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Moro V, Canals J, Moreno S, Higgins-Wood S, Alonso O, Waag A, Prades JD, Dieguez A. Fluorescence Multi-Detection Device Using a Lensless Matrix Addressable microLED Array. BIOSENSORS 2024; 14:264. [PMID: 38920568 PMCID: PMC11202237 DOI: 10.3390/bios14060264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/25/2024] [Revised: 04/29/2024] [Accepted: 05/21/2024] [Indexed: 06/27/2024]
Abstract
A Point-of-Care system for molecular diagnosis (PoC-MD) is described, combining GaN and CMOS chips. The device is a micro-system for fluorescence measurements, capable of analyzing both intensity and lifetime. It consists of a hybrid micro-structure based on a 32 × 32 matrix addressable GaN microLED array, with square LEDs of 50 µm edge length and 100 µm pitch, with an underneath wire bonded custom chip integrating their drivers and placed face-to-face to an array of 16 × 16 single-photon avalanche diodes (SPADs) CMOS. This approach replaces instrumentation based on lasers, bulky optical components, and discrete electronics with a full hybrid micro-system, enabling measurements on 32 × 32 spots. The reported system is suitable for long lifetime (>10 ns) fluorophores with a limit of detection ~1/4 µM. Proof-of-concept measurements of streptavidin conjugate Qdot™ 605 and Amino PEG Qdot™ 705 are demonstrated, along with the device ability to detect both fluorophores in the same measurement.
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Affiliation(s)
- Victor Moro
- Electronic and Biomedical Engineering Department, University of Barcelona, 08028 Barcelona, Spain; (J.C.); (S.M.); (O.A.); (J.D.P.)
| | - Joan Canals
- Electronic and Biomedical Engineering Department, University of Barcelona, 08028 Barcelona, Spain; (J.C.); (S.M.); (O.A.); (J.D.P.)
| | - Sergio Moreno
- Electronic and Biomedical Engineering Department, University of Barcelona, 08028 Barcelona, Spain; (J.C.); (S.M.); (O.A.); (J.D.P.)
| | - Steffen Higgins-Wood
- Institute of Semiconductor Technology, Technical University of Braunschweig, 38106 Braunschweig, Germany; (S.H.-W.); (A.W.)
| | - Oscar Alonso
- Electronic and Biomedical Engineering Department, University of Barcelona, 08028 Barcelona, Spain; (J.C.); (S.M.); (O.A.); (J.D.P.)
| | - Andreas Waag
- Institute of Semiconductor Technology, Technical University of Braunschweig, 38106 Braunschweig, Germany; (S.H.-W.); (A.W.)
| | - J. Daniel Prades
- Electronic and Biomedical Engineering Department, University of Barcelona, 08028 Barcelona, Spain; (J.C.); (S.M.); (O.A.); (J.D.P.)
- Institute of Semiconductor Technology, Technical University of Braunschweig, 38106 Braunschweig, Germany; (S.H.-W.); (A.W.)
| | - Angel Dieguez
- Electronic and Biomedical Engineering Department, University of Barcelona, 08028 Barcelona, Spain; (J.C.); (S.M.); (O.A.); (J.D.P.)
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Maluleke K, Musekiwa A, Mashamba-Thompson T. Evaluating supply chain management of SARS-CoV-2 point-of-care (POC) diagnostic services in primary healthcare clinics in Mopani District, Limpopo Province, South Africa. PLoS One 2023; 18:e0287477. [PMID: 37368879 DOI: 10.1371/journal.pone.0287477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Accepted: 06/06/2023] [Indexed: 06/29/2023] Open
Abstract
Access to point-of-care (POC) diagnostics in resource-limited settings, where laboratory-based diagnostics are limited, depends on efficient supply chain management (SCM). This study evaluated the SCM for SARS-CoV-2 POC diagnostic services in resource-limited settings to determine the effect of SCM on accessibility to SARS-CoV-2 POC tests and to identify barriers and enablers of accessibility to SARS-CoV-2 diagnostic services in Mopani District, Limpopo Province, South Africa. We purposively assessed 47 clinics providing POC diagnostic services between June and September 2022. One participant per clinic completed an audit tool developed by the authors with guidance from the World Health Organization and the Management Sciences for Health guidelines. The audit tool evaluated the following SCM parameters: selection, quantification, storage, procurement, quality assurance, distribution, redistribution, inventory management, and human resource capacity. Percentage rating scores between 90-100% indicated that the facility was compliant with SCM guidelines, while rating scores < 90% indicated non-compliance. The clinic audit scores were summarized and compared across clinics and sub-districts. Clinics had compliance scores ranging from 60.5% to 89.2%. Compliance scores were the highest for procurement, redistribution, and quality assurance (all 100%), followed by storage (mean = 95.2%, 95% CI: 90.7-99.7), quantification (mean = 89.4%, 95% CI: 80.2-98.5), and selection (mean = 87.5%, 95% CI: 87.5%-87.5%). Compliance scores were the lowest for inventory management (mean = 53.2%, 95% CI: 47.9%-58.5%), distribution (mean = 48.6%, 95% CI: 44.6%-52.7%), and human resource capacity (mean = 50.6%, 95% CI: 43.3%-58.0%). A significant correlation was found between compliance score and clinic headcount (r = 0.4, p = 0.008), and compliance score and ideal clinic score (r = 0.4, p = 0.0003). Overall, the 47 clinics audited did not comply with international SCM guidelines. Of the nine SCM parameters evaluated, only procurement, redistribution, and quality assurance did not need improvement. All parameters are key in ensuring full functionality of SCM systems and equitable access to SARS-CoV-2 POC diagnostics in resource limited settings.
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Affiliation(s)
- Kuhlula Maluleke
- School of Health Systems and Public Health, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
| | - Alfred Musekiwa
- School of Health Systems and Public Health, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
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Oehme R, Sandholzer-Yilmaz AS, Heise M, Frese T, Fankhaenel T. Utilization of point-of-care tests among general practitioners, a cross-sectional study. BMC PRIMARY CARE 2022; 23:41. [PMID: 35264103 PMCID: PMC8906527 DOI: 10.1186/s12875-022-01643-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Accepted: 02/14/2022] [Indexed: 11/15/2022]
Abstract
Background Point-of-care testing (POCT) has numerous potential benefits to improve health care service, especially in resource-limited settings. We aim to identify which POC-tests (POCTs) of laboratory parameters are known, employed, and rated as useful by general practitioners (GPs). Methods A questionnaire with 27 POCTs was posted to a random selection of GPs (n = 451) in Saxony, Germany. Results A total of 208 GPs replied (response rate 46.1%). Out of 27 POCTs, each GP knew an average of 20.3 as laboratory parameters and 9.2 as POCTs. Urine test strips (99.0%), blood glucose test (98.1%), and Troponin I/T (86.4%) were the best-known, followed by INR/Quick (82.5%), Microalbumin (79.1%), and D-dimer (78.6%) POCTs. Yet, solely 0 to 13 POC tests were actually used (mean value 4.6). Urine test strips were employed most frequently (97.6%), followed by blood glucose test (94.7%), Troponin I/T (57.8%), Microalbumin (57.3%), and INR/Quick POCTs (41.7%). Heart fatty binding protein (H-FABP), Syphilis, Coeliac disease, and Malaria appeared as the least frequently used POCTs. The majority of the GPs declared 14 of the 27 POCTs to be useful. Discussion/conclusion The most recurrently employed POCTs are those for diagnosing or monitoring diabetes mellitus, ensued by POCTs addressing acute cardiovascular diseases (Troponin I/T, D-dimer) or monitoring the therapy of infectious diseases or the anticoagulant therapy. POCTs most often rated as useful by GPs are also widely known and frequently used. Nonetheless, the majority of GPs rate only a very limited number of POCTs as useful. Frequent concerns might be low economic benefit, over-reliance, and test accuracy coming along with the complex implementation of the tests requiring technical skills, accurate storage, and the correct interpretation of test results. Trial registration In accordance with the (Model) Professional Code for Physicians in Germany, neither human body materials nor data that can be assigned to a specific human being are used in our study. A declaration of no objection from the Ethics Committee of the Martin-Luther University Halle-Wittenberg (Medical Faculty) confirms no professional or ethical concerns due to completely anonymized data collection and analysis. Our study was therefore not registered in a corresponding registry. Supplementary Information The online version contains supplementary material available at 10.1186/s12875-022-01643-9.
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Martin K, Wenlock R, Roper T, Butler C, Vera JH. Facilitators and barriers to point-of-care testing for sexually transmitted infections in low- and middle-income countries: a scoping review. BMC Infect Dis 2022; 22:561. [PMID: 35725437 PMCID: PMC9208134 DOI: 10.1186/s12879-022-07534-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Accepted: 06/13/2022] [Indexed: 11/10/2022] Open
Abstract
Background Sexually transmitted infections (STIs) in low- and middle-income countries (LMICs) are predominantly managed by syndromic management. However, most STIs are asymptomatic. These untreated STIs cause individual morbidity, and lead to high STI prevalences. There is increasing interest in the use of point-of-care tests (POCTs) for STIs in LMICs, which could facilitate same day testing and treatment. To best utilise these tests, we must understand the facilitators and barriers to their implementation. The aim of this review is to explore how point-of-care testing for STIs has been implemented into healthcare systems in LMIC and the facilitators and barriers to doing so. Methods A scoping review was conducted by searching MEDLINE, Embase, Emcare, CINAHL, Scopus, LILACS, the Cochrane Library, and ProQuest Dissertations and Theses for studies published between 1st January 1998 and 5th June 2020. Abstracts and full articles were screened independently by two reviewers. Studies were considered for inclusion if they assessed the acceptability, feasibility, facilitators, or barriers to implementation of point-of-care testing for chlamydia, gonorrhoea, trichomoniasis or syphilis in LMICs. Thematic analysis was used to analyse and present the facilitators and barriers to point-of-care STI testing. Results The literature search revealed 82 articles suitable for inclusion; 44 (53.7%) from sub-Saharan Africa; 21 (25.6%) from Latin American and the Caribbean; 10 (12.2%) from East Asia and the Pacific; 6 (7.3%) from South Asia; and one (1.2%) multi-regional study. Thematic analysis revealed seven overarching themes related to the implementation of POCTs in LMICs, namely (i) Ideal test characteristics, (ii) Client factors, (iii) Healthcare provision factors, (iv) Policy, infrastructure and health system factors, (v) Training, audit, and feedback, (vi) Reaching new testing environments, and (vii) Dual testing. Conclusion Implementation of POCTs in LMICs is complex, with many of the barriers due to wider health system weakness. In addition to pressing for broader structural change to facilitate basic healthcare delivery, these themes may also be used as a basis on which to develop future interventions. The literature was heavily skewed towards syphilis testing, and so more research needs to be conducted assessing chlamydia, gonorrhoea, and trichomoniasis testing, as well as home or self-testing. Supplementary Information The online version contains supplementary material available at 10.1186/s12879-022-07534-9.
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Affiliation(s)
- Kevin Martin
- Department of Clinical Research, London School of Hygiene & Tropical Medicine, London, WC1E 7HT, UK. .,Biomedical Research and Training Institute, Harare, Zimbabwe. .,Department of Global Health and Infection, Brighton and Sussex Medical School, Brighton, UK.
| | - Rhys Wenlock
- University Hospitals Sussex NHS Foundation Trust, Brighton, UK
| | - Tom Roper
- University Hospitals Sussex NHS Foundation Trust, Brighton, UK
| | - Ceri Butler
- Department of Medical Education, Brighton and Sussex Medical School, Brighton, UK
| | - Jaime H Vera
- Department of Global Health and Infection, Brighton and Sussex Medical School, Brighton, UK.,University Hospitals Sussex NHS Foundation Trust, Brighton, UK
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Spooner E, Reddy T, Mchunu N, Reddy S, Daniels B, Ngomane N, Luthuli N, Kiepiela P, Coutsoudis A. Point-of-care CD4 testing: Differentiated care for the most vulnerable. J Glob Health 2022; 12:04004. [PMID: 35136596 PMCID: PMC8818294 DOI: 10.7189/jogh.12.04004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Background South Africa, with the highest burden of HIV infection globally, has made huge strides in its HIV/ART programme, but AIDS deaths have not decreased proportionally to ART uptake. Advanced HIV disease (CD4 < 200 cells/mm3) persists, and CD4 count testing is being overlooked since universal test-and-treat was implemented. Point-of-care CD4 testing could address this gap and assure differentiated care to these vulnerable patients with low CD4 counts. Methods A time randomised implementation trial was conducted, enrolling 603 HIV positive non-ART, not pregnant patients at a primary health care clinic in Durban, South Africa. Weeks were randomised to either point-of-care CD4 testing (n = 305 patients) or standard-of-care central laboratory CD4 testing (n = 298 patients) to assess the proportion initiating ART at 3 months. Cox regression, with robust standard errors adjusting for clustering by week, were used to assess the relationship between treatment initiation and arm. Results Among the 578 (299 point-of-care and 279 standard-of-care) patients eligible for analysis, there was no significant difference in the number of eligible patients initiating ART within 3 months in the point-of-care (73%) and the standard-of-care (68%) groups (P = 0.112). The time-to-treat analysis was not significantly different in patients with CD4 counts of 201-500 cells/mm3 which could have been due to appointment scheduling to cope with the large burden of cases. However, in patients with advanced HIV disease (CD4 < 200cells/mm3) 65% more patients started ART earlier in the point-of-care group (HR 1.65 (95% confidence interval (CI) = 0.99-2.75; P = 0.052) compared to the standard-of-care group. Conclusions Point-of-care testing decreased time-to-treatment in those with advanced HIV disease. With universal test and treat for HIV, rollout of simple point-of-care CD4 testing would ensure early diagnosis of advanced HIV disease and facilitate differentiated care for these vulnerable patients as per the World Health Organisation 2020 target product profile for point-of-care CD4 testing. Trial registration ISRCTN14220457.
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Affiliation(s)
- Elizabeth Spooner
- Department of Paediatrics and Child Health, University of KwaZulu-Natal, Durban, South Africa
- South African Medical Research Council, HIV Prevention Research Unit, Durban, South Africa
| | - Tarylee Reddy
- South African Medical Research Council, Biostatistics Unit, Durban, South Africa
| | - Nobuhle Mchunu
- South African Medical Research Council, Biostatistics Unit, Durban, South Africa
- School of Mathematics, Statistics and Computer Science, University of KwaZulu-Natal, Pietermaritzburg, South Africa
| | | | - Brodie Daniels
- South African Medical Research Council, HIV Prevention Research Unit, Durban, South Africa
| | | | | | | | - Anna Coutsoudis
- Department of Paediatrics and Child Health, University of KwaZulu-Natal, Durban, South Africa
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Chamane N, Thompson R, Goldstone S, Mashamba-Thompson TP. Designing and Piloting of a Mobile Learning Curriculum for Quality Point-Of-Care Diagnostics Services in Rural Clinics of KwaZulu-Natal, South Africa. FRONTIERS IN REPRODUCTIVE HEALTH 2022; 3:728309. [PMID: 36304058 PMCID: PMC9580687 DOI: 10.3389/frph.2021.728309] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 12/16/2021] [Indexed: 11/23/2022] Open
Abstract
Background The use of mobile technology has been reported to help improve access to education for people in remote areas. However, there is limited evidence of its adoption in resource-limited settings. The aim of this study was to utilize stakeholder generated ideas to design and pilot a mobile learning curriculum, with the purpose of facilitating training to improve the quality of point-of-care diagnostics services in KwaZulu-Natal (KZN) rural clinics. Methods Nominal Group Technique was employed to enable collaboration with stakeholders in designing and piloting of a POC diagnostics curriculum. Stakeholders were selected from 11 KZN districts to participate in a clinic-based piloting of the curriculum using an online application. The application was designed in collaboration with a teacher training institute in Durban. Moodle was used as an established reliable online learning management system. During piloting, quantitative and qualitative data were generated and analyzed using descriptive statistics and content analysis. Findings and Conclusion Guided by the Nominal Group Technique results, five delivery modes for curriculum content through Mobile Learning were generated. An interactive course page was created on the Moodle site, titled: Quality HIV Point of Care Diagnostics Curriculum Delivery for Nurses in Rural Areas. The course content consisted of three teaching units, activities, an online quiz and an online survey. An analytic-algorithm built into the online course enabled monitoring of participation and assessment outcomes automatically. At piloting, 64% of the invited representative clinics were able to access the course, with 47% meeting the course completion requirements. All the participants achieved the set pass mark of 75% with an average of 87%. The activity completion report showed that topics presented through images, videos and simple text were accessed more than those presented as attachments of national documents. Despite poor network coverage and limited access to mobile technology, exacerbated by Covid-19 related restrictions, Point of care diagnostics Mobile Learning curriculum was well-received in participating rural clinics. Recommendations relating to course improvement and access, included extending collaboration with specialists in eHealth systems development and with South African cell phone network providers.
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Affiliation(s)
- Nkosinothando Chamane
- Department of Public Health Medicine, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
- *Correspondence: Nkosinothando Chamane
| | - Rowan Thompson
- Department of Mathematics, Science and Technology, Stadio School of Education Formerly the Embury Institute for Higher Education, Durban, South Africa
- Rowan Thompson
| | - Simon Goldstone
- Department of Digitally Enhanced Learning, Teaching and Assessment, Stadio School of Education Formerly the Embury Institute for Higher Education, Durban, South Africa
- Simon Goldstone
| | - Tivani Phosa Mashamba-Thompson
- Department of Public Health Medicine, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
- Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
- Tivani Phosa Mashamba-Thompson
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Jani IV, Peter TF. Nucleic Acid Point-of-Care Testing to Improve Diagnostic Preparedness. Clin Infect Dis 2022; 75:723-728. [PMID: 35015842 PMCID: PMC9464067 DOI: 10.1093/cid/ciac013] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Indexed: 01/18/2023] Open
Abstract
Testing programs for severe acute respiratory syndrome coronavirus 2 have relied on high-throughput polymerase chain reaction laboratory tests and rapid antigen assays to meet diagnostic needs. Both technologies are essential; however, issues of cost, accessibility, manufacturing delays, and performance have limited their use in low-resource settings and contributed to the global inequity in coronavirus disease 2019 testing. Emerging low-cost, multidisease point-of-care nucleic acid tests may address these limitations and strengthen pandemic preparedness, especially within primary healthcare where most cases of disease first present. Widespread deployment of these novel technologies will also help close long-standing test access gaps for other diseases, including tuberculosis, human immunodeficiency virus, cervical cancer, viral hepatitis, and sexually transmitted infections. We propose a more optimized testing framework based on greater use of point-of-care nucleic acid tests together with rapid immunologic assays and high-throughput laboratory molecular tests to improve the diagnosis of priority endemic and epidemic diseases, as well as strengthen the overall delivery of primary healthcare services.
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Affiliation(s)
- Ilesh V Jani
- Instituto Nacional da Saúde, Marracuene, Mozambique
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Colucci G, Uceda Renteria S, Ceriotti F, Lampertico P. Clinical Evaluation of Plasma Separation Cards as a Tool to Collect, Store, and Test Blood Samples for Hepatitis B and C Serological Markers. Clin Chem 2021; 68:214-217. [PMID: 34969104 DOI: 10.1093/clinchem/hvab170] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Accepted: 07/16/2021] [Indexed: 11/13/2022]
Abstract
BACKGROUND The plasma separation card (PSC) is a new device for collecting finger-pricking-derived small amount of blood in a solid support that is stable at room temperature and can be archived, mailed, and processed at a later time. This tool can facilitate screening at risk populations located in rural areas without local health care infrastructures. We evaluated the performance of PSC in the collection and preparation of blood samples for the determination of hepatitis B and C serological markers. METHODS Blood obtained from 334 consecutive patients referred for the detection of hepatitis B surface antigens (HBsAg), hepatitis B surface antibodies (anti-HBs) and hepatitis C antibodies (anti-HCV) was analyzed in parallel using standard (STD) and PSC-based sample collection and preparation procedures. Results obtained from STD or PSC processed samples were compared for their detection rate and correlation. RESULTS Using STD, we detected 5 samples positive for HBsAg, 150 for anti-HBs, and 23 for anti-HCV with a rate of concordance with PSC of 100%, 100%, and 91% respectively. The 100% concordance observed for anti-HBs was based on a cutoff of 2.6 IU/L for PSC-derived sample corresponding to the 10 IU/L threshold associated with immunity to hepatitis B. STD and PSC showed a good correlation (R2 = 0.85) in the detection of anti-HBs titers. The 2 anti-HCV PSC negative samples had no detectable viremia. CONCLUSIONS These data confirm the utility of PSC as a tool to support viral hepatitis screening programs in rural areas lacking local clinical infrastructures and testing facilities.
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Affiliation(s)
- Giuseppe Colucci
- Division of Gastroenterology and Hepatology, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Sara Uceda Renteria
- Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Department of Clinical Laboratory, Virology Unit, Milan, Italy
| | - Ferruccio Ceriotti
- Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Department of Clinical Laboratory, Virology Unit, Milan, Italy
| | - Pietro Lampertico
- Division of Gastroenterology and Hepatology, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- CRC "A. M. and A. Migliavacca" Center for Liver Disease, Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
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Ochodo EA, Guleid F, Deeks JJ, Mallett S. Point-of-care tests detecting HIV nucleic acids for diagnosis of HIV-1 or HIV-2 infection in infants and children aged 18 months or less. Cochrane Database Syst Rev 2021; 8:CD013207. [PMID: 34383961 PMCID: PMC8406580 DOI: 10.1002/14651858.cd013207.pub2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND The standard method of diagnosing HIV in infants and children less than 18 months is with a nucleic acid amplification test reverse transcriptase polymerase chain reaction test (NAT RT-PCR) detecting viral ribonucleic acid (RNA). Laboratory testing using the RT-PCR platform for HIV infection is limited by poor access, logistical support, and delays in relaying test results and initiating therapy in low-resource settings. The use of rapid diagnostic tests at or near the point-of-care (POC) can increase access to early diagnosis of HIV infection in infants and children less than 18 months of age and timely initiation of antiretroviral therapy (ART). OBJECTIVES To summarize the diagnostic accuracy of point-of-care nucleic acid-based testing (POC NAT) to detect HIV-1/HIV-2 infection in infants and children aged 18 months or less exposed to HIV infection. SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (until 2 February 2021), MEDLINE and Embase (until 1 February 2021), and LILACS and Web of Science (until 2 February 2021) with no language or publication status restriction. We also searched conference websites and clinical trial registries, tracked reference lists of included studies and relevant systematic reviews, and consulted experts for potentially eligible studies. SELECTION CRITERIA We defined POC tests as rapid diagnostic tests conducted at or near the patient site. We included any primary study that compared the results of a POC NAT to a reference standard of laboratory NAT RT-PCR or total nucleic acid testing to detect the presence or absence of HIV infection denoted by HIV viral nucleic acids in infants and children aged 18 months or less who were exposed to HIV-1/HIV-2 infection. We included cross-sectional, prospective, and retrospective study designs and those that provided sufficient data to create the 2 × 2 table to calculate sensitivity and specificity. We excluded diagnostic case control studies with healthy controls. DATA COLLECTION AND ANALYSIS We extracted information on study characteristics using a pretested standardized data extraction form. We used the QUADAS-2 (Quality Assessment of Diagnostic Accuracy Studies) tool to assess the risk of bias and applicability concerns of the included studies. Two review authors independently selected and assessed the included studies, resolving any disagreements by consensus. The unit of analysis was the participant. We first conducted preliminary exploratory analyses by plotting estimates of sensitivity and specificity from each study on forest plots and in receiver operating characteristic (ROC) space. For the overall meta-analyses, we pooled estimates of sensitivity and specificity using the bivariate meta-analysis model at a common threshold (presence or absence of infection). MAIN RESULTS We identified a total of 12 studies (15 evaluations, 15,120 participants). All studies were conducted in sub-Saharan Africa. The ages of included infants and children in the evaluations were as follows: at birth (n = 6), ≤ 12 months (n = 3), ≤ 18 months (n = 5), and ≤ 24 months (n = 1). Ten evaluations were field evaluations of the POC NAT test at the point of care, and five were laboratory evaluations of the POC NAT tests.The POC NAT tests evaluated included Alere q HIV-1/2 Detect qualitative test (recently renamed m-PIMA q HIV-1/2 Detect qualitative test) (n = 6), Xpert HIV-1 qualitative test (n = 6), and SAMBA HIV-1 qualitative test (n = 3). POC NAT pooled sensitivity and specificity (95% confidence interval (CI)) against laboratory reference standard tests were 98.6% (96.1 to 99.5) (15 evaluations, 1728 participants) and 99.9% (99.7 to 99.9) (15 evaluations, 13,392 participants) in infants and children ≤ 18 months. Risk of bias in the included studies was mostly low or unclear due to poor reporting. Five evaluations had some concerns for applicability for the index test, as they were POC tests evaluated in a laboratory setting, but there was no difference detected between settings in sensitivity (-1.3% (95% CI -4.1 to 1.5)); and specificity results were similar. AUTHORS' CONCLUSIONS For the diagnosis of HIV-1/HIV-2 infection, we found the sensitivity and specificity of POC NAT tests to be high in infants and children aged 18 months or less who were exposed to HIV infection.
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Affiliation(s)
- Eleanor A Ochodo
- Centre for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya
- Centre for Evidence-based Health Care, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Fatuma Guleid
- KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya
| | - Jonathan J Deeks
- Test Evaluation Research Group, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Sue Mallett
- UCL Centre for Medical Imaging, Division of Medicine, Faculty of Medical Sciences, University College London, London, UK
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Randell EW, Thakur V. Leading POCT Networks: Operating POCT Programs Across Multiple Sites Involving Vast Geographical Areas and Rural Communities. EJIFCC 2021; 32:179-189. [PMID: 34421486 PMCID: PMC8343053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 10/29/2022]
Abstract
Few peer-reviewed publications provide laboratory leaders with useful strategies on which to develop and implement point of care testing (POCT) programs to support delivery of acute care services to remote rural communities, with or without trained laboratory staff on site. This mini review discusses common challenges faced by laboratory leaders poised to implement and operate POCT programs at multiple remote and rural sites. It identifies areas for consideration during the initial program planning phases and provides areas for focus during evaluation and for continued improvement of POCT services at remote locations. Finally, it discusses a potential oversight framework for governance and leadership of multisite POCT programs servicing remote and rural communities.
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Affiliation(s)
- Edward W. Randell
- Laboratory Medicine, Eastern Health Authority, St. John’s, Newfoundland and Labrador, Canada, Faculty of Medicine, Memorial University, St. John’s, Newfoundland and Labrador, Canada,Corresponding author: Prof. Edward W. Randell Lab. Medicine, Eastern Health Authority & Faculty of Medicine, Memorial University Rm 1J442 Laboratory Medicine Eastern Health St. John’s, NL Canada Phone: 709-777-6375 Fax: 709-777-2442 E-mail:
| | - Vinita Thakur
- Laboratory Medicine, Eastern Health Authority, St. John’s, Newfoundland and Labrador, Canada, Faculty of Medicine, Memorial University, St. John’s, Newfoundland and Labrador, Canada
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Babyar J. Laboratory science and a glimpse into the future. INTERNATIONAL JOURNAL OF HEALTHCARE MANAGEMENT 2020. [DOI: 10.1080/20479700.2019.1603276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Kpokiri EE, Marley G, Tang W, Fongwen N, Wu D, Berendes S, Ambil B, Loveday SJ, Sampath R, Walker JS, Matovu JKB, Boehme C, Pai NP, Tucker JD. Diagnostic Infectious Diseases Testing Outside Clinics: A Global Systematic Review and Meta-analysis. Open Forum Infect Dis 2020; 7:ofaa360. [PMID: 33072806 PMCID: PMC7545117 DOI: 10.1093/ofid/ofaa360] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Accepted: 08/10/2020] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Most people around the world do not have access to facility-based diagnostic testing, and the gap in availability of diagnostic tests is a major public health challenge. Self-testing, self-sampling, and institutional testing outside conventional clinical settings are transforming infectious disease diagnostic testing in a wide range of low- and middle-income countries (LMICs). We examined the delivery models of infectious disease diagnostic testing outside clinics to assess the impact on test uptake and linkage to care. METHODS We conducted a systematic review and meta-analysis, searching 6 databases and including original research manuscripts comparing testing outside clinics with conventional testing. The main outcomes were test uptake and linkage to care, delivery models, and adverse outcomes. Data from studies with similar interventions and outcomes within thematic areas of interest were pooled, and the quality of evidence was assessed using GRADE. This study was registered in PROSPERO (CRD42019140828).We identified 10 386 de-duplicated citations, and 76 studies were included. Data from 18 studies were pooled in meta-analyses. Studies focused on HIV (48 studies), chlamydia (8 studies), and multiple diseases (20 studies). HIV self-testing increased test uptake compared with facility-based testing (9 studies: pooled odds ratio [OR], 2.59; 95% CI, 1.06-6.29; moderate quality). Self-sampling for sexually transmitted infections increased test uptake compared with facility-based testing (7 studies: pooled OR, 1.74; 95% CI, 0.97-3.12; moderate quality). Conclusions. Testing outside of clinics increased test uptake without significant adverse outcomes. These testing approaches provide an opportunity to expand access and empower patients. Further implementation research, scale-up of effective service delivery models, and policies in LMIC settings are needed.
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Affiliation(s)
- Eneyi E Kpokiri
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
| | - Gifty Marley
- School of Public Health, Nanjing Medical University, Jiangsu, China
| | - Weiming Tang
- Dermatology Hospital, Southern Medical University, Guangzhou, China
- University of North Carolina at Chapel Hill, Project-China, Chapel Hill, North Carolina, USA
| | - Noah Fongwen
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
| | - Dan Wu
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
| | - Sima Berendes
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
| | - Bhavana Ambil
- Department of Global Health, North Carolina State University, Raleigh, North Carolina, USA
| | | | - Ranga Sampath
- Foundation for Innovative New Diagnostics, Switzerland
| | - Jennifer S Walker
- Health Sciences Library, University of North Carolina, Chapel Hill, North Carolina, USA
| | | | | | - Nitika Pant Pai
- CORE, Research Institute of McGill University Health Centre, Montreal, Quebec, Canada
- Division of Clinical Epidemiology & Infectious Diseases, Department of Medicine, McGill University, Montreal, Quebec, Canada
| | - Joseph D Tucker
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
- Institute of Global Health and Infectious Diseases, University of North Carolina, Chapel Hill, North Carolina, USA
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Modern diagnostic technologies for HIV. Lancet HIV 2020; 7:e574-e581. [PMID: 32763220 DOI: 10.1016/s2352-3018(20)30190-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Revised: 04/30/2020] [Accepted: 05/14/2020] [Indexed: 12/14/2022]
Abstract
Novel diagnostic technologies, including nanotechnology, microfluidics, -omics science, next-generation sequencing, genomics big data, and machine learning, could contribute to meeting the UNAIDS 95-95-95 targets to end the HIV epidemic by 2030. Novel technologies include multiplexed technologies (including biomarker-based point-of-care tests and molecular platform technologies), biomarker-based combination antibody and antigen technologies, dried-blood-spot testing, and self-testing. Although biomarker-based rapid tests, in particular antibody-based tests, have dominated HIV diagnostics since the development of the first HIV test in the mid-1980s, targets such as nucleic acids and genes are now used in nanomedicine, biosensors, microfluidics, and -omics to enable early diagnosis of HIV. These novel technologies show promise as they are associated with ease of use, high diagnostic accuracy, rapid detection, and the ability to detect HIV-specific markers. Additional clinical and implementation research is needed to generate evidence for use of novel technologies and a public health approach will be required to address clinical and operational challenges to optimise their global deployment.
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Point-of-Care Diagnostic Services as an Integral Part of Health Services during the Novel Coronavirus 2019 Era. Diagnostics (Basel) 2020; 10:diagnostics10070449. [PMID: 32635234 PMCID: PMC7400507 DOI: 10.3390/diagnostics10070449] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Accepted: 07/02/2020] [Indexed: 12/19/2022] Open
Abstract
Point-of-care (POC) diagnostic services are commonly associated with pathology laboratory services. This issue presents a holistic approach to POC diagnostics services from a variety of disciplines including pathology, radiological and information technology as well as mobile technology and artificial intelligence. This highlights the need for transdisciplinary collaboration to ensure the efficient development and implementation of point-of-care diagnostics. The advent of the novel coronavirus 2019 (COVID-19) pandemic has prompted rapid advances in the development of new POC diagnostics. Global private and public sector agencies have significantly increased their investment in the development of POC diagnostics. There is no longer a question about the availability and accessibility of POC diagnostics. The question is “how can POC diagnostic services be integrated into health services in way that is useful and acceptable in the COVID-19 era?”.
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Stakeholders' Perspectives for the Development of a Point-of-Care Diagnostics Curriculum in Rural Primary Clinics in South Africa-Nominal Group Technique. Diagnostics (Basel) 2020; 10:diagnostics10040195. [PMID: 32244633 PMCID: PMC7235861 DOI: 10.3390/diagnostics10040195] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Revised: 01/06/2020] [Accepted: 01/07/2020] [Indexed: 02/02/2023] Open
Abstract
Poor knowledge and adherence to point-of-care (POC) HIV testing standards have been reported in rural KwaZulu-Natal (KZN), a high HIV prevalent setting. Improving compliance to HIV testing standards is critical, particularly during the gradual phasing out of lay counsellor providers and the shifting of HIV testing and counselling duties to professional nurses. The main objective of this study was to identify priority areas for development of POC diagnostics curriculum to improve competence and adherence to POC diagnostics quality standards for primary healthcare (PHC) nurses in rural South Africa. Method: PHC clinic stakeholders were invited to participate in a co-creation workshop. Participants were purposely sampled from each of the 11 KwaZulu-Natal Districts. Through the Nominal Group Technique (NGT), participants identified training related challenges concerning delivery of quality point of care diagnostics and ranked them from highest to lowest priority. An importance ranking score (scale 1–5) was calculated for each of the identified challenges. Results: Study participants included three PHC professional nurses, one TB professional nurse, one HIV lay councilor, one TB assistant and three POC diagnostics researchers, aged 23–50. Participants identified ten POC diagnostics related challenges. Amongst the highest ranked challenges were the following:absence of POC testing Curriculum for nurses, absence of training of staff on HIV testing and counselling as lay counsellor providers are gradually being phased out,. absence of Continuous Professional Development opportunities and lack of Staff involvement in POC Management programs. Conclusion: Key stakeholders perceived training of PHC nurses as the highest priority for the delivery of quality POC diagnostic testing at PHC level. We recommend continual collaboration among all POC diagnostics stakeholders in the development of an accessible curriculum to improve providers’ competence and ensure sustainable quality delivery of POC diagnostic services in rural PHC clinics.
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An internet of things-based intensity and time-resolved fluorescence reader for point-of-care testing. Biosens Bioelectron 2020; 154:112074. [PMID: 32056969 DOI: 10.1016/j.bios.2020.112074] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Revised: 01/10/2020] [Accepted: 02/03/2020] [Indexed: 11/24/2022]
Abstract
A miniature internet of things (IoT)-based point-of-care testing (PoCT) fluorescence reader, able to perform both intensity and time-resolved measurements of different fluorescent tags, is presented. This low cost platform has been conceived for performing tests in low-resource and remote settings, displaying versatile performance and yet simple operation. It consists on an external case of 43 × 30 × 42 mm3 (built in a 3D-printer) where all the elements are fixed, including some basic optics (3 lenses and 2 filters), a laser diode and a custom designed Single-Photon Avalanche Diodes (SPADs) camera. Both, the laser and the camera are controlled by a Field Programmable Gate Array (FPGA) with IoT capabilities. The PoCT was validated by detecting Plasmodium antigen in a fluorescent enzyme-linked immunosorbent assay (ELISA) using a fluorescence substrate. The results were compared to those provided in parallel by two commercial fluorescent plate readers. As it will be shown, the PoCT fluorescent readout was more sensitive than its colorimetric counterpart. Furthermore, the PoCT displayed similar signal trends and levels of detection than the bulkier and more expensive commercial fluorescence plate readers. These results demonstrate that the PoCT platform developed could bring the performance of central laboratory assay techniques closer to the end-user level.
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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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Mashamba-Thompson TP, Drain PK, Kuupiel D, Sartorius B. Impact of Implementing Antenatal Syphilis Point-of-Care Testing on Maternal Mortality in KwaZulu-Natal, South Africa: An Interrupted Time Series Analysis. Diagnostics (Basel) 2019; 9:diagnostics9040218. [PMID: 31835603 PMCID: PMC6963181 DOI: 10.3390/diagnostics9040218] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2019] [Revised: 11/29/2019] [Accepted: 12/05/2019] [Indexed: 12/19/2022] Open
Abstract
Background: Syphilis infection has been associated with an increased risk of HIV infection during pregnancy which poses greater risk for maternal mortality, and antenatal syphilis point-of-care (POC) testing has been introduced to improve maternal and child health outcomes. There is limited evidence on the impact of syphilis POC testing on maternal outcomes in high HIV prevalent settings. We used syphilis POC testing as a model to evaluate the impact of POC diagnostics on the improvement of maternal mortality in KwaZulu-Natal, South Africa. Methods: We extracted 132 monthly data points on the number of maternal deaths in facilities and number of live births in facilities for 12 tertiary healthcare facilities in KwaZulu-Natal (KZN), South Africa from 2004 to 2014 from District Health Information System (DHIS) health facility archived. We employed segmented Poisson regression analysis of interrupted time series to assess the impact of the exposure on maternal mortality ratio (MMR) before and after the implementation of antenatal syphilis POC testing. We processed and analyzed data using Stata Statistical Software: Release 13. (Stata, Corp LP, College Station, TX, USA). Results: The provincial average annual maternal mortality ratio (MMR) was estimated at 176.09 ± 43.92 ranging from a minimum of 68.48 to maximum of 225.49 per 100,000 live births. The data comprised 36 temporal points before the introduction of syphilis POC test exposure and 84 after the introduction in primary health care clinics in KZN. The average annual MMR for KZN from 2004 to 2014 was estimated at 176.09 ± 43.92. A decrease in MMR level was observed during 2008 after syphilis POC test implementation, followed by a rise during 2009. Analysis of the MMR trend estimates a significant 1.5% increase in MMR trends during the period before implementation and 1.3% increase after implementation of syphilis POC testing (p < 0.001). Conclusion: Although our finding suggests a brief reduction in the MMR trend after the implementation of antenatal syphilis POC testing, a continued increase in syphilis rates is seen in KwaZulu-Natal, South Africa. The study used one of the most powerful quasi-experimental research methods, segmented Poisson regression analysis of interrupted time series to model the impact of syphilis POC on maternal outcome. The study finding requires confirmation by use of more rigorous primary study design.
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Affiliation(s)
- Tivani P. Mashamba-Thompson
- Discipline of Public Health Medicine, School of Nursing and Public Health, University of KwaZulu-Natal, Durban 4041, South Africa; (T.P.M.-T.); (B.S.)
| | - Paul K. Drain
- International Clinical Research Center, Department of Global Health, University of Washington, Seattle, WA 98195-7965, USA;
- Division of Infectious Diseases, Department of Medicine, University of Washington, Seattle, WA 98195-7965, USA
- Department of Epidemiology, University of Washington, Seattle, WA 98195-7965, USA
- Department of Surgery, Harvard University, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Desmond Kuupiel
- Discipline of Public Health Medicine, School of Nursing and Public Health, University of KwaZulu-Natal, Durban 4041, South Africa; (T.P.M.-T.); (B.S.)
- Correspondence:
| | - Benn Sartorius
- Discipline of Public Health Medicine, School of Nursing and Public Health, University of KwaZulu-Natal, Durban 4041, South Africa; (T.P.M.-T.); (B.S.)
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London WC1H 9SH, UK
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Kuupiel D, Bawontuo V, Drain PK, Gwala N, Mashamba-Thompson TP. Supply chain management and accessibility to point-of-care testing in resource-limited settings: a systematic scoping review. BMC Health Serv Res 2019; 19:519. [PMID: 31340833 PMCID: PMC6657084 DOI: 10.1186/s12913-019-4351-3] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Accepted: 07/16/2019] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND World Health Organization (WHO) has created an essential list of in-vitro diagnostics. Supply chain management (SCM) is said to be the vehicle that ensures that developed point-of-care (POC) tests reach their targeted settings for use. We therefore, mapped evidence on SCM of and accessibility to POC testing (availability and use of POC tests) in low- and middle-income countries (LMICs). METHODS We conducted a systematic scoping review using Arksey and O'Malley's framework as a guide. We searched PubMed; CINAHL; MEDLINE; WEB of Science; Science Direct; and Google Scholar databases for studies that focused on POC diagnostic tests and SCM. The review included studies that were undertaken in 140 countries defined by the World Bank as LMICs published up to August 2017. Two reviewers independently screened the abstracts and full articles against the eligibility criteria. The study used the mixed methods appraisal tool version 2011 to assess the risk of bias for the included studies. NVivo version 11 was employed to extract themes from all included studies and results presented using a narrative approach. RESULTS Of 292 studies identified in this review, only 15 published between 2009 and 2017 included evidence on POC diagnostics and SCM. Of the 15 studies, three were conducted in Zambia, one each in Mozambique, Uganda, Guatemala; South Africa, one in Burkina Faso, Zimbabwe, and one multi-country study (Tanzania, Uganda, China, Peru and Zambia and Brazil). Six studies were not country specific since they were not primary studies. Majority of the studies reported stock-outs of HIV, syphilis, and malaria POC tests. There was a moderate to substantial level of agreement between the reviewers' responses at full article screening stage (Kappa statistic = 0.80, p < 0.01). Nine studies underwent methodological quality appraisal and all, scored between 90 and 100%. CONCLUSIONS The results demonstrated limited published research on SCM of and accessibility to POC testing in LMICs. Further studies aimed at investigating SCM of POC tests in resource-limited settings to identify the barriers/challenges and provide a context-specific evidence-based solutions for policy/decision makers, implementers, and POC developers, funders, and development partners would be essential. PROSPERO REGISTRATION NUMBER CRD42016043711.
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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
| | - Vitalis Bawontuo
- Faculty of Health and Allied Sciences, Catholic University College of Ghana, Fiapre, Sunyani, Ghana
| | - Paul K. Drain
- International Clinical Research Center, Department of Global Health, University of Washington, Seattle, USA
- Division of Infectious Diseases, Department of Medicine, University of Washington, Seattle, USA
- Department of Epidemiology, University of Washington, Seattle, USA
| | - Nonjabulo Gwala
- Department of Public Health Medicine, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
| | - 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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Spooner E, Govender K, Reddy T, Ramjee G, Mbadi N, Singh S, Coutsoudis A. Point-of-care HIV testing best practice for early infant diagnosis: an implementation study. BMC Public Health 2019; 19:731. [PMID: 31185962 PMCID: PMC6560857 DOI: 10.1186/s12889-019-6990-z] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2018] [Accepted: 05/15/2019] [Indexed: 01/05/2023] Open
Abstract
Background With Universal Health Coverage and Integrated People-centred Health Care, streamlined health-systems and respectful care are necessary. South Africa has made great strides in prevention of mother-to-child transmission (PMTCT) but with the great burden of HIV, a minimum of birth and 10-week HIV-PCR testing are required for the estimated 360,000 HIV-exposed infants born annually which presents many challenges including delayed results and loss to follow-up. Point-of-care (POC) HIV testing of infants addresses these challenges well and facilitates initiation of HIV-infected infants rapidly after diagnosis for best clinical outcomes. Methods Objectives were to determine accuracy, feasibility and acceptability of POC testing compared to standard-of-care (SOC) central-laboratory testing. HIV-exposed infants for birth PCR testing in hospital (n = 323) and follow-up at a primary health care clinic (n = 117) in Durban, South Africa were included. A baseline situational-analysis reviewed registers and phoned mothers of HIV-exposed infants prior to the intervention. An effectiveness-implementation study of the Alere™q HIV-1/2 Detect POC test (heel-prick specimen processed in 50 min) was compared with SOC with questionnaires to mothers and staff. Stata 14 was used for analysis. Results At baseline 2% of birth HIV tests were missed; only 40% of mothers could be contacted; 17% did not receive birth test result; 19% did not have a 10-week test; 39% had not received the 10-week results. There were 5(1.5%) HIV-infected and 318(98.5%) HIV-negative infants detected in hospital with all clinic babies negative. All positive infants commenced ART before discharge. Ultimately POC and SOC had perfect concordance but for 10 SOC tests researchers actively tracked-down results or repeated tests. Turn around times for SOC tests were on average 8-days (IQR 6-10 days) and for POC testing was 0-days. The POC error-rate was 9,6% with all giving a result when repeated. The majority of mothers (92%) preferred POC testing with 7% having no preference. No staff preferred SOC testing with 79% preferring POC and 21% having no preference. Conclusions Point-of-care HIV testing for EID is accurate, feasible and acceptable, with benefits of early ART for all positive infants at birth facilities. We recommend that it be considered best practice for EID. Trial registration ISRCTN38911104 registered 9 January 2018 – retrospectively registered. Electronic supplementary material The online version of this article (10.1186/s12889-019-6990-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Elizabeth Spooner
- Department of Paediatrics and Child Health, School of Clinical Medicine, University of KwaZulu-Natal, Durban, South Africa.
| | - Kerusha Govender
- Department of Virology, Inkosi Albert Luthuli Central Hospital, National Health Laboratory Service, Durban, KwaZulu-Natal, South Africa
| | - Tarylee Reddy
- South African Medical Research Council, Biostatistics Unit, Durban, South Africa
| | - Gita Ramjee
- South African Medical Research Council, HIV Prevention Research Unit, Durban, South Africa
| | - Noxolo Mbadi
- Department of Paediatrics, Addington Hospital, Durban, South Africa
| | - Swaran Singh
- Department of Paediatrics, Addington Hospital, Durban, South Africa
| | - Anna Coutsoudis
- Department of Paediatrics and Child Health, School of Clinical Medicine, University of KwaZulu-Natal, Durban, South Africa
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Point-of-Care HIV Viral Load Testing: an Essential Tool for a Sustainable Global HIV/AIDS Response. Clin Microbiol Rev 2019; 32:32/3/e00097-18. [PMID: 31092508 DOI: 10.1128/cmr.00097-18] [Citation(s) in RCA: 61] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
The global public health community has set ambitious treatment targets to end the HIV/AIDS pandemic. With the notable absence of a cure, the goal of HIV treatment is to achieve sustained suppression of an HIV viral load, which allows for immunological recovery and reduces the risk of onward HIV transmission. Monitoring HIV viral load in people living with HIV is therefore central to maintaining effective individual antiretroviral therapy as well as monitoring progress toward achieving population targets for viral suppression. The capacity for laboratory-based HIV viral load testing has increased rapidly in low- and middle-income countries, but implementation of universal viral load monitoring is still hindered by several barriers and delays. New devices for point-of-care HIV viral load testing may be used near patients to improve HIV management by reducing the turnaround time for clinical test results. The implementation of near-patient testing using these new and emerging technologies may be an essential tool for ensuring a sustainable response that will ultimately enable an end to the HIV/AIDS pandemic. In this report, we review the current and emerging technology, the evidence for decentralized viral load monitoring by non-laboratory health care workers, and the additional considerations for expanding point-of-care HIV viral load testing.
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Accessibility of pregnancy-related point-of-care diagnostic tests for maternal healthcare in rural primary healthcare facilities in Northern Ghana: A cross-sectional survey. Heliyon 2019; 5:e01236. [PMID: 30828664 PMCID: PMC6383048 DOI: 10.1016/j.heliyon.2019.e01236] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2018] [Revised: 12/25/2018] [Accepted: 02/11/2019] [Indexed: 01/07/2023] Open
Abstract
Background Improving access to maternal healthcare in resource-limited settings plays a critical role in improving maternal health outcomes and reducing maternal deaths. However, barriers and challenges may exist in rural clinics and could affect successful implementation. This study assessed the current accessibility of pregnancy-related point-of-care (POC) diagnostic tests for maternal healthcare in rural primary healthcare (PHC) clinics in northern Ghana. Method We randomly selected 100 PHC clinics providing maternal healthcare from a total list of 356 PHC clinicss obtained from the Regional Health Directorate. Selected clinics were surveyed from February to March 2018, using an adopted survey tool. We obtained data for clinic-level staffing, availability, usage, and desired POC diagnostic tests. Stata 14 was used for data analysis. Findings Majority (64%) of the respondents were midwives. The mean ± standard deviation (SD) years of work experience and working hours per week were estimated at 5.6 years ± 0.4 and 122 hours ± 5.2 respectively. Average antenatal clinic attendance (clinic census) per month was 65 ± 67 pregnant women (Range: 3–360). The mean ± SD POC tests available and use was 4.9 tests ± 2.2. POC tests for malaria, HIV, urine pregnancy, and blood pressure monitoring devices were available in most clinics. POC tests requested by the clinics to assist them care for pregnant women included: Glucose-6-phosphate dehydrogenase (95%); hepatitis C (94%); sickling (91%); tuberculosis, blood glucose and blood type (89%) each; urinary tract infection (87%); urine protein (81%); hepatitis B (78%); haemoglobin (76%); and syphilis (76%). Interpretation There is poor accessibility to pregnancy-related POC diagnostic tests for maternal healthcare due to low availability (≤5 tests per PHC clinic) of POC tests in rural PHC clinics in northern Ghana.
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