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Seifert M, Vargas E, Ruiz-Valdepeñas Montiel V, Wang J, Rodwell TC, Catanzaro A. Detection and quantification of Mycobacterium tuberculosis antigen CFP10 in serum and urine for the rapid diagnosis of active tuberculosis disease. Sci Rep 2021; 11:19193. [PMID: 34584117 PMCID: PMC8478938 DOI: 10.1038/s41598-021-98471-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2021] [Accepted: 09/01/2021] [Indexed: 12/02/2022] Open
Abstract
Outside of the ongoing COVID-19 pandemic, tuberculosis is the leading cause of infectious disease mortality globally. Currently, there is no commercially available point-of-care diagnostic that is rapid, inexpensive, and highly sensitive for the diagnosis of active tuberculosis disease. Here we describe the development and optimization of a novel, highly sensitive prototype bioelectronic tuberculosis antigen (BETA) assay to detect tuberculosis-specific antigen, CFP10, in small-volume serum and urine samples. In this proof-of-concept study we evaluated the performance of the BETA assay using clinical specimens collected from presumptive tuberculosis patients from three independent cohorts. Circulating CFP10 antigen was detected in ALL serum (n = 19) and urine (n = 3) samples from bacteriologically confirmed tuberculosis patients who were untreated or had less than one week of treatment at time of serum collection, successfully identifying all culture positive tuberculosis patients. No CFP10 antigen was detected in serum (n = 7) or urine (n = 6) samples from individuals who were determined to be negative for tuberculosis disease. Additionally, antigen quantification using the BETA assay of paired serum samples collected from tuberculosis patients (n = 8) both before and after treatment initiation, indicate consistently declining within-person levels of CFP10 antigen during treatment. This novel, low-cost assay demonstrates potential as a rapid, non-sputum-based, point-of-care tool for the diagnosis of tuberculosis disease.
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Affiliation(s)
- Marva Seifert
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, University of California San Diego, 9500 Gilman Drive, La Jolla, CA, 92093, USA.
| | - Eva Vargas
- Department of Nanoengineering, University California San Diego, 9500 Gilman Drive, La Jolla, CA, 92093, USA
| | | | - Joseph Wang
- Department of Nanoengineering, University California San Diego, 9500 Gilman Drive, La Jolla, CA, 92093, USA
| | - Timothy C Rodwell
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, University of California San Diego, 9500 Gilman Drive, La Jolla, CA, 92093, USA
| | - Antonino Catanzaro
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, University of California San Diego, 9500 Gilman Drive, La Jolla, CA, 92093, USA
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2
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Shanmugakani RK, Bonam W, Erickson D, Mehta S. An isothermal amplification-based point-of-care diagnostic platform for the detection of Mycobacterium tuberculosis: A proof-of-concept study. CURRENT RESEARCH IN BIOTECHNOLOGY 2021; 3:154-159. [PMID: 34308334 PMCID: PMC8301208 DOI: 10.1016/j.crbiot.2021.05.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
The timely diagnosis of active tuberculosis disease (TB) is crucial to interrupt the transmission and combat the spread of Mycobacterium tuberculosis (Mtb), the causative agent for TB. Here, we demonstrate the development of a specimen-direct rapid diagnostic method for TB which consists of an isothermal amplification device, Tiny Isothermal Nucleic acid quantification sYstem (TINY), coupled with helicase-dependent amplification (HDA). HDA, an isothermal amplification technique is established over TINY using pUCIDT-AMP vector carrying IS6110, the target DNA sequence for Mtb. The limit of detection of this technique for detecting the IS6110 within a threshold time of 50 min is 2.5 × 105 copies of IS6110. HDA in TINY for TB detection was evaluated using three IS6110-positive Mtb strains - H37Rv, CDC 1551, and Erdman wild-type and one IS6110-negative Mycobacterium avium. For spiked oral swabs, HDA in TINY detects IS6110 without any non-specificity in relatively short turnaround time (<1.5 h), highlighting its potential utility as a specimen-direct point-of-care diagnostic for TB. TINY does not require an uninterrupted power supply and its lightweight and small footprint offers portability and easier operation in clinical settings with poor infrastructure. Overall, HDA in TINY could serve as an efficient rapid, and portable platform for the qualitative detection of TB at the point-of-care.
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Affiliation(s)
- Rathina Kumar Shanmugakani
- Institute for Nutritional Sciences, Global Health, and
Technology, Cornell University, Ithaca, NY, USA
- Division of Nutritional Sciences, Cornell University,
Ithaca, NY, USA
| | - Wesley Bonam
- Arogyavaram Medical Centre, Andhra Pradesh, India
| | - David Erickson
- Institute for Nutritional Sciences, Global Health, and
Technology, Cornell University, Ithaca, NY, USA
- Division of Nutritional Sciences, Cornell University,
Ithaca, NY, USA
- Sibley School of Mechanical and Aerospace Engineering,
Cornell University, Ithaca, NY, USA
| | - Saurabh Mehta
- Institute for Nutritional Sciences, Global Health, and
Technology, Cornell University, Ithaca, NY, USA
- Division of Nutritional Sciences, Cornell University,
Ithaca, NY, USA
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3
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Deo S, Jindal P, Papineni S. Integrating Xpert MTB/RIF for TB diagnosis in the private sector: evidence from large-scale pilots in Patna and Mumbai, India. BMC Infect Dis 2021; 21:123. [PMID: 33509114 PMCID: PMC7844908 DOI: 10.1186/s12879-021-05817-1] [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: 07/14/2020] [Accepted: 01/18/2021] [Indexed: 12/30/2022] Open
Abstract
Background Xpert MTB/RIF (Xpert) has been recommended by WHO as the initial diagnostic test for TB and rifampicin-resistance detection. Existing evidence regarding its uptake is limited to public health systems and corresponding resource and infrastructure challenges. It cannot be readily extended to private providers, who treat more than half of India’s TB cases and demonstrate complex diagnostic behavior. Methods We used routine program data collected from November 2014 to April 2017 from large-scale private sector engagement pilots in Mumbai and Patna. It included diagnostic vouchers issued to approximately 150,000 patients by about 1400 providers, aggregated to 18,890 provider-month observations. We constructed three metrics to capture provider behavior with regards to adoption of Xpert and studied their longitudinal variation: (i) Uptake (ordering of test), (ii) Utilization for TB diagnosis, and (iii) Non-adherence to negative results. We estimated multivariate linear regression models to assess heterogeneity in provider behavior based on providers’ prior experience and Xpert testing volumes. Results Uptake of Xpert increased considerably in both Mumbai (from 36 to 60.4%) and Patna (from 12.2 to 45.1%). However, utilization of Xpert for TB diagnosis and non-adherence to negative Xpert results did not show systematic trends over time. In regression models, cumulative number of Xpert tests ordered was significantly associated with Xpert uptake in Patna and utilization for diagnosis in Mumbai (p-value< 0.01). Uptake of Xpert and its utilization for diagnosis was predicted to be higher in high-volume providers compared to low-volume providers and this gap was predicted to widen over time. Conclusions Private sector engagement led to substantial increase in uptake of Xpert, especially among high-volume providers, but did not show strong evidence of Xpert results being integrated with TB diagnosis. Increasing availability and affordability of a technically superior diagnostic tool may not be sufficient to fundamentally change diagnosis and treatment of TB in the private sector. Behavioral interventions, specifically aimed at, integrating Xpert results into clinical decision making of private providers may be required to impact patient-level outcomes. Supplementary Information The online version contains supplementary material available at 10.1186/s12879-021-05817-1.
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Affiliation(s)
- Sarang Deo
- Indian School of Business, AC 3, L1, #3113, ISB Campus, Gachibowli, Hyderabad, 500032, India.
| | - Pankaj Jindal
- Indian School of Business, AC 3, L1, #3113, ISB Campus, Gachibowli, Hyderabad, 500032, India.,UCLA Anderson School of Management, Los Angeles, United States
| | - Sirisha Papineni
- Harvard Medical School, Boston, United States.,World Health Partners, New Delhi, India
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4
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Banu S, Haque F, Ahmed S, Sultana S, Rahman MM, Khatun R, Paul KK, Kabir S, Rahman SMM, Banu RS, Islam MS, Ross AG, Clemens JD, Stevens R, Creswell J. Social Enterprise Model (SEM) for private sector tuberculosis screening and care in Bangladesh. PLoS One 2020; 15:e0241437. [PMID: 33226990 PMCID: PMC7682881 DOI: 10.1371/journal.pone.0241437] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2020] [Accepted: 10/14/2020] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND In Bangladesh, about 80% of healthcare is provided by the private sector. Although free diagnosis and care is offered in the public sector, only half of the estimated number of people with tuberculosis are diagnosed, treated, and notified to the national program. Private sector engagement strategies often have been small scale and time limited. We evaluated a Social Enterprise Model combining external funding and income generation at three tuberculosis screening centres across the Dhaka Metropolitan Area for diagnosing and treating tuberculosis. METHODS AND FINDINGS The model established three tuberculosis screening centres across Dhaka Metropolitan Area that carried the icddr,b brand and offered free Xpert MTB/RIF tests to patients visiting the screening centres for subsidized, digital chest radiographs from April 2014 to December 2017. A network of private and public health care providers, and community recommendation was formed for patient referral. No financial incentives were offered to physicians for referrals. Revenues from radiography were used to support screening centres' operation. Tuberculosis patients could choose to receive treatment from the private or public sector. Between 2014 and 2017, 1,032 private facilities networked with 8,466 private providers were mapped within the Dhaka Metropolitan Area. 64, 031 patients with TB symptoms were referred by the private providers, public sector and community residents to the three screening centres with 80% coming from private providers. 4,270 private providers made at least one referral. Overall, 10,288 pulmonary and extra-pulmonary tuberculosis cases were detected and 7,695 were bacteriologically positive by Xpert, corresponding to 28% of the total notifications in Dhaka Metropolitan Area. CONCLUSION The model established a network of private providers who referred individuals with presumptive tuberculosis without financial incentives to icddr,b's screening centres, facilitating a quarter of total tuberculosis notifications in Dhaka Metropolitan Area. Scaling up this approach may enhance national and international tuberculosis response.
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Affiliation(s)
- Sayera Banu
- icddr,b (International Centre for Diarrhoeal Diseases Research Bangladesh), Dhaka, Bangladesh
- * E-mail:
| | - Farhana Haque
- icddr,b (International Centre for Diarrhoeal Diseases Research Bangladesh), Dhaka, Bangladesh
| | - Shahriar Ahmed
- icddr,b (International Centre for Diarrhoeal Diseases Research Bangladesh), Dhaka, Bangladesh
| | - Sonia Sultana
- icddr,b (International Centre for Diarrhoeal Diseases Research Bangladesh), Dhaka, Bangladesh
| | - Md. Mahfuzur Rahman
- icddr,b (International Centre for Diarrhoeal Diseases Research Bangladesh), Dhaka, Bangladesh
| | - Razia Khatun
- icddr,b (International Centre for Diarrhoeal Diseases Research Bangladesh), Dhaka, Bangladesh
| | - Kishor Kumar Paul
- icddr,b (International Centre for Diarrhoeal Diseases Research Bangladesh), Dhaka, Bangladesh
| | - Senjuti Kabir
- icddr,b (International Centre for Diarrhoeal Diseases Research Bangladesh), Dhaka, Bangladesh
| | - S. M. Mazidur Rahman
- icddr,b (International Centre for Diarrhoeal Diseases Research Bangladesh), Dhaka, Bangladesh
| | - Rupali Sisir Banu
- National Tuberculosis Control Program (NTP), Ministry of Health and Welfare, Dhaka, Bangladesh
| | - Md. Shamiul Islam
- National Tuberculosis Control Program (NTP), Ministry of Health and Welfare, Dhaka, Bangladesh
| | - Allen G. Ross
- icddr,b (International Centre for Diarrhoeal Diseases Research Bangladesh), Dhaka, Bangladesh
| | - John D. Clemens
- icddr,b (International Centre for Diarrhoeal Diseases Research Bangladesh), Dhaka, Bangladesh
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5
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Faust L, Zimmer AJ, Kohli M, Saha S, Boffa J, Bayot ML, Nsofor I, Campos L, Mashamba-Thompson T, Herrera R, Emeka E, Shrestha S, Ugarte-Gil C, Katamba A, Pambudi I, Bichara D, Calderon RI, Ahmadzada N, Safdar MA, Nikam C, Dos Santos Lázari C, Hussain H, Win MM, Than KZ, Ahumibe A, Waning B, Pai M. SARS-CoV-2 testing in low- and middle-income countries: availability and affordability in the private health sector. Microbes Infect 2020; 22:511-514. [PMID: 33065265 PMCID: PMC7553871 DOI: 10.1016/j.micinf.2020.10.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Revised: 10/05/2020] [Accepted: 10/07/2020] [Indexed: 11/22/2022]
Affiliation(s)
- Lena Faust
- McGill International TB Centre, Montreal, Canada; Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Canada
| | - Alexandra J Zimmer
- McGill International TB Centre, Montreal, Canada; Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Canada
| | - Mikashmi Kohli
- McGill International TB Centre, Montreal, Canada; Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Canada
| | - Senjuti Saha
- Child Health Research Foundation, Dhaka, Bangladesh
| | - Jody Boffa
- Dahdaleh Institute for Global Health, York University, Canada; Centre for Rural Health, University of KwaZulu-Natal, South Africa
| | | | | | | | | | - Rosa Herrera
- Instituto de Servicios de Salud Pública del Estado de Baja California, Mexico
| | - Elom Emeka
- TB Laboratory Services Unit, NTBLCP, Federal Ministry of Health, Dept of Public Health, Federal Capital Territory, Abuja, Nigeria
| | | | - Cesar Ugarte-Gil
- Instituto de Medicina Tropical Alexander von Humboldt, Universidad Peruana Cayetano Heredia, Lima, Peru; School of Medicine, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Achilles Katamba
- Clinical Epidemiology & Biostatistics Unit, Department of Medicine School of Medicine, Makerere University College of Health Sciences, Uganda; Uganda Tuberculosis Implementation Research Consortium, Kampala, Uganda
| | | | - David Bichara
- Scientific Department of Amaral Costa Laboratory, Belém, PA, Brazil
| | - Roger I Calderon
- Socios En Salud Sucursal Peru, Lima, Peru; Programa Acadêmico de Tuberculose, Faculdade de Medicina, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | | | | | | | - Carolina Dos Santos Lázari
- Infectious Disease Medical Department, Grupo Fleury, Brazil; Molecular Biology Section, Central Laboratory Division, University of São Paulo Clinical Hospital, Brazil
| | | | | | | | | | | | - Madhukar Pai
- McGill International TB Centre, Montreal, Canada; Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Canada.
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6
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Chen SCI, Liu C, Hu R, Mo Y, Ye X. "Nomen Omen": Exploring Connected Healthcare through the Perspective of Name Omen. Healthcare (Basel) 2020; 8:E66. [PMID: 32210024 PMCID: PMC7151183 DOI: 10.3390/healthcare8010066] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Revised: 03/03/2020] [Accepted: 03/17/2020] [Indexed: 11/21/2022] Open
Abstract
Background: The evolution of names, from "medical informatics" to "connected health", implies that the evolvement of technology in health care has been shifted from technology-oriented to healthcare-oriented implementation. Connected healthcare, a healthcare platform of remote monitoring and self-management through technological measures, is suggested to contribute to the efficiency, cost-effectiveness, and satisfaction of healthcare recipient enhancement. However, limited understanding of related connected health (CH) terminology may constrain its implementation. Whether CH is a buzzword only or a practice that can contribute to an aging society is controversial. Objective: This study aims to distinguish CH-related terminology and to identify the trend of CH through reviewing its definition, initiation, development, and evolvement, in order to offer management insights and implications. The objective is to understand what is connected and who is cared about in the connected health model so that better applications can be addressed for the benefit of society. Method: This study reviews the evolution of names, from "medical informatics" in the 1970s to "connected health" after 2000, as well as relevant literature of CH, including e-health, telemedicine, telehealth, telecare, and m-health, to discover the trend of technology-related healthcare innovations. Results: The current status and issues facing accessibility, quality, and cost were presented. Its future trends will be explored through reviewing how changes in healthcare are managed, in addition to its operation and practice. Pre-conditions and requirements for implementing CH are identified to select a typical case to study. Findings suggest that areas with a complete business ecosystem-isolated locations, advanced information technology, aging in population, integrated health, and social care system-are prevalent for designing friendly CH environments. Conclusion: The evidence and tendency of technological convergence create a demand for innovation and partnering with start-up companies that offer a competitive advantage in innovation.
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Affiliation(s)
- Sonia Chien-I Chen
- Institute of Quantitative Economics, Huaqiao University, Xiamen 362021, Fujian, China;
| | - Chenglian Liu
- School of Computing, Neusoft Institute of Guangdong, Foshan 528225, China;
| | - Ridong Hu
- Institute of Quantitative Economics, Huaqiao University, Xiamen 362021, Fujian, China;
| | - Yiyi Mo
- College of Civil engineering, Huaqiao University, Xiamen 361021, Fujian, China; (Y.M.); (X.Y.)
| | - Xiupin Ye
- College of Civil engineering, Huaqiao University, Xiamen 361021, Fujian, China; (Y.M.); (X.Y.)
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7
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Piatek AS, Wells WA, Shen KC, Colvin CE. Realizing the "40 by 2022" Commitment from the United Nations High-Level Meeting on the Fight to End Tuberculosis: What Will It Take to Meet Rapid Diagnostic Testing Needs? GLOBAL HEALTH, SCIENCE AND PRACTICE 2019; 7:551-563. [PMID: 31818871 PMCID: PMC6927833 DOI: 10.9745/ghsp-d-19-00244] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Accepted: 09/17/2019] [Indexed: 11/23/2022]
Abstract
Existing rapid diagnostics offer faster and more sensitive diagnosis of tuberculosis (TB) and simultaneous detection of multidrug-resistant TB. A 5-fold increase in investment in these tools is needed to meet the needs of the TB community and the United Nations’ ambitious 40 million by 2022 diagnosis and treatment target. The potential gains from full adoption of World Health Organization (WHO)-recommended rapid diagnostics (WRDs) for tuberculosis (TB) are significant, but there is no current analysis of the additional investment needed to reach this goal. We sought to estimate the necessary investment in instruments, tests, and money, using Xpert MTB/RIF (Xpert), which detects Mycobacterium tuberculosis (MTB) and tests for resistance to rifampicin (RIF), as an example. An existing calculator for TB diagnostic needs was adapted to estimate the Xpert needs for a group of 24 countries with high TB burdens. This analysis assumed that countries will achieve the case-finding commitments agreed to at the recent United Nations High-Level Meeting on the Fight to End Tuberculosis, and that countries would adopt the WHO-recommended algorithm in which all people with signs and symptoms of TB receive an Xpert test. When compared to the current investments in these countries, this baseline model revealed that countries would require a 4-fold increase in the number of Xpert modules and a 6-fold increase in the number of Xpert test cartridges per year to meet their full testing needs. The incremental cost of the additional instruments for these countries would total approximately US$474 million, plus an incremental cost each year of cartridges of approximately $586 million, or a 5-fold increase over current investments. A sensitivity analysis revealed a variety of possible changes under alternative scenarios, but most of these changes either do not meet the global goals, are unrealistic, or would result in even greater investment needs. These findings suggest that a major investment is needed in WRD capacity to implement the recommended diagnostic algorithm for TB and reach the case-finding commitments by 2022.
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Affiliation(s)
- Amy S Piatek
- United States Agency for International Development, Washington, DC, USA
| | - William A Wells
- United States Agency for International Development, Washington, DC, USA.
| | - Kaiser C Shen
- United States Agency for International Development, Washington, DC, USA
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8
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Ponnudurai N, Denkinger CM, Van Gemert W, Pai M. New TB Tools Need to be Affordable in the Private Sector: The Case Study of Xpert MTB/RIF. J Epidemiol Glob Health 2019; 8:103-105. [PMID: 30864749 PMCID: PMC7377554 DOI: 10.2991/j.jegh.2018.04.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Accepted: 04/25/2018] [Indexed: 01/22/2023] Open
Affiliation(s)
| | | | | | - Madhukar Pai
- McGill International TB Centre, McGill University, Montreal, Canada.,Manipal McGill Centre for Infectious Diseases, Manipal Academy of Higher Education, Manipal, India
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9
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Land KJ. The Many Roads to an Ideal Paper-based Device. PAPER-BASED DIAGNOSTICS 2018. [PMCID: PMC7119996 DOI: 10.1007/978-3-319-96870-4_6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
The recent Zika and Ebola virus outbreaks highlight the need for low-cost diagnostics that can be rapidly deployed and used outside of established clinical infrastructure. This demand for robust point-of-care (POC) diagnostics is further driven by the increasing burden of drug-resistant diseases, concern for food and water safety, and bioterrorism. As has been discussed in previous chapters, paper-based tests provide a simple and compelling solution to such needs.
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Affiliation(s)
- Kevin J. Land
- Council for Scientific and Industrial Research, Pretoria, South Africa
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10
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Ma D, Shen L, Wu K, Diehnelt CW, Green AA. Low-cost detection of norovirus using paper-based cell-free systems and synbody-based viral enrichment. Synth Biol (Oxf) 2018; 3:ysy018. [PMID: 30370338 PMCID: PMC6195790 DOI: 10.1093/synbio/ysy018] [Citation(s) in RCA: 79] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2018] [Revised: 08/18/2018] [Accepted: 09/14/2018] [Indexed: 11/14/2022] Open
Abstract
Noroviruses are a primary cause of gastroenteritis and foodborne illness with cases that affect millions of people worldwide each year. Inexpensive tests for norovirus that do not require sophisticated laboratory equipment are important tools for ensuring that patients receive timely treatment and for containing outbreaks. Herein, we demonstrate a low-cost colorimetric assay that detects norovirus from clinical samples by combining paper-based cell-free transcription-translation systems, isothermal amplification and virus enrichment by synbodies. Using isothermal amplification and cell-free RNA sensing with toehold switches, we demonstrate that the assay enables detection of norovirus GII.4 Sydney from stool down to concentrations of 270 aM in reactions that can be directly read by eye. Furthermore, norovirus-binding synbodies and magnetic beads are used to concentrate the virus and provide a 1000-fold increase in assay sensitivity extending its detection limit to 270 zM. These results demonstrate the utility of paper-based cell-free diagnostic systems for identification of foodborne pathogens and provide a versatile diagnostic assay that can be applied to the concentration, amplification and detection of a broad range of infectious agents.
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Affiliation(s)
- Duo Ma
- Biodesign Center for Molecular Design and Biomimetics, The Biodesign Institute and School of Molecular Sciences, Arizona State University, AZ, USA
| | - Luhui Shen
- Biodesign Center for Innovations in Medicine, The Biodesign Institute and School of Molecular Sciences, Arizona State University, AZ, USA
| | - Kaiyue Wu
- Biodesign Center for Molecular Design and Biomimetics, The Biodesign Institute and School of Molecular Sciences, Arizona State University, AZ, USA
| | - Chris W Diehnelt
- Biodesign Center for Innovations in Medicine, The Biodesign Institute and School of Molecular Sciences, Arizona State University, AZ, USA
| | - Alexander A Green
- Biodesign Center for Molecular Design and Biomimetics, The Biodesign Institute and School of Molecular Sciences, Arizona State University, AZ, USA
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11
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Ponnudurai N, Denkinger CM, Van Gemert W, Pai M. New TB Tools Need to be Affordable in the Private Sector: The Case Study of Xpert MTB/RIF. J Epidemiol Glob Health 2018. [DOI: 10.1016/j.jegh.2018.04.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
Affiliation(s)
| | | | | | - Madhukar Pai
- McGill International TB Centre, McGill University, Montreal, Canada
- Manipal McGill Centre for Infectious Diseases, Manipal Academy of Higher Education, Manipal, India
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12
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Abstract
Rapid and accurate diagnosis is critical for timely initiation of anti-tuberculosis (TB) treatment, but many people with TB (or TB symptoms) do not have access to adequate initial diagnosis. In many countries, TB diagnosis is still reliant on sputum microscopy, a test with known limitations. However, new diagnostics are starting to change the landscape. Stimulated, in part, by the success and rollout of Xpert MTB/RIF, an automated, molecular test, there is now considerable interest in new technologies. The landscape looks promising with a pipeline of new tools, particularly molecular diagnostics, and well over 50 companies actively engaged in product development, and many tests have been reviewed by WHO for policy endorsement. However, new diagnostics are yet to reach scale, and there needs to be greater convergence between diagnostics development and the development of shorter TB drug regimens. Another concern is the relative absence of non-sputum-based diagnostics in the pipeline for children, and of biomarker tests for triage, cure, and latent TB progression. Increased investments are necessary to support biomarker discovery, validation, and translation into clinical tools. While transformative tools are being developed, high-burden countries will need to improve the efficiency of their health care delivery systems, ensure better uptake of new technologies, and achieve greater linkages across the TB and HIV care continuum. While we wait for next-generation technologies, national TB programs must scale up the best diagnostics currently available, and use implementation science to get the maximum impact.
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13
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Méndez-Samperio P. Diagnosis of Tuberculosis in HIV Co-infected Individuals: Current Status, Challenges and Opportunities for the Future. Scand J Immunol 2017; 86:76-82. [PMID: 28513865 DOI: 10.1111/sji.12567] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2017] [Accepted: 05/07/2017] [Indexed: 02/03/2023]
Abstract
Tuberculosis (TB) remains one of the most important causes of death among people co-infected with human immunodeficiency virus (HIV). The diagnosis of TB remains challenging in HIV co-infected individuals, due to a high frequency of smear-negative disease and high rates of extrapulmonary TB. Accurate, ease of use and rapid diagnosis of active TB are critical to the World Health Organization (WHO) End TB Strategy by 2050. Traditional laboratory techniques do not provide rapid and accurate results to effectively manage HIV co-infected patients. Over the last decade, molecular methods have provided significant steps in the fight against TB. However, many HIV co-infected patients do not have access to these molecular diagnostic tests. Given the costs closely related with confirming a TB diagnosis in HIV patients, an overtreatment for TB is used in this patient population. Nowadays, an estimated US $8 billion a year is required to provide TB treatment, which is very high compared with making an important strategy to improve the current diagnostic tests. This review focuses on current advances in diagnosing active TB with an emphasis on the diagnosis of HIV-associated TB. Also discussed are the main challenges that need to be overcome for improving an adequate initial diagnosis of active TB in HIV-positive patients.
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Affiliation(s)
- P Méndez-Samperio
- Departamento de Inmunología, Escuela Nacional de Ciencias Biológicas, IPN, México, México
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14
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Vergara Gómez A, González-Martín J, García-Basteiro AL. Xpert® MTB/RIF: Usefulness for the diagnosis of tuberculosis and resistance to rifampicin. Med Clin (Barc) 2017; 149:399-405. [PMID: 28739268 DOI: 10.1016/j.medcli.2017.06.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Revised: 06/05/2017] [Accepted: 06/06/2017] [Indexed: 11/19/2022]
Abstract
The advent of the Xpert® MTB/RIF technique was a revolution in the diagnosis of tuberculosis, especially in areas with high incidence and low resources. It allows the detection of Mycobacterium tuberculosis complex and simultaneously the most common resistance mutations to rifampicin in less than 2h. For respiratory samples the sensitivity is very high, but it decreases for extrapulmonary samples and children. Although it is faster and simpler than conventional methods, it presents some limitations and new and better techniques are needed to reduce the number of cases and deaths caused by tuberculosis. This review aims to assess the scientific evidence around the diagnostic performance of Xpert® MTB/RIF in different types of samples and populations, as well as analyse its strengths and limitations for TB diagnosis.
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Affiliation(s)
- Andrea Vergara Gómez
- Servicio de Microbiología, CDB, Hospital Clínic de Barcelona, Universitat de Barcelona, Barcelona, España
| | - Julià González-Martín
- Servicio de Microbiología, CDB, Hospital Clínic de Barcelona, Universitat de Barcelona, Barcelona, España; Institut de Salut Global de Barcelona (ISGlobal), Barcelona, España
| | - Alberto L García-Basteiro
- Institut de Salut Global de Barcelona (ISGlobal), Barcelona, España; Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique; Amsterdam Institute for Global Health and Development (AIGHD), Ámsterdam, Países Bajos.
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15
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Pai M, Furin J. Tuberculosis innovations mean little if they cannot save lives. eLife 2017; 6. [PMID: 28460659 PMCID: PMC5413344 DOI: 10.7554/elife.25956] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2017] [Accepted: 04/10/2017] [Indexed: 12/18/2022] Open
Abstract
The past decade has seen the emergence of new diagnostics and drugs for tuberculosis, a disease that kills over 1.8 million people each year. However, these new tools are yet to reach scale, and access remains a major challenge for patients in low and middle income countries. Urgent action is needed if we are committed to ending the TB epidemic. This means raising the level of ambition, embracing innovation, increasing financial investments, addressing implementation gaps, and ensuring that new technologies reach those who need them to survive. Otherwise, the promise of innovative technologies will never be realized.
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Affiliation(s)
- Madhukar Pai
- McGill Global Health Programs and McGill International Tuberculosis Centre, McGill University, Montreal, Canada.,Manipal McGill Centre for Infectious Diseases, Manipal University, Manipal, India
| | - Jennifer Furin
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, United States
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16
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Rahman MT, Codlin AJ, Rahman MM, Nahar A, Reja M, Islam T, Qin ZZ, Khan MAS, Banu S, Creswell J. An evaluation of automated chest radiography reading software for tuberculosis screening among public- and private-sector patients. Eur Respir J 2017; 49:1602159. [PMID: 28529202 PMCID: PMC5460641 DOI: 10.1183/13993003.02159-2016] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2016] [Accepted: 01/09/2017] [Indexed: 11/22/2022]
Abstract
Computer-aided reading (CAR) of medical images is becoming increasingly common, but few studies exist for CAR in tuberculosis (TB). We designed a prospective study evaluating CAR for chest radiography (CXR) as a triage tool before Xpert MTB/RIF (Xpert).Consecutively enrolled adults in Dhaka, Bangladesh, with TB symptoms received CXR and Xpert. Each image was scored by CAR and graded by a radiologist. We compared CAR with the radiologist for sensitivity and specificity, area under the receiver operating characteristic curve (AUC), and calculated the potential Xpert tests saved.A total of 18 036 individuals were enrolled. TB prevalence by Xpert was 15%. The radiologist graded 49% of CXRs as abnormal, resulting in 91% sensitivity and 58% specificity. At a similar sensitivity, CAR had a lower specificity (41%), saving fewer (36%) Xpert tests. The AUC for CAR was 0.74 (95% CI 0.73-0.75). CAR performance declined with increasing age. The radiologist grading was superior across all sub-analyses.Using CAR can save Xpert tests, but the radiologist's specificity was superior. Differentiated CAR thresholds may be required for different populations. Access to, and costs of, human readers must be considered when deciding to use CAR software. More studies are needed to evaluate CAR using different screening approaches.
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Affiliation(s)
- Md Toufiq Rahman
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | | | - Md Mahfuzur Rahman
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Ayenun Nahar
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Mehdi Reja
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Tariqul Islam
- National Institute of Neurosciences and Hospital, Dhaka, Bangladesh
| | | | | | - Sayera Banu
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
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17
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Direct Detection of Rifampin and Isoniazid Resistance in Sputum Samples from Tuberculosis Patients by High-Resolution Melt Curve Analysis. J Clin Microbiol 2017; 55:1755-1766. [PMID: 28330890 DOI: 10.1128/jcm.02104-16] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2016] [Accepted: 03/17/2017] [Indexed: 01/22/2023] Open
Abstract
Drug-resistant tuberculosis (TB) is a major threat to TB control worldwide. Globally, only 40% of the 340,000 notified TB patients estimated to have multidrug-resistant-TB (MDR-TB) were detected in 2015. This study was carried out to evaluate the utility of high-resolution melt curve analysis (HRM) for the rapid and direct detection of MDR-TB in Mycobacterium tuberculosis in sputum samples. A reference plasmid library was first generated of the most frequently observed mutations in the resistance-determining regions of rpoB, katG, and an inhA promoter and used as positive controls in HRM. The assay was first validated in 25 MDR M. tuberculosis clinical isolates. The assay was evaluated on DNA isolated from 99 M. tuberculosis culture-positive sputum samples that included 84 smear-negative sputum samples, using DNA sequencing as gold standard. Mutants were discriminated from the wild type by comparing melting-curve patterns with those of control plasmids using HRM software. Rifampin (RIF) and isoniazid (INH) monoresistance were detected in 11 and 21 specimens, respectively, by HRM. Six samples were classified as MDR-TB by sequencing, one of which was missed by HRM. The HRM-RIF, INH-katG, and INH-inhA assays had 89% (95% confidence interval [CI], 52, 100%), 85% (95% CI, 62, 97%), and 100% (95% CI, 74, 100%) sensitivity, respectively, in smear-negative samples, while all assays had 100% sensitivity in smear-positive samples. All assays had 100% specificity. Concordance of 97% to 100% (κ value, 0.9 to 1) was noted between sequencing and HRM. Heteroresistance was observed in 5 of 99 samples by sequencing. In conclusion, the HRM assay was a cost-effective (Indian rupee [INR]400/US$6), rapid, and closed-tube method for the direct detection of MDR-TB in sputum, especially for direct smear-negative cases.
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18
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MacLean E, Huddart S, Pai M. Molecular diagnosis of tuberculosis: we need solutions that span the healthcare value chain. Expert Rev Mol Diagn 2016; 17:5-7. [PMID: 27892734 DOI: 10.1080/14737159.2017.1265889] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Emily MacLean
- a Department of Epidemiology & Biostatistics , McGill University , Montreal , Canada.,b McGill International TB Centre , McGill University , Montreal , Canada
| | - Sophie Huddart
- a Department of Epidemiology & Biostatistics , McGill University , Montreal , Canada.,b McGill International TB Centre , McGill University , Montreal , Canada
| | - Madhukar Pai
- a Department of Epidemiology & Biostatistics , McGill University , Montreal , Canada.,b McGill International TB Centre , McGill University , Montreal , Canada
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19
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Salve S, Sheikh K, Porter JDH. Private Practitioners' Perspectives on Their Involvement With the Tuberculosis Control Programme in a Southern Indian State. Int J Health Policy Manag 2016; 5:631-642. [PMID: 27801358 PMCID: PMC5088723 DOI: 10.15171/ijhpm.2016.52] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2015] [Accepted: 05/01/2016] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Public and private health sectors both play a crucial role in the health systems of low- and middle-income countries (LMICs). The tuberculosis (TB) control strategy in India encourages the public sector to actively partner with private practitioners (PPs) to improve the quality of front line service delivery. However, ensuring effective and sustainable involvement of PPs constitutes a major challenge. This paper reports the findings from an empirical study focusing on the perspectives and experiences of PPs towards their involvement in TB control programme in India. METHODS The study was carried out between November 2010 and December 2011 in a district of a Southern Indian State and utilised qualitative methodologies, combining observations and in-depth interviews with 21 PPs from different medical systems. The collected data was coded and analysed using thematic analysis. RESULTS PPs perceived themselves to be crucial healthcare providers, with different roles within the public-private mix (PPM) TB policy. Despite this, PPs felt neglected and undervalued in the actual process of implementation of the PPM-TB policy. The entire process was considered to be government driven and their professional skills and knowledge of different medical systems remained unrecognised at the policy level, and weakened their relationship and bond with the policy and with the programme. PPs had contrasting perceptions about the different components of the TB programme that demonstrated the public sector's dominance in the overall implementation of the DOTS strategy. Although PPs felt responsible for their TB patients, they found it difficult to perceive themselves as 'partners with the TB programme.' CONCLUSION Public-private partnerships (PPPs) are increasingly utilized as a public health strategy to strengthen health systems. These policies will fail if the concerns of the PPs are neglected. To ensure their long-term involvement in the programme the abilities of PPs and the important perspectives from other Indian medical systems need to be recognised and supported.
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Affiliation(s)
- Solomon Salve
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
- The Maharashtra Association of Anthropological Sciences, Centre for Health Research and Development (MAAS-CHRD), Savitribai Phule Pune University, Pune, India
| | - Kabir Sheikh
- Public Health Foundation of India, New Delhi, India
| | - John DH Porter
- Departments of Clinical Research and Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
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20
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Chen Y, Zhang J, Wang X, Wu Y, Zhu L, Lu L, Shen Q, Qin Y. HMGB1 level in cerebrospinal fluid as a complimentary biomarker for the diagnosis of tuberculous meningitis. SPRINGERPLUS 2016; 5:1775. [PMID: 27795917 PMCID: PMC5061653 DOI: 10.1186/s40064-016-3478-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/07/2016] [Accepted: 10/05/2016] [Indexed: 01/08/2023]
Abstract
Purpose High mobility group box-1 (HMGB1) is a proinflammatory, DAMP protein that participates in many pathological conditions. In this study, we evaluated the usability of CSF HMGB1 as a biomarker for the diagnosis of tuberculous meningitis (TBM). Methods A total of 59 TBM patients and 169 control patients were included in our study. CSF samples were obtained and analyzed for HMGB1 using a commercial ELISA kit. Results The mean CSF HMGB1 was 19.36 ng/ml in TBM patients (n = 59) versus 3.12 ng/ml in non-TB meningitis patients (n = 30), 2.13 ng/ml in patients with extra neural tuberculosis (n = 73), and 1.06 ng/m in controls (n = 66). According to the receiver operator characteristic curves, a cut-off value of 3.4 ng/ml was calculated, indicating that the sensitivity and specificity of CSF HMGB1 alone in diagnosis of TBM were 61.02 and 89.94 %, respectively. In patients with extra neural tuberculosis and a high risk of TBM, CSF HMGB1 seemed to be a good candidate for early differential diagnosis of TBM at the cut-off value of 3.8 ng/ml, when the sensitivity and specificity were 79.49 and 94.52 % respectively. Conclusion Our finding may prove to be clinically useful, because CSF HMGB1 ELISA can be performed in almost all clinical laboratories, especially when sophisticated technologies are either time consuming or unavailable.
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Affiliation(s)
- Yan Chen
- Department of Clinical Laboratory Medicine, Shanghai Tenth People's Hospital, Tongji University, Shanghai, 200072 People's Republic of China.,Department of Laboratory Diagnosis, Changhai Hospital, the Second Military Medical University, Shanghai, 200433 People's Republic of China
| | - Jun Zhang
- Department of Clinical Laboratory Medicine, Shanghai Pulmonary Hospital, Tongji University, Shanghai, 200433 People's Republic of China
| | - Xiaofei Wang
- Department of Clinical Laboratory Medicine, Shanghai Pulmonary Hospital, Tongji University, Shanghai, 200433 People's Republic of China
| | - Yu Wu
- Department of Laboratory Diagnosis, Changhai Hospital, the Second Military Medical University, Shanghai, 200433 People's Republic of China
| | - Li Zhu
- Department of Laboratory Diagnosis, Changhai Hospital, the Second Military Medical University, Shanghai, 200433 People's Republic of China
| | - Longkun Lu
- Department of Laboratory Diagnosis, Changhai Hospital, the Second Military Medical University, Shanghai, 200433 People's Republic of China
| | - Qian Shen
- Department of Laboratory Diagnosis, Changhai Hospital, the Second Military Medical University, Shanghai, 200433 People's Republic of China
| | - Yanghua Qin
- Department of Laboratory Diagnosis, Changhai Hospital, the Second Military Medical University, Shanghai, 200433 People's Republic of China
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21
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Small PM. Making Tuberculosis Care and Control Easy Again. Am J Respir Crit Care Med 2016; 194:537-8. [DOI: 10.1164/rccm.201603-0442ed] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Peter M. Small
- Global Health InstituteStony Brook UniversityStony Brook, New Yorkand
- Center for Strategic and International StudiesWashington, DC
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22
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Albert H, Nathavitharana RR, Isaacs C, Pai M, Denkinger CM, Boehme CC. Development, roll-out and impact of Xpert MTB/RIF for tuberculosis: what lessons have we learnt and how can we do better? Eur Respir J 2016; 48:516-25. [PMID: 27418550 PMCID: PMC4967565 DOI: 10.1183/13993003.00543-2016] [Citation(s) in RCA: 208] [Impact Index Per Article: 26.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2016] [Accepted: 05/14/2016] [Indexed: 12/03/2022]
Abstract
The global roll-out of Xpert MTB/RIF (Cepheid Inc., Sunnyvale, CA, USA) has changed the diagnostic landscape of tuberculosis (TB). More than 16 million tests have been performed in 122 countries since 2011, and detection of multidrug-resistant TB has increased three- to eight-fold compared to conventional testing. The roll-out has galvanised stakeholders, from donors to civil society, and paved the way for universal drug susceptibility testing. It has attracted new product developers to TB, resulting in a robust molecular diagnostics pipeline. However, the roll-out has also highlighted gaps that have constrained scale-up and limited impact on patient outcomes. The roll-out has been hampered by high costs for under-funded programmes, unavailability of a complete solution package (notably comprehensive training, quality assurance, implementation plans, inadequate service and maintenance support) and lack of impact assessment. Insufficient focus has been afforded to effective linkage to care of diagnosed patients, and clinical impact has been blunted by weak health systems. In many countries the private sector plays a dominant role in TB control, yet this sector has limited access to subsidised pricing. In light of these lessons, we advocate for a comprehensive diagnostics implementation approach, including increased engagement of in-country stakeholders for product launch and roll-out, broader systems strengthening in preparation for new technologies, as well as quality impact data from programmatic settings. A comprehensive diagnostic solution approach including systems strengthening is essential for TB diagnostics impacthttp://ow.ly/uWSy300CfJT
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Affiliation(s)
| | - Ruvandhi R Nathavitharana
- Division of Infectious Diseases, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | | | - Madhukar Pai
- Dept of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, QC, Canada
| | - Claudia M Denkinger
- Division of Infectious Diseases, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA FIND, Geneva, Switzerland
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