantify viral nucleic acids are at the developmental stage. DBSs offer the main advantage of enabling storage of desiccated blood that can be easily transported to reference centres, where state-of-the-art molecular and serological diagnostic tests are available. However, standardisation and better automation of DBS handling are needed. Herein, we review alternatives to classical hepatitis B and C virological tests, examining POC tests and DBSs, as well as alternatives to nucleic acid testing. Innovations in testing approaches resulting from the availability of these new assays are also discussed.
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Affiliation(s)
- Stéphane Chevaliez
- National Reference Center for Viral Hepatitis B, C and D, Department of Virology, Hôpital Henri Mondor, Université Paris-Est, Créteil, France; INSERM U955, Créteil, France.
| | - Jean-Michel Pawlotsky
- National Reference Center for Viral Hepatitis B, C and D, Department of Virology, Hôpital Henri Mondor, Université Paris-Est, Créteil, France; INSERM U955, Créteil, France
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Snodgrass R, Gardner A, Semeere A, Kopparthy VL, Duru J, Maurer T, Martin J, Cesarman E, Erickson D. A portable device for nucleic acid quantification powered by sunlight, a flame or electricity. Nat Biomed Eng 2018; 2:657-665. [PMID: 30906647 PMCID: PMC6425734 DOI: 10.1038/s41551-018-0286-y] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
A decentralized approach to diagnostics can decrease the time to
treatment of infectious diseases in resource-limited settings. Yet most modern
diagnostic tools require stable electricity and are not portable. Here, we
describe a portable device for isothermal nucleic-acid quantification that can
operate with power from electricity, sunlight or a flame, and that can store
heat from intermittent energy sources, for operation when electrical power is
not available or reliable. We deployed the device in two Ugandan health clinics,
where it successfully operated through multiple power outages, with equivalent
performance when powered via sunlight or electricity. A direct comparison
between the portable device and commercial qPCR (quantitative polymerase chain
reaction) machines for samples from 71 Ugandan patients (29 of which were tested
in Uganda) for the presence of Kaposi’s sarcoma-associated herpesvirus
DNA showed 94% agreement, with the four discordant samples having the lowest
concentration of the herpesvirus DNA. The device’s flexibility in power
supply provides a needed solution for on-field diagnostics.
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Affiliation(s)
- Ryan Snodgrass
- Sibley School of Mechanical and Aerospace Engineering, Cornell University, Ithaca, NY, USA
| | - Andrea Gardner
- Department of Pathology and Laboratory Medicine, Weill Cornell Medical College, New York, NY, USA
| | | | | | - Jens Duru
- Sibley School of Mechanical and Aerospace Engineering, Cornell University, Ithaca, NY, USA
| | - Toby Maurer
- Department of Dermatology, University of California, San Francisco, CA, USA
| | - Jeffrey Martin
- Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA.
| | - Ethel Cesarman
- Department of Pathology and Laboratory Medicine, Weill Cornell Medical College, New York, NY, USA.
| | - David Erickson
- Sibley School of Mechanical and Aerospace Engineering, Cornell University, Ithaca, NY, USA.
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Weihser P, Giles D. Establishing an ambulatory care service using point-of-care testing diagnostics. Br J Hosp Med (Lond) 2018; 79:520-523. [PMID: 30188207 DOI: 10.12968/hmed.2018.79.9.520] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The use of ambulatory emergency care services in the NHS has been shown to reduce the emergency inpatient burden and enhance the overall patient experience, while demonstrating a cost saving to the NHS. At the James Paget University Hospital point-of-care testing was used as an enabler within an evidence-based lean service redesign to successfully set up a novel unit. A 3-month pilot period, with limited operational times, showed a dramatic improvement in patient flow through the acute medicine pathway, with an equivalent of 59 bed days saved during the pilot period. Further expansion of the unit to a dedicated area with full 7-day opening allowed a continued improvement in performance. This resulted in a mean length of stay of 115 minutes (a 54% reduction from pre-baseline), and just 6.1% of an average of 18.1 daily attendances were converted to full admission. This demonstrated a clinical, operational and financial benefit, allowing improved clinical outcomes.
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Affiliation(s)
- Philip Weihser
- Divisional Operational Manager, Department of Medicine, James Paget University Hospital, Great Yarmouth, Norfolk NR31 6LA
| | - Dominic Giles
- ST7, Department of Acute Medicine, James Paget University Hospital, Great Yarmouth, Norfolk
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A Simple Imaging Device for Fluorescence-Relevant Applications. MICROMACHINES 2018; 9:mi9080418. [PMID: 30424351 PMCID: PMC6211139 DOI: 10.3390/mi9080418] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Revised: 08/13/2018] [Accepted: 08/18/2018] [Indexed: 12/12/2022]
Abstract
This article unveiled the development of an inexpensive, lightweight, easy-to-use, and portable fluorescence imaging device for paper-based analytical applications. We used commercial fluorescent dyes, as proof of concept, to verify the feasibility of our fluorescence imaging device for bioanalysis. This approach may provide an alternative method for nucleotide detection and semen analysis, using a miniaturized fluorescence reader that is more compact and portable than conventional analytical equipment.
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Detection of 1,5-anhydroglucitol as a Biomarker for Diabetes Using an Organic Field-Effect Transistor-Based Biosensor. TECHNOLOGIES 2018. [DOI: 10.3390/technologies6030077] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Sensor devices that can be fabricated on a flexible plastic film produced at a low cost using inkjet-printing technology are suitable for point-of-care applications. An organic field-effect transistor (OFET)-based biosensor can function as a potentiometric electrochemical sensor. To investigate the usefulness of an OFET-based biosensor, we demonstrated the detection of 1,5-anhydroglucitol (1,5-AG) and glucose, which are monosaccharides used as biomarkers of diabetes. An OFET-based biosensor combined with a Prussian blue (PB) electrode, modified with glucose oxidase (GOx) or pyranose oxidase (POx), was utilized for the detection of the monosaccharides. When the GOx- or POx-PB electrode was immersed in glucose solution at the determined concentration, shifts in the low-voltage direction of transfer characteristic curves of the OFET were observed to be dependent on the glucose concentrations in the range of 0–10 mM. For 1,5-AG, the curve shifts were observed only with the POx-PB electrode. Detection of glucose and 1,5-AG was achieved in a substrate-specific manner of the enzymes on the printed OFET-biosensor. Although further improvements are required in the detection concentration range, the plastic-filmOFET-biosensors will enable the measurement of not only diabetes biomarkers but also various other biomarkers.
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Landis RC, Abayomi EA, Bain BC, Greene E, Janossy G, Joseph P, Kerrigan D, McCoy JP, Nunez C, O'Gorman M, Pastoors A, Parekh BS, Quimby KR, Quinn TC, Robertson KR, Thomas R, van Gorp E, Vermund SH, Wilson V. Shifting the HIV Paradigm from Care to Cure: Proceedings from the Caribbean Expert Summit in Barbados, August 2017. AIDS Res Hum Retroviruses 2018; 34:561-569. [PMID: 29732897 PMCID: PMC6053839 DOI: 10.1089/aid.2017.0310] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
The CCAS EXPERT SUMMIT convened an array of international experts in Barbados on August 27-31, 2017 under the theme "From Care to Cure-Shifting the HIV Paradigm." The Caribbean Cytometry & Analytical Society (CCAS) partnered with the Joint United Nations Programme on HIV/AIDS (UNAIDS) to deliver a program that reviewed the advances in antiretroviral therapy and the public health benefits accruing from treatment as prevention. Particular emphasis was placed on reexamining stigma and discrimination through a critical appraisal of whether public health messaging and advocacy had kept pace with the advances in medicine. Persistent fear of HIV driving discriminatory behavior was widely reported in different regions and sectors, including the healthcare profession itself; continued fear of the disease was starkly misaligned with the successes of new medical treatments and progress toward the UNAIDS 90-90-90 targets. The summit therefore adopted the mantra "Test-Treat-Defeat" to help engage with the public in a spirit of optimism aimed at creating a more conducive environment for persons to be tested and treated and, thereby, help reduce HIV disease and stigma at the individual and community levels.
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Affiliation(s)
- R. Clive Landis
- Edmund Cohen Laboratory for Vascular Research, George Alleyne Chronic Disease Research Centre, The University of the West Indies, Bridgetown, Barbados
- Office of the Deputy Principal, The University of the West Indies - Cave Hill Campus, Bridgetown, Barbados
| | - E. Akinola Abayomi
- Division of Haematopathology, Faculty of Medicine, Tygerberg Academic Hospital, Stellenbosch University, Cape Town, South Africa
| | - Brendan C. Bain
- Department of Medicine, University Hospital of the West Indies, Mona, Jamaica
| | - Edward Greene
- Office of the UN Secretary General, United Nations, New York, New York
| | - George Janossy
- Department of Immunology, University College Medical School, University College, London, United Kingdom
| | - Patrice Joseph
- Groupe Haïtien Etude pour le Sarcome de Kaposi et les Infections Opportunistes (GHESKIO), Port-au-Prince, Haiti
| | - Deanna Kerrigan
- Department of Health, Behavior and Society, The Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
| | - J. Philip McCoy
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - Cesar Nunez
- UNAIDS Latin American and Caribbean Regional Support Team, Panama City, Panama
| | - Maurice O'Gorman
- Department of Pathology and Laboratory Medicine, Children's Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, California
| | | | - Bharat S. Parekh
- Division of Global HIV and TB, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Kim R. Quimby
- Edmund Cohen Laboratory for Vascular Research, George Alleyne Chronic Disease Research Centre, The University of the West Indies, Bridgetown, Barbados
| | - Thomas C. Quinn
- National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland
| | - Kevin R. Robertson
- Department of Neurology, University of North Carolina, Chapel Hill, North Carolina
| | | | - Eric van Gorp
- Department of Viroscience, Erasmus Medical Centre, Rotterdam, the Netherlands
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Meggi B, Vojnov L, Mabunda N, Vubil A, Zitha A, Tobaiwa O, Mudenyanga C, Mutsaka D, Bollinger T, Loquiha O, Peter TF, Jani IV. Performance of point-of-care birth HIV testing in primary health care clinics: An observational cohort study. PLoS One 2018; 13:e0198344. [PMID: 29912987 PMCID: PMC6005575 DOI: 10.1371/journal.pone.0198344] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2017] [Accepted: 05/17/2018] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Failure to timely diagnose HIV in infants is a major barrier for scaling-up paediatric antiretroviral treatment (ART). WHO recommends birth testing for earlier diagnosis and to improve test coverage, but current diagnosis takes 2-3 weeks to complete, thereby limiting the ability of care givers to provide follow-on care, especially in low-resource settings. We evaluated the benefit of implementing rapid diagnosis of HIV at birth in primary health care maternity wards in Mozambique. METHODS AND FINDINGS Infants born to HIV-infected mothers delivering consecutively at eight primary health care clinics were tested within 24 hours of delivery using on-site POC (Alere q HIV1/2 Detect) and standard laboratory (Roche COBAS AmpliPrep/TaqMan HIV-1 qualitative assay v2.0) testing. Infants were also tested at 4-6 weeks of age with both assays. Of 2,350 HIV-exposed infants enrolled in this implementation research study, 33 tested HIV-positive at birth on both assays. Sensitivity and specificity of POC testing compared with laboratory testing at birth were 100% (95% CI 89·4-100·0) and 100% (95% CI 99·8-100·0), respectively. At 4-6 weeks of age, 61 infants were identified as HIV-positive; of these 29 (47·5%) had a positive test at birth. Testing at both birth and 4-6 weeks identified 71 HIV-positive infants compared with 61 infants by testing at 4-6 weeks alone, a 16% increase. Two infants tested positive at birth but tested HIV-negative during follow-up. CONCLUSIONS Adding POC birth testing to the 4-6 week screen may increase access to HIV diagnosis and expedite ART initiation in primary health care settings within low resource settings. Guidance on appropriate confirmatory HIV testing algorithms for birth testing is needed.
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Affiliation(s)
| | - Lara Vojnov
- Clinton Health Access Initiative, Maputo, Mozambique
| | | | | | | | - Ocean Tobaiwa
- Clinton Health Access Initiative, Maputo, Mozambique
| | | | | | | | - Osvaldo Loquiha
- Department of Mathematics and Informatics, Universidade Eduardo Mondlane, Maputo, Mozambique
| | | | - Ilesh V. Jani
- Instituto Nacional da Saúde, Maputo, Mozambique
- * E-mail:
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Kumar V, Hebbar S, Bhat A, Panwar S, Vaishnav M, Muniraj K, Nath V, Vijay RB, Manjunath S, Thyagaraj B, Siddalingappa C, Chikkamoga Siddaiah M, Dasgupta I, Anandh U, Kamala T, Srikanta SS, Krishnaswamy PR, Bhat N. Application of a Nanotechnology-Based, Point-of-Care Diagnostic Device in Diabetic Kidney Disease. Kidney Int Rep 2018; 3:1110-1118. [PMID: 30197977 PMCID: PMC6127407 DOI: 10.1016/j.ekir.2018.05.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2018] [Revised: 05/10/2018] [Accepted: 05/21/2018] [Indexed: 12/03/2022] Open
Abstract
Introduction Early detection of diabetes mellitus (DM) and diabetic kidney disease (DKD) is important for preventing end-stage renal failure and reducing cardiovascular complications. Availability of a validated point-of-care (PoC) device that can measure various DKD markers would be useful in this respect, especially in resource-poor parts of the world. Methods We validated a novel nanotechnology-based multianalyte PoC device (minimally invasive and does not require trained medical personnel) against laboratory gold standard tests for the detection of 5 biomarkers related to management of DM and DKD. The prospective study was funded by an International Society of Nephrology American Nephrologists of Indian Origin grant in 2 phases: (i) proof of concept: random samples were tested for the analytes with the PoC device and correlated with the laboratory gold standard; and (ii) clinical validation in a well-characterized cohort of patients. A nonenzymatic- and nonantibody-based electrochemical PoC device for quantitative measurement of markers—glycosylated hemoglobin (HbA1c), hemoglobin, serum albumin, microalbuminuria, urine creatinine, and albumin-to-creatinine ratio−was developed and used in this study. The disposable strips were interfaced with a multipotentiostat hand-held PoC device (3.7-V rechargeable lithium battery, 5-inch touch screen, Bluetooth enabled) working in amperometry mode, which provided the results in <1 minute. Data were analyzed using linearity plots and Bland-Altman difference plot analysis. Results A total of 4717 individuals were screened during the study (phase 1: 2576 and phase 2: 2141.) In phase 2, samples were tested in 529 subjects (346 females)—120 subjects with type 1 DM, 255 subjects with type 2 DM, 54 subjects without DM, 400 subjects with stage 2 chronic kidney disease, and 30 subjects with stage 3 chronic kidney disease. Conclusion A nanotechnology-based PoC device for quantitative measurement of HbA1c, hemoglobin, serum albumin, microalbuminuria, and the urine albumin-to-creatinine ratio was developed for detection of early DKD and showed excellent correlation between the device and laboratory results. This device has the potential for early detection of DM and/or DKD, especially in remote communities in underserved areas of the world where prevalence of diabetes is rapidly increasing.
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Affiliation(s)
- Vinay Kumar
- PathShodh Healthcare Pvt. Ltd., Bangalore, India
| | - Suraj Hebbar
- PathShodh Healthcare Pvt. Ltd., Bangalore, India
| | | | | | - Madhumati Vaishnav
- Samatvam Diabetes Endocrinology Centre, Jnana Sanjeevini Medical Center and Diabetes Hospital Diabetes Collaborative Study Group, Bangalore, India
| | - Kavitha Muniraj
- Samatvam Diabetes Endocrinology Centre, Jnana Sanjeevini Medical Center and Diabetes Hospital Diabetes Collaborative Study Group, Bangalore, India
| | - Vasanthi Nath
- Samatvam Diabetes Endocrinology Centre, Jnana Sanjeevini Medical Center and Diabetes Hospital Diabetes Collaborative Study Group, Bangalore, India
| | - Reshma Banaki Vijay
- Samatvam Diabetes Endocrinology Centre, Jnana Sanjeevini Medical Center and Diabetes Hospital Diabetes Collaborative Study Group, Bangalore, India
| | - Sapna Manjunath
- Samatvam Diabetes Endocrinology Centre, Jnana Sanjeevini Medical Center and Diabetes Hospital Diabetes Collaborative Study Group, Bangalore, India
| | - Babithadevi Thyagaraj
- Samatvam Diabetes Endocrinology Centre, Jnana Sanjeevini Medical Center and Diabetes Hospital Diabetes Collaborative Study Group, Bangalore, India
| | - Chandraprabha Siddalingappa
- Samatvam Diabetes Endocrinology Centre, Jnana Sanjeevini Medical Center and Diabetes Hospital Diabetes Collaborative Study Group, Bangalore, India
| | | | | | | | - Thummala Kamala
- Samatvam Diabetes Endocrinology Centre, Jnana Sanjeevini Medical Center and Diabetes Hospital Diabetes Collaborative Study Group, Bangalore, India
| | - S S Srikanta
- Samatvam Diabetes Endocrinology Centre, Jnana Sanjeevini Medical Center and Diabetes Hospital Diabetes Collaborative Study Group, Bangalore, India
| | - P R Krishnaswamy
- Centre for Nano Science and Engineering, Indian Institute of Science, Bangalore, India
| | - Navakanta Bhat
- PathShodh Healthcare Pvt. Ltd., Bangalore, India.,Centre for Nano Science and Engineering, Indian Institute of Science, Bangalore, India
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