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The use of dried tube specimens of Plasmodium falciparum in an external quality assessment programme to evaluate health worker performance for malaria rapid diagnostic testing in healthcare centres in Togo. Malar J 2021; 20:50. [PMID: 33472640 PMCID: PMC7819240 DOI: 10.1186/s12936-020-03569-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Accepted: 12/24/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The use of rapid diagnostic tests (RDTs) to diagnose malaria is common in sub-Saharan African laboratories, remote primary health facilities and in the community. Currently, there is a lack of reliable methods to ascertain health worker competency to accurately use RDTs in the testing and diagnosis of malaria. Dried tube specimens (DTS) have been shown to be a consistent and useful method for quality control of malaria RDTs; however, its application in National Quality Management programmes has been limited. METHODS A Plasmodium falciparum strain was grown in culture and harvested to create DTS of varying parasite density (0, 100, 200, 500 and 1000 parasites/µL). Using the dried tube specimens as quality control material, a proficiency testing (PT) programme was carried out in 80 representative health centres in Togo. Health worker competency for performing malaria RDTs was assessed using five blinded DTS samples, and the DTS were tested in the same manner as a patient sample would be tested by multiple testers per health centre. RESULTS All the DTS with 100 parasites/µl and 50% of DTS with 200 parasites/µl were classified as non-reactive during the pre-PT quality control step. Therefore, data from these parasite densities were not analysed as part of the PT dataset. PT scores across all 80 facilities and 235 testers was 100% for 0 parasites/µl, 63% for 500 parasites/µl and 93% for 1000 parasites/µl. Overall, 59% of the 80 healthcare centres that participated in the PT programme received a score of 80% or higher on a set of 0, 500 and 1000 parasites/ µl DTS samples. Sixty percent of health workers at these centres recorded correct test results for all three samples. CONCLUSIONS The use of DTS for a malaria PT programme was the first of its kind ever conducted in Togo. The ease of use and stability of the DTS illustrates that this type of samples can be considered for the assessment of staff competency. The implementation of quality management systems, refresher training and expanded PT at remote testing facilities are essential elements to improve the quality of malaria diagnosis.
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Visser T, Ramachandra S, Pothin E, Jacobs J, Cunningham J, Menach AL, Gatton ML, Dos Santos Souza S, Nelson S, Rooney L, Aidoo M. A comparative evaluation of mobile medical APPS (MMAS) for reading and interpreting malaria rapid diagnostic tests. Malar J 2021; 20:39. [PMID: 33435999 PMCID: PMC7805067 DOI: 10.1186/s12936-020-03573-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2020] [Revised: 12/23/2020] [Accepted: 12/28/2020] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND The World Health Organization recommends confirmatory diagnosis by microscopy or malaria rapid diagnostic test (RDT) in patients with suspected malaria. In recent years, mobile medical applications (MMAs), which can interpret RDT test results have entered the market. To evaluate the performance of commercially available MMAs, an evaluation was conducted by comparing RDT results read by MMAs to RDT results read by the human eye. METHODS Five different MMAs were evaluated on six different RDT products using cultured Plasmodium falciparum blood samples at five dilutions ranging from 20 to 1000 parasites (p)/microlitre (µl) and malaria negative blood samples. The RDTs were performed in a controlled, laboratory setting by a trained operator who visually read the RDT results. A second trained operator then used the MMAs to read the RDT results. Sensitivity (Sn) and specificity (Sp) for the RDTs were calculated in a Bayesian framework using mixed models. RESULTS The RDT Sn of the P. falciparum (Pf) test line, when read by the trained human eye was significantly higher compared to when read by MMAs (74% vs. average 47%) at samples of 20 p/µl. In higher density samples, the Sn was comparable to the human eye (97%) for three MMAs. The RDT Sn of test lines that detect all Plasmodium species (Pan line), when read by the trained human eye was significantly higher compared to when read by MMAs (79% vs. average 56%) across all densities. The RDT Sp, when read by the human eye or MMAs was 99% for both the Pf and Pan test lines across all densities. CONCLUSIONS The study results show that in a laboratory setting, most MMAs produced similar results interpreting the Pf test line of RDTs at parasite densities typically found in patients that experience malaria symptoms (> 100 p/µl) compared to the human eye. At low parasite densities for the Pf line and across all parasite densities for the Pan line, MMAs were less accurate than the human eye. Future efforts should focus on improving the band/line detection at lower band intensities and evaluating additional MMA functionalities like the ability to identify and classify RDT errors or anomalies.
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Affiliation(s)
| | | | - Emilie Pothin
- Swiss Tropical and Public Health Institute, Basel, Switzerland
| | - Jan Jacobs
- Institute of Tropical Medicine, Antwerp, Belgium.,Department of Microbiology and Immunology, KU Leuven, Leuven, Belgium
| | | | | | | | | | | | - Luke Rooney
- Clinton Health Access Initiative, Boston, USA
| | - Michael Aidoo
- Centers for Disease Control and Prevention, Atlanta, USA
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Wahba HMF, Emara TH, Elbokl A, Mohamed MH, Essa Salwe AM, Du’ale AA. The feasibility of the ‘treat and teach’ telemedicine package: the Somali pilot. HEALTH AND TECHNOLOGY 2020. [DOI: 10.1007/s12553-020-00475-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Kalinga AK, Ishengoma DS, Kavishe R, Temu L, Mswanya C, Mwanziva C, Mgina EJ, Chiduo S, Mahikwano L, Mgata S, Anova L, Amoo G, Wurapa E, Vesely B, Kamau E, Hickman M, Waters N, Kreishman-Deitrick M, Paris R, Ohrt C. The use of Fionet technology for external quality control of malaria rapid diagnostic tests and monitoring health workers' performance in rural military health facilities in Tanzania. PLoS One 2018; 13:e0208583. [PMID: 30589853 PMCID: PMC6307929 DOI: 10.1371/journal.pone.0208583] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Accepted: 11/20/2018] [Indexed: 02/07/2023] Open
Abstract
INTRODUCTION Internal and external quality control (QC) of rapid diagnostic tests (RDTs) is important to increase reliability of RDTs currently used to diagnose malaria. However, cross-checking of used RDTs as part of quality assurance can rarely be done by off-site personnel because there is no guarantee of retaining visible test lines after manufacturers' recommended reading time. Therefore, this study examined the potential of using Fionet™ technology for remote RDT quality monitoring at seven clinics, identifying reasons for making RDT processing and interpretation errors, and taking corrective actions for improvement of diagnosis and consequently improved management of febrile patients. METHODS The study was conducted at seven military health facilities in Mainland Tanzania and utilized RDTs capable of detecting Plasmodium falciparum specific Histidine-rich protein 2 (Pf-HRP2) and the genus specific Plasmodium lactate dehydrogenase (pLDH) for other species of plasmodium (P. vivax, P. malariae or P. ovale; pan-pLDH). Patients' data and images of processed RDTs from seven clinics were uploaded on a Fionet web portal and reviewed regularly to monitor preparation procedures and visual interpretation of test results compared to automated analysis using the Deki reader of RDT. Problems detected were rapidly communicated to remote laboratory personnel at the clinic for corrective action and follow-up of patients who were falsely diagnosed as negative and missed treatment. Factors contributing to making errors in visual interpretation of RDT results were analyzed during visits to the health facilities. RESULTS A total of 1,367 (1.6%) out of 83,294 RDT test images uploaded to the Fionet portal had discordant test results of which 822 (60.1%) and 545 (39.9%) were falsely reported as negative and positive, respectively. False negative and false positive test results were common for a single test line in 515 (62.7%) and 741 (54.2%) tests, respectively. Out of 1,367 RDT images assessed, 98 (7.2%) had quality problems related to preparation procedures of which 95(96.9%) errors were due to putting too much blood on the sample well or insufficient buffer in the respective wells. The reasons for discrepant results included, false reporting of none existent lines in 526 (38.5%) tests, missing a faint positive line in 493 (36.1%), missing a strong positive line in 248(18.1%) and errors caused by poorly processed RDTs in 96 (7.2%) tests. Among the false negative tests (n = 822), 669 (48.9%) patients were eligible for follow-up and only 339 (48.5%) were reached and 291 (85.8%) received appropriate anti-malaria therapy. CONCLUSION Fionet technology enabled remote monitoring of RDT quality issues, identifying reasons contributing to laboratory personnel making errors and provided a rapid method to implement corrective actions at remote sites to improve malaria diagnosis and consequently improved health care management of febrile patients infected with malaria.
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Affiliation(s)
- Akili K. Kalinga
- National Institute for Medical Research, Tukuyu Centre, Tukuyu, Tanzania
- Kilimanjaro Christian Medical University College, Moshi, Tanzania
- * E-mail:
| | - Deus S. Ishengoma
- National Institute for Medical Research, Tanga Centre, Tanga, Tanzania
| | - Reginald Kavishe
- Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Lucky Temu
- Henry Jackson Foundation Medical Research International, Dar es Salaam, Tanzania
| | | | | | - Erick J. Mgina
- National Institute for Medical Research, Tukuyu Centre, Tukuyu, Tanzania
| | - Sarah Chiduo
- Henry Jackson Foundation Medical Research International, Dar es Salaam, Tanzania
| | - Lucas Mahikwano
- Henry Jackson Foundation Medical Research International, Dar es Salaam, Tanzania
| | - Saidi Mgata
- Henry Jackson Foundation Medical Research International, Dar es Salaam, Tanzania
| | - Lalaine Anova
- Walter Reed Army Institute of Research, MD, Washington DC, United States of America
| | - George Amoo
- FORGYN Health Systems Consultants LLc, Washington DC, United States of America
| | - Eyako Wurapa
- Walter Reed Army Institute of Research, MD, Washington DC, United States of America
| | - Brian Vesely
- Walter Reed Army Institute of Research, MD, Washington DC, United States of America
| | - Edwin Kamau
- Walter Reed Army Institute of Research, MD, Washington DC, United States of America
| | - Mark Hickman
- Walter Reed Army Institute of Research, MD, Washington DC, United States of America
| | - Norman Waters
- Walter Reed Army Institute of Research, MD, Washington DC, United States of America
| | | | - Robert Paris
- Walter Reed Army Institute of Research, MD, Washington DC, United States of America
| | - Colin Ohrt
- Walter Reed Army Institute of Research, MD, Washington DC, United States of America
- Consortium for Health Action, Phnom Penh, Cambodia
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Vernelen K, Barbé B, Gillet P, Van Esbroeck M, China B, Jacobs J. Photo-based External Quality Assessment of Malaria rapid diagnostic tests in a non-endemic setting. PLoS One 2018; 13:e0201622. [PMID: 30169508 PMCID: PMC6118386 DOI: 10.1371/journal.pone.0201622] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Accepted: 07/18/2018] [Indexed: 11/20/2022] Open
Abstract
Introduction In non-endemic settings, expertise in malaria microscopy is limited and rapid diagnostic tests (RDTs) are an adjunct to malaria diagnosis. Aim We performed an External Quality Assessment (EQA) on reading and interpretation of malaria RDTs in a non-endemic setting. Methods Participants were medical laboratories in Belgium and the Grand Duchy of Luxembourg using malaria RDTs; they received (i) 10 high-resolution photographs presenting test line combinations of RDTs with interpretations listed in a multiple choice format and (ii) a questionnaire about their practices of malaria diagnosis. Results Among 135 subscribing laboratories, 134 (99.3%) used 139 RDT products (11 different products from 8 brands). After exclusion of the results of one laboratory, analysis was done for 133 laboratories using 137 RDT products. Scores of 10/10, 9/10 and 8/10 were achieved for 58.4%, 13.1% and 8.0% of 137 RDT products respectively. For three-band P. falciparum–pan-Plasmodium RDTs (113 (82.5%) products, 6 brands), most frequent errors were (1) disregarding faint test lines (18.6%), (2) reporting invalid instead of P. falciparum (16.8%) and (3) reporting “Plasmodium spp., no further differentiation possible” without mentioning the presence or absence of P. falciparum (11.5%). For four-band RDTs (21 (15.3%) products, 1 brand), errors were (4) disregarding faint P. vivax test lines (47.6%) and (5) reporting “Plasmodium spp., no further differentiation possible” without mentioning the presence of P. falciparum and P. vivax (28.6%). Instructions for use (IFU) of only 4 out of 10 RDT products mentioned to interpret faint-intensity test lines as positive (conducive to errors 1 and 4) and IFU of 2 products displayed incorrect information (conducive to errors 2 and 5). Outside of office hours, 36.1% of participants relied on RDTs as the initial diagnostic test; 13.9% did not perform microscopic confirmation. Conclusion Reading and interpretation of malaria RDTs was satisfactory, but errors were embedded in the instructions for use of the products. Relying on RDTs alone for malaria diagnosis (about one third of participants) is not a recommended practice.
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Affiliation(s)
- Kris Vernelen
- Quality of Medical Laboratories, Institute of Public Health, Sciensano, Brussels, Belgium
- * E-mail:
| | | | | | | | - Bernard China
- Quality of Medical Laboratories, Institute of Public Health, Sciensano, Brussels, Belgium
| | - Jan Jacobs
- Institute of Tropical Medicine, Antwerp, Belgium
- KU Leuven, Department of Microbiology and Immunology, Leuven, Belgium
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Ombelet S, Ronat JB, Walsh T, Yansouni CP, Cox J, Vlieghe E, Martiny D, Semret M, Vandenberg O, Jacobs J. Clinical bacteriology in low-resource settings: today's solutions. THE LANCET. INFECTIOUS DISEASES 2018. [PMID: 29519767 DOI: 10.1016/s1473-3099(18)30093-8] [Citation(s) in RCA: 110] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Low-resource settings are disproportionately burdened by infectious diseases and antimicrobial resistance. Good quality clinical bacteriology through a well functioning reference laboratory network is necessary for effective resistance control, but low-resource settings face infrastructural, technical, and behavioural challenges in the implementation of clinical bacteriology. In this Personal View, we explore what constitutes successful implementation of clinical bacteriology in low-resource settings and describe a framework for implementation that is suitable for general referral hospitals in low-income and middle-income countries with a moderate infrastructure. Most microbiological techniques and equipment are not developed for the specific needs of such settings. Pending the arrival of a new generation diagnostics for these settings, we suggest focus on improving, adapting, and implementing conventional, culture-based techniques. Priorities in low-resource settings include harmonised, quality assured, and tropicalised equipment, consumables, and techniques, and rationalised bacterial identification and testing for antimicrobial resistance. Diagnostics should be integrated into clinical care and patient management; clinically relevant specimens must be appropriately selected and prioritised. Open-access training materials and information management tools should be developed. Also important is the need for onsite validation and field adoption of diagnostics in low-resource settings, with considerable shortening of the time between development and implementation of diagnostics. We argue that the implementation of clinical bacteriology in low-resource settings improves patient management, provides valuable surveillance for local antibiotic treatment guidelines and national policies, and supports containment of antimicrobial resistance and the prevention and control of hospital-acquired infections.
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Affiliation(s)
- Sien Ombelet
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium; Department of Microbiology and Immunology, KU Leuven, Leuven, Belgium.
| | | | | | - Cedric P Yansouni
- JD MacLean Centre for Tropical Diseases, McGill University Health Centre, Montreal, QC, Canada
| | - Janneke Cox
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Erika Vlieghe
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium; Department of General Internal Medicine, Infectious and Tropical Diseases, Antwerp University Hospital, Antwerp, Belgium; Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Delphine Martiny
- Department of Microbiology, LHUB-ULB, Pôle Hospitalier Universitaire de Bruxelles, Brussels, Belgium
| | - Makeda Semret
- JD MacLean Centre for Tropical Diseases, McGill University Health Centre, Montreal, QC, Canada; St Mary's Hospital Centre, Montreal, QC, Canada
| | - Olivier Vandenberg
- Department of Microbiology, LHUB-ULB, Pôle Hospitalier Universitaire de Bruxelles, Brussels, Belgium; Center for Environmental Health and Occupational Health, Public Health School, Université Libre de Bruxelles, Brussels, Belgium
| | - Jan Jacobs
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium; Department of Microbiology and Immunology, KU Leuven, Leuven, Belgium
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Laktabai J, Platt A, Menya D, Turner EL, Aswa D, Kinoti S, O’Meara WP. A mobile health technology platform for quality assurance and quality improvement of malaria diagnosis by community health workers. PLoS One 2018; 13:e0191968. [PMID: 29389958 PMCID: PMC5794091 DOI: 10.1371/journal.pone.0191968] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2017] [Accepted: 01/15/2018] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Community health workers (CHWs) play an important role in improving access to services in areas with limited health infrastructure or workforce. Supervision of CHWs by qualified health professionals is the main link between this lay workforce and the formal health system. The quality of services provided by lay health workers is dependent on adequate supportive supervision. It is however one of the weakest links in CHW programs due to logistical and resource constraints, especially in large scale programs. Interventions such as point of care testing using malaria rapid diagnostic tests (RDTs) require real time monitoring to ensure diagnostic accuracy. In this study, we evaluated the utility of a mobile health technology platform to remotely monitor malaria RDT (mRDT) testing by CHWs for quality improvement. METHODS As part of a large implementation trial involving mRDT testing by CHWs, we introduced the Fionet system composed of a mobile device (Deki Reader, DR) to assist in processing and automated interpretation of mRDTs, which connects to a cloud-based database which captures reports from the field in real time, displaying results in a custom dashboard of key performance indicators. A random sample of 100 CHWs were trained and provided with the Deki Readers and instructed to use it on 10 successive patients. The CHWs interpretation was compared with the Deki Reader's automatic interpretation, with the errors in processing and interpreting the RDTs recorded. After the CHW entered their interpretation on the DR, the DR provided immediate, automated feedback and interpretation based on its reading of the same cassette. The study team monitored the CHW performance remotely and provided additional support. RESULTS A total of 1251 primary and 113 repeat tests were performed by the 97 CHWs who used the DR. 91.6% of the tests had agreement between the DR and the CHWs. There were 61 (4.9%) processing and 52 (4.2%) interpretation errors among the primary tests. There was a tendency towards lower odds of errors with increasing number and frequency of tests, though not statistically significant. Of the 62 tests that were repeated due to errors, 79% achieved concordance between the CHW and the DR. Satisfaction with the use of the DR by the CHWs was high. CONCLUSIONS Use of innovative mHealth strategies for monitoring and quality control can ensure quality within a large scale implementation of community level testing by lay health workers.
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Affiliation(s)
- Jeremiah Laktabai
- Department of Family Medicine, Moi University School of Medicine, Eldoret, Kenya
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
- * E-mail:
| | - Alyssa Platt
- Duke Global Health Institute, Duke University, Durham, North Carolina, United States of America
- Department of Biostatistics and Bioinformatics, Duke University, Durham, North Carolina, United States of America
| | - Diana Menya
- Department of Epidemiology and Biostatistics, Moi University School of Public Health, College of Health Sciences, Eldoret, Kenya
| | - Elizabeth L. Turner
- Duke Global Health Institute, Duke University, Durham, North Carolina, United States of America
- Department of Biostatistics and Bioinformatics, Duke University, Durham, North Carolina, United States of America
| | - Daniel Aswa
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
| | | | - Wendy Prudhomme O’Meara
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
- Duke Global Health Institute, Duke University, Durham, North Carolina, United States of America
- Department of Epidemiology and Biostatistics, Moi University School of Public Health, College of Health Sciences, Eldoret, Kenya
- Division of Infectious Diseases and International Health, Duke University Medical Center, Durham, North Carolina, United States of America
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Berrueta M, Cafferata ML, Mwenechanya M, Nkamba Mukadi D, Althabe F, Bergel E, Gibbons L, Ciganda A, Klein K, Mwapule Tembo A, Habulembe Mwanakalanga F, Banda E, Mavila Kilonga A, Lusamba Dikassa P, Xiong X, Chomba E, Tshefu AK, Buekens P. Syphilis screening and treatment in pregnant women in Kinshasa, Democratic Republic of the Congo and in Lusaka, Zambia: a cross-sectional study. Gates Open Res 2017; 1:13. [PMID: 29355227 PMCID: PMC5764227 DOI: 10.12688/gatesopenres.12768.1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/11/2018] [Indexed: 11/20/2022] Open
Abstract
Background: Congenital syphilis is associated with perinatal deaths, preterm births and congenital malformations. Low rates of syphilis screening during pregnancy and treatment of those found seropositive have been reported in the Democratic Republic of the Congo (DRC) and Zambia. We report the rates on antenatal syphilis screening, the seroprevalence of syphilis infection, and the frequency of antibiotic treatment in pregnant women screened positive for syphilis during their attendance at antenatal care (ANC) clinics in Kinshasa, DRC and Lusaka, Zambia. Methods: Women attending their first ANC were enrolled consecutively during a 9-month period in 16 and 13 ANC clinics in Kinshasa and Lusaka respectively, in the context of the baseline period of a cluster trial. Study personnel collected data on women’s characteristics, the syphilis screening practices, the test results, and the frequency of treatment, that were done under routine ANC conditions and registered in the clinic records. Results: 4,153 women in Kinshasa and 18,097 women in Lusaka were enrolled. The frequency of screening at the first visit was 59.7% (n= 2,479) in Kinshasa, and 27.8% (n=5,025) in Lusaka. Screening test availability varied. In the periods in which tests were available the screening rates were 92.8% in Kinshasa and 52.0% in Lusaka. The frequency of women screened seropositive was 0.4% (n=10) in Kinshasa and 2.2% (n=109) in Lusaka. Respectively, 10% (n=1) and 11.9% (n= 13) among seropositive women received treatment at the first visit. Conclusions: The results of the study show that screening for syphilis in pregnancy is not universal even when supplies are available. Our ongoing trial will evaluate the impact of a behavioral intervention on changing health providers’ practices to increase screening and treatment rates when supplies are available.
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Affiliation(s)
- Mabel Berrueta
- Institute for Clinical Effectiveness and Health Policy (IECS), Dr. Emilio Ravignani 2024, Buenos Aires, 1414 CABA, Argentina
| | - Maria Luisa Cafferata
- Institute for Clinical Effectiveness and Health Policy (IECS), Dr. Emilio Ravignani 2024, Buenos Aires, 1414 CABA, Argentina
| | - Musaku Mwenechanya
- University Teaching Hospital of Lusaka, Private Bag RW1X Ridgeway, Nationalist Road, Lusaka, Zambia
| | - Dalau Nkamba Mukadi
- Kinshasa School of Public Health, University of Kinshasa, Kinshasa, Congo, Democratic Republic
| | - Fernando Althabe
- Institute for Clinical Effectiveness and Health Policy (IECS), Dr. Emilio Ravignani 2024, Buenos Aires, 1414 CABA, Argentina
| | - Eduardo Bergel
- Institute for Clinical Effectiveness and Health Policy (IECS), Dr. Emilio Ravignani 2024, Buenos Aires, 1414 CABA, Argentina
| | - Luz Gibbons
- Institute for Clinical Effectiveness and Health Policy (IECS), Dr. Emilio Ravignani 2024, Buenos Aires, 1414 CABA, Argentina
| | - Alvaro Ciganda
- Institute for Clinical Effectiveness and Health Policy (IECS), Dr. Emilio Ravignani 2024, Buenos Aires, 1414 CABA, Argentina
| | - Karen Klein
- Institute for Clinical Effectiveness and Health Policy (IECS), Dr. Emilio Ravignani 2024, Buenos Aires, 1414 CABA, Argentina
| | - Abigail Mwapule Tembo
- University Teaching Hospital of Lusaka, Private Bag RW1X Ridgeway, Nationalist Road, Lusaka, Zambia
| | | | - Ernest Banda
- University Teaching Hospital of Lusaka, Private Bag RW1X Ridgeway, Nationalist Road, Lusaka, Zambia
| | - Arlette Mavila Kilonga
- Kinshasa School of Public Health, University of Kinshasa, Kinshasa, Congo, Democratic Republic
| | - Paul Lusamba Dikassa
- Kinshasa School of Public Health, University of Kinshasa, Kinshasa, Congo, Democratic Republic
| | - Xu Xiong
- Tulane University School of Public Health and Tropical Medicine, 6823 St Charles Ave, New Orleans, LA 70118, USA
| | - Elwyn Chomba
- University Teaching Hospital of Lusaka, Private Bag RW1X Ridgeway, Nationalist Road, Lusaka, Zambia
| | - Antoinette K Tshefu
- Kinshasa School of Public Health, University of Kinshasa, Kinshasa, Congo, Democratic Republic
| | - Pierre Buekens
- Tulane University School of Public Health and Tropical Medicine, 6823 St Charles Ave, New Orleans, LA 70118, USA
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Bauer WS, Richardson KA, Adams NM, Ricks KM, Gasperino DJ, Ghionea SJ, Rosen M, Nichols KP, Weigl BH, Haselton FR, Wright DW. Rapid concentration and elution of malarial antigen histidine-rich protein II using solid phase Zn(II) resin in a simple flow-through pipette tip format. BIOMICROFLUIDICS 2017; 11:034115. [PMID: 28652885 PMCID: PMC5457299 DOI: 10.1063/1.4984788] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/05/2017] [Accepted: 05/18/2017] [Indexed: 05/31/2023]
Abstract
Rapid diagnostic tests (RDTs) designed to function at the point of care are becoming more prevalent in malaria diagnostics because of their low cost and simplicity. While many of these tests function effectively with high parasite density samples, their poor sensitivity can often lead to misdiagnosis when parasitemia falls below 100 parasites/μl. In this study, a flow-through pipette-based column was explored as a cost-effective means to capture and elute more Plasmodium falciparum histidine-rich protein II (HRPII) antigen, concentrating the biomarker available in large-volume lysed whole blood samples into volumes compatible with Plasmodium falciparum-specific RDTs. A systematic investigation of immobilized metal affinity chromatography divalent metal species and solid phase supports established the optimal design parameters necessary to create a flow-through column incorporated into a standard pipette tip. The bidirectional flow inherent to this format maximizes mixing efficiency so that in less than 5 min of sample processing, the test band signal intensity was increased up to a factor of twelve from HRPII concentrations as low as 25 pM. In addition, the limit of detection per sample was decreased by a factor of five when compared to the RDT manufacturer's suggested protocol. Both the development process and commercial viability of this application are explored, serving as a potential model for future applications.
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Affiliation(s)
- Westley S Bauer
- Department of Chemistry, Vanderbilt University, Nashville, Tennessee 37235, USA
| | - Kelly A Richardson
- Department of Chemistry, Vanderbilt University, Nashville, Tennessee 37235, USA
| | - Nicholas M Adams
- Department of Biomedical Engineering, Vanderbilt University, Nashville, Tennessee 37235, USA
| | - Keersten M Ricks
- Department of Chemistry, Vanderbilt University, Nashville, Tennessee 37235, USA
| | - David J Gasperino
- Intellectual Ventures Laboratory, 14360 SE Eastgate Way, Bellevue, Washington 98007, USA
| | - Simon J Ghionea
- Intellectual Ventures Laboratory, 14360 SE Eastgate Way, Bellevue, Washington 98007, USA
| | - Mathew Rosen
- Intellectual Ventures Laboratory, 14360 SE Eastgate Way, Bellevue, Washington 98007, USA
| | - Kevin P Nichols
- Intellectual Ventures Laboratory, 14360 SE Eastgate Way, Bellevue, Washington 98007, USA
| | - Bernhard H Weigl
- Intellectual Ventures Laboratory, 14360 SE Eastgate Way, Bellevue, Washington 98007, USA
| | | | - David W Wright
- Department of Chemistry, Vanderbilt University, Nashville, Tennessee 37235, USA
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Scherr TF, Gupta S, Wright DW, Haselton FR. An embedded barcode for "connected" malaria rapid diagnostic tests. LAB ON A CHIP 2017; 17:1314-1322. [PMID: 28252130 PMCID: PMC6474256 DOI: 10.1039/c6lc01580h] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
Many countries are shifting their efforts from malaria control to disease elimination. New technologies will be necessary to meet the more stringent demands of elimination campaigns, including improved quality control of malaria diagnostic tests, as well as an improved means for communicating test results among field healthcare workers, test manufacturers, and national ministries of health. In this report, we describe and evaluate an embedded barcode within standard rapid diagnostic tests as one potential solution. This information-augmented diagnostic test operates on the familiar principles of traditional lateral flow assays and simply replaces the control line with a control grid patterned in the shape of a QR (quick response) code. After the test is processed, the QR code appears on both positive or negative tests. In this report we demonstrate how this multipurpose code can be used not only to fulfill the control line role of test validation, but also to embed test manufacturing details, serve as a trigger for image capture, enable registration for image analysis, and correct for lighting effects. An accompanying mobile phone application automatically captures an image of the test when the QR code is recognized, decodes the QR code, performs image processing to determine the concentration of the malarial biomarker histidine-rich protein 2 at the test line, and transmits the test results and QR code payload to a secure web portal. This approach blends automated, sub-nanomolar biomarker detection, with near real-time reporting to provide quality assurance data that will help to achieve malaria elimination.
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Affiliation(s)
- Thomas F Scherr
- Department of Biomedical Engineering, Vanderbilt University, Nashville, TN, USA.
| | - Sparsh Gupta
- Department of Biomedical Engineering, Vanderbilt University, Nashville, TN, USA.
| | - David W Wright
- Department of Chemistry, Vanderbilt University, Nashville, TN, USA.
| | - Frederick R Haselton
- Department of Biomedical Engineering, Vanderbilt University, Nashville, TN, USA. and Department of Chemistry, Vanderbilt University, Nashville, TN, USA.
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Mobile phone imaging and cloud-based analysis for standardized malaria detection and reporting. Sci Rep 2016; 6:28645. [PMID: 27345590 PMCID: PMC4921854 DOI: 10.1038/srep28645] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2016] [Accepted: 06/06/2016] [Indexed: 01/16/2023] Open
Abstract
Rapid diagnostic tests (RDTs) have been widely deployed in low-resource settings. These tests are typically read by visual inspection, and accurate record keeping and data aggregation remains a substantial challenge. A successful malaria elimination campaign will require new strategies that maximize the sensitivity of RDTs, reduce user error, and integrate results reporting tools. In this report, an unmodified mobile phone was used to photograph RDTs, which were subsequently uploaded into a globally accessible database, REDCap, and then analyzed three ways: with an automated image processing program, visual inspection, and a commercial lateral flow reader. The mobile phone image processing detected 20.6 malaria parasites/microliter of blood, compared to the commercial lateral flow reader which detected 64.4 parasites/microliter. Experienced observers visually identified positive malaria cases at 12.5 parasites/microliter, but encountered reporting errors and false negatives. Visual interpretation by inexperienced users resulted in only an 80.2% true negative rate, with substantial disagreement in the lower parasitemia range. We have demonstrated that combining a globally accessible database, such as REDCap, with mobile phone based imaging of RDTs provides objective, secure, automated, data collection and result reporting. This simple combination of existing technologies would appear to be an attractive tool for malaria elimination campaigns.
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Herrera S, Vallejo AF, Quintero JP, Arévalo-Herrera M, Cancino M, Ferro S. Field evaluation of an automated RDT reader and data management device for Plasmodium falciparum/Plasmodium vivax malaria in endemic areas of Colombia. Malar J 2014; 13:87. [PMID: 24612585 PMCID: PMC3995821 DOI: 10.1186/1475-2875-13-87] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2013] [Accepted: 03/02/2014] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Massive implementation of malaria diagnostics in low-resource countries is regarded as a pivotal strategy in control and elimination efforts. Although malaria rapid diagnostic tests (RDTs) are considered a viable alternative, there are still obstacles to the widespread implementation of this strategy, such as reporting constraints and lack of proper quality assurance of RDT-based programmes at point-of-care (POC). METHODS A prospective cohort of patients, seeking routine care for febrile episodes at health centres in malaria-endemic areas of Colombia, was used to assess the diagnostic performance of a device based on smartphone technology (Deki ReaderTM, former codename "GenZero"), that assists users at POC to process RDTs. After informed consent, patients were enrolled into the study and blood samples were collected for thick blood smear (TBS) and RDT. The RDT results were interpreted by both visual inspection and Deki Reader device and concordance between visual and device interpretation was measured. Microscopy corrected by real-time polymerase chain reaction (PCR) and microscopy were "gold standard" tests to assess the diagnostic performance. RESULTS In total, 1,807 patients were enrolled at seven health centres in malaria-endemic areas of Colombia. Thirty-three Plasmodium falciparum and 100 Plasmodium vivax cases were positive by corrected microscopy. Both sensitivity and specificity were 93.9% (95% CI 69.7-95.2) and 98.7% (95% CI 98.5-99.4) for P. falciparum, and 98.0% (95% CI 90.3-98.9) and 97.9% (95% CI 97.1-98.5) for P. vivax. Percentage concordance between visual and device interpretation of RDT was 98.5% and 99.0% for P. vivax and P. falciparum, respectively.The RDT, when compared to TBS, showed high sensitivity and specificity for P. falciparum in both visual and device interpretation, and good overall diagnostic performance for P. vivax. Comparison between PCR as gold standard and visual and device interpretation showed acceptable overall performance for both species. CONCLUSIONS The diagnostic performance of the Deki Reader was comparable to visual interpretation of RDTs (without significant differences) for both malaria species. Providing standardized automated interpretation of RDTs at POC in remote areas, in addition to almost real-time reporting of cases and enabling quality control would greatly benefit large-scale implementation of RDT-based malaria diagnostic programmes.
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Affiliation(s)
- Sócrates Herrera
- Caucaseco Scientific Research Center, Cali, Colombia
- Latin American Center for Malaria Research, Cali, Colombia
| | - Andrés F Vallejo
- Caucaseco Scientific Research Center, Cali, Colombia
- Latin American Center for Malaria Research, Cali, Colombia
| | - Juan P Quintero
- Caucaseco Scientific Research Center, Cali, Colombia
- Latin American Center for Malaria Research, Cali, Colombia
| | - Myriam Arévalo-Herrera
- Caucaseco Scientific Research Center, Cali, Colombia
- Latin American Center for Malaria Research, Cali, Colombia
- Faculty of Health, Universidad del Valle, Cali, Colombia
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