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Perkins J, Chandler C, Kelly A, Street A. The social lives of point-of-care tests in low- and middle-income countries: a meta-ethnography. Health Policy Plan 2024; 39:782-798. [PMID: 38907518 PMCID: PMC11308614 DOI: 10.1093/heapol/czae054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Revised: 05/28/2024] [Accepted: 06/21/2024] [Indexed: 06/24/2024] Open
Abstract
Point-of-care tests (POCTs) have become technological solutions for many global health challenges. This meta-ethnography examines what has been learned about the 'social lives' of POCTs from in-depth qualitative research, highlighting key social considerations for policymakers, funders, developers and users in the design, development and deployment of POCTs. We screened qualitative research examining POCTs in low- and middle-income countries and selected 13 papers for synthesis. The findings illuminate five value-based logics-technological autonomy, care, scalability, rapidity and certainty-shaping global health innovation ecosystems and their entanglement with health systems. Our meta-ethnography suggests that POCTs never achieve the technological autonomy often anticipated during design and development processes. Instead, they are both embedded in and constitutive of the dynamic relationships that make up health systems in practice. POCTs are often imagined as caring commodities; however, in use, notions of care inscribed in these devices are constantly negotiated and transformed in relation to multiple understandings of care. POCTs promise to standardize care across scale, yet our analysis indicates nonstandard processes, diagnoses and treatment pathways as essential to 'fluid technologies' rather than dangerous aberrations. The rapidity of POCTs is constructed and negotiated within multiple distinct temporal registers, and POCTs operate as temporal objects that can either speed up or slow down experiences of diagnosis and innovation. Finally, while often valued as epistemic tools that can dispel diagnostic uncertainty, these papers demonstrate that POCTs contribute to new forms of uncertainty. Together, these papers point to knowledge practices as multiple, and POCTs as contributing to, rather than reducing, this multiplicity. The values embedded in POCTs are fluid and contested, with important implications for the kind of care these tools can deliver. These findings can contribute to more reflexive approaches to global health innovation, which take into account limitations of established global health logics, and recognize the socio-technical complexity of health systems.
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Affiliation(s)
- Janet Perkins
- Department of Social Anthropology, School of Social and Political Science, University of Edinburgh, Chrystal Macmillan Building, 15a George Square, Edinburgh EH8 9LD, United Kingdom
| | - Clare Chandler
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London WC1H 9SH, United Kingdom
| | - Ann Kelly
- Department of Global Health and Social Medicine, King’s College London, Bush House North East Wing, 30 Aldwych, London WC2B 4BG, United Kingdom
| | - Alice Street
- Department of Social Anthropology, School of Social and Political Science, University of Edinburgh, Chrystal Macmillan Building, 15a George Square, Edinburgh EH8 9LD, United Kingdom
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Patikorn C, Cho JY, Higashi J, Huang XX, Chaiyakunapruk N. Financial hardship among patients suffering from neglected tropical diseases: A systematic review and meta-analysis of global literature. PLoS Negl Trop Dis 2024; 18:e0012086. [PMID: 38739636 PMCID: PMC11090293 DOI: 10.1371/journal.pntd.0012086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Accepted: 03/20/2024] [Indexed: 05/16/2024] Open
Abstract
INTRODUCTION Neglected tropical diseases (NTDs) mainly affect underprivileged populations, potentially resulting in catastrophic health spending (CHS) and impoverishment from out-of-pocket (OOP) costs. This systematic review aimed to summarize the financial hardship caused by NTDs. METHODS We searched PubMed, EMBASE, EconLit, OpenGrey, and EBSCO Open Dissertations, for articles reporting financial hardship caused by NTDs from database inception to January 1, 2023. We summarized the study findings and methodological characteristics. Meta-analyses were performed to pool the prevalence of CHS. Heterogeneity was evaluated using the I2 statistic. RESULTS Ten out of 1,768 studies were included, assessing CHS (n = 10) and impoverishment (n = 1) among 2,761 patients with six NTDs (Buruli ulcer, chikungunya, dengue, visceral leishmaniasis, leprosy, and lymphatic filariasis). CHS was defined differently across studies. Prevalence of CHS due to OOP costs was relatively low among patients with leprosy (0.0-11.0%), dengue (12.5%), and lymphatic filariasis (0.0-23.0%), and relatively high among patients with Buruli ulcers (45.6%). Prevalence of CHS varied widely among patients with chikungunya (11.9-99.3%) and visceral leishmaniasis (24.6-91.8%). Meta-analysis showed that the pooled prevalence of CHS due to OOP costs of visceral leishmaniasis was 73% (95% CI; 65-80%, n = 2, I2 = 0.00%). Costs of visceral leishmaniasis impoverished 20-26% of the 61 households investigated, depending on the costs captured. The reported costs did not capture the financial burden hidden by the abandonment of seeking healthcare. CONCLUSION NTDs lead to a substantial number of households facing financial hardship. However, financial hardship caused by NTDs was not comprehensively evaluated in the literature. To develop evidence-informed strategies to minimize the financial hardship caused by NTDs, studies should evaluate the factors contributing to financial hardship across household characteristics, disease stages, and treatment-seeking behaviors.
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Affiliation(s)
- Chanthawat Patikorn
- Department of Pharmacotherapy, College of Pharmacy, University of Utah, Salt Lake City, Utah, United States of America
- Department of Social and Administrative Pharmacy, Faculty of Pharmaceutical Sciences, Chulalongkorn University, Bangkok, Thailand
| | - Jeong-Yeon Cho
- Department of Pharmacotherapy, College of Pharmacy, University of Utah, Salt Lake City, Utah, United States of America
- School of Pharmacy, Sungkyunkwan University, Suwon, South Korea
| | - Joshua Higashi
- Corvaxan Foundation, Villanova, Pennsylvania, United States of America
| | - Xiao Xian Huang
- Department of Global Programme for Neglected Tropical Diseases, World Health Organization, Geneva, Switzerland
| | - Nathorn Chaiyakunapruk
- Department of Pharmacotherapy, College of Pharmacy, University of Utah, Salt Lake City, Utah, United States of America
- IDEAS Center, Veterans Affairs Salt Lake City Healthcare System, Salt Lake City, Utah, United States of America
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Street A, Taylor EM. Equivocal diagnostics: Making a 'good' point-of-care test for elimination in global health. SOCIAL STUDIES OF SCIENCE 2024:3063127241246727. [PMID: 38654559 DOI: 10.1177/03063127241246727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/26/2024]
Abstract
What is a diagnostic test for? We might assume the answer to this question is straightforward. A good test would help identify what disease someone suffers from, assist health providers to determine the correct course of treatment and/or enable public health authorities to know and intervene in health at the level of the population. In this article, we show that what a specific diagnostic test is for, the value it holds for different actors, and what makes it good, or not, is often far from settled. We tell the story of the development and design of a rapid antibody test for onchocerciasis, or river blindness, tracking multiple iterations of the device through three configurational moments in the framing of onchocerciasis disease and reshaping of the global health innovation ecosystem. Efforts to build that ecosystem for diagnostics are often premised on the notion that public health needs for diagnostics are pre-given and stable; the challenge is seen to be how to incentivize investment and find a customer base for diagnostics in under-resourced settings. By contrast, we show that for any disease, diagnostic needs are both multiple and constantly in flux, and are unlikely to be met by a single, stand-alone product. In the case of the onchocerciasis Ov-16 rapid test, the failure to recognize and address the multiplicity and instability of diagnostic needs in the innovation process resulted in the development of a rapid point of care test that might be manufactured, procured and used, but is unloved by public health experts and commercial manufacturers alike. The equivocal value of the onchocerciasis rapid test, we suggest, reveals the inadequacy of the current global health innovation ecosystem for developing diagnostic 'goods'.
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Nikièma AS, Koala L, Post RJ, Kima A, Compaoré J, Kafando CM, Nana JB, Bougouma C, Faye B, Traoré S, Dabiré RK. Progress towards elimination of onchocerciasis in the Region du Sud-Ouest of Burkina Faso which was previously subject to a recrudescence event after vector control. PLoS Negl Trop Dis 2024; 18:e0012118. [PMID: 38683750 PMCID: PMC11057763 DOI: 10.1371/journal.pntd.0012118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Accepted: 03/29/2024] [Indexed: 05/02/2024] Open
Abstract
BACKGROUND The Sud-Ouest region of Burkina Faso (especially the Bougouriba valley) has been historically problematic with respect to onchocerciasis control, with a recrudescence of infections after vector control carried out the WHO Onchocerciasis Control Programme was halted in 1989. After 1996, mass drug administration of ivermectin was instigated to control the recrudescence so that it would no longer constitute a public health problem. However, in 2010 WHO changed its recommended policy from control to elimination, and in 2013 biannual Community-Directed Treatment with Ivermectin (CDTI) was instigated. Epidemiological surveys were carried-out in 2011 and 2018 to determine whether CDTI was producing a decline in infection levels and progress towards elimination. METHODOLOGY/PRINCIPAL FINDINGS A cross-sectional study was conducted across 20 villages in four health districts in 2011 and 29 villages in 2018. Individuals aged five years and above were examined by skin-snip, and the prevalence and microfilarial load was determined for each village. In 2011, 75% of villages had some infections and 20% had prevalences >5%, with a mean prevalence across all villages of 2.63% (range 0.0-9.7%), and community microfilarial load ranging from 0 to 0.25 microfilariae per biopsy. In 2018, nine villages (= 31% of total) had some infections, with prevalences ranging from 0.41% to 3.54%, and a mean prevalence across all villages of 0.37%. Community microfilarial load ranged from 0 to 0.1. Amongst those people found to be microfilarial positive, 87% had a history of migration. CONCLUSIONS/SIGNIFICANCE The endemicity of onchocerciasis infection in the Sud-Ouest region has declined to low levels and seems to be progressing towards elimination. Our findings indicated that biannual CDTI is having good effect, but it should continue for a number of years to ensure elimination of transmission. However, progress towards elimination has a troublesome history in this region, and it would be advisable to select more sentinel villages to have confidence in any future epidemiological and entomological surveys, especially Stop-MDA surveys. With positive individuals migrating between countries, cross-border collaboration needs more attention to ensure effective treatment for onchocerciasis elimination.
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Affiliation(s)
- Achille Sindimbasba Nikièma
- Ministère de l’Enseignement Supérieur, de la Recherche et de l’Innovation, Institut de Recherche en Sciences de la Santé, Direction Régionale de l’Ouest (IRSS/Bobo-Dioulasso), Ouagadougou, Burkina Faso
- Université Cheikh Anta Diop, Dakar, Sénégal
| | - Lassane Koala
- Ministère de l’Enseignement Supérieur, de la Recherche et de l’Innovation, Institut de Recherche en Sciences de la Santé, Direction Régionale de l’Ouest (IRSS/Bobo-Dioulasso), Ouagadougou, Burkina Faso
| | - Rory J. Post
- School of Biological & Environmental Sciences, Liverpool John Moores University, Liverpool, United Kingdom
| | - Appolinaire Kima
- Ministère de la Santé, Direction de la Protection de la Santé de la Population, Programme National de Lutte Contre les Maladies Tropicales Négligées, Ouagadougou, Burkina Faso
| | - Justin Compaoré
- Ministère de la Santé, Direction de la Protection de la Santé de la Population, Programme National de Lutte Contre les Maladies Tropicales Négligées, Ouagadougou, Burkina Faso
| | - Claude M. Kafando
- Ministère de la Santé, Direction de la Protection de la Santé de la Population, Programme National de Lutte Contre les Maladies Tropicales Négligées, Ouagadougou, Burkina Faso
| | - Jean Baptiste Nana
- Ministère de la Santé, Direction de la Protection de la Santé de la Population, Programme National de Lutte Contre les Maladies Tropicales Négligées, Ouagadougou, Burkina Faso
| | - Clarisse Bougouma
- Ministère de la Santé, Direction de la Protection de la Santé de la Population, Programme National de Lutte Contre les Maladies Tropicales Négligées, Ouagadougou, Burkina Faso
| | | | - Soungalo Traoré
- Ministère de la Santé, Direction de la Protection de la Santé de la Population, Programme National de Lutte Contre les Maladies Tropicales Négligées, Ouagadougou, Burkina Faso
| | - Roch Kounbobr Dabiré
- Ministère de l’Enseignement Supérieur, de la Recherche et de l’Innovation, Institut de Recherche en Sciences de la Santé, Direction Régionale de l’Ouest (IRSS/Bobo-Dioulasso), Ouagadougou, Burkina Faso
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Semahegn A, Manyazewal T, Getachew E, Fekadu B, Assefa E, Kassa M, Davey G, Hopkins M, Araya M, Woldehanna T, Hanlon C, Fekadu A. Burden of neglected tropical diseases and access to medicine and diagnostics in Ethiopia: a scoping review. Syst Rev 2023; 12:140. [PMID: 37580784 PMCID: PMC10424375 DOI: 10.1186/s13643-023-02302-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Accepted: 07/28/2023] [Indexed: 08/16/2023] Open
Abstract
BACKGROUND More than 1.7 billion people are affected by neglected tropical diseases (NTDs) worldwide. Forty percent of the NTD-affected people live in Africa with the poorest, most vulnerable, and hard to reach geographical areas. The NTDs cause significant social and economic burden and deepen marginalization and stigmatization. The World Health Organization's current roadmap for NTD aims to prevent, control, eliminate, or eradicate 20 tropical diseases. Ethiopia experiences a high burden of these diseases, but current access to diagnostics, medicine, and/or care has been little explored to inform the country's NTD strategic plan. The overall purpose of the scoping review was to map and characterize the burden of NTDs and challenges in access to diagnostics, medicine, and/or care in Ethiopia. METHODS A systematic search of evidence was conducted in PubMed, Cochrane Library, and Google Scholar from January 2000 until May 2022, without restrictions of language or study design. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Review was followed for screening of studies. Key findings were extracted and narrated qualitatively. RESULTS The search resulted in 4532 articles, of which 105 met the inclusion criteria and were included in the scoping review under three themes: burden of NTDs, access to diagnostics, medicine and/or care, and key barriers. Although gains have been made in the prevention and control of NTDs in Ethiopia, the burden remains high, and progress in access to diagnostics, medicine/drugs, and/or care is very slow. Poverty, poor quality of life, and underfunding of NTD programs decelerate the process of NTD elimination program in the country. CONCLUSIONS The scoping review identified a considerable number of studies on the burden of NTDs in Ethiopia and strategies for diagnosis, treatment, and/or care; however, there is a paucity of evidence on the suitability and potential benefits of novel diagnostic technologies and medicines in the country. A regular review and analysis of such country-level evidence is important to inform the country NTDs roadmap and local implementation strategies.
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Affiliation(s)
- Agumasie Semahegn
- Centre for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia.
- College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia.
- Department of Population, Family and Reproductive Health, School of Public Health, Unversity of Ghana, Accra, Ghana.
| | - Tsegahun Manyazewal
- Centre for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Eyerusalem Getachew
- Centre for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Bethelhem Fekadu
- Centre for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Esubalew Assefa
- Centre for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
- Health Economics and Policy Research Unit, Wolfson Institute of Population Health, Queen Mary University of London, London, UK
- Department of Economics, Faculty of Arts and Social Sciences, The Open University, Milton Keynes, UK
| | - Munir Kassa
- Ministry of Health of Ethiopia, Addis Ababa, Ethiopia
| | - Gail Davey
- Global Health & Infection Department, Brighton and Sussex Medical School, Brighton, UK
- School of Public Health, College of Health Science, Addis Ababa University, Addis Ababa, Ethiopia
| | - Michael Hopkins
- Science Policy Research Unit, University of Sussex, Brighton, UK
| | - Mesele Araya
- College of Business and Economics, Addis Ababa University, Addis Ababa, Ethiopia
- Policy Studies Institute, Addis Ababa, Ethiopia
| | - Tassew Woldehanna
- College of Business and Economics, Addis Ababa University, Addis Ababa, Ethiopia
| | - Charlotte Hanlon
- Centre for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
- Centre for Global Mental Health, Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- Department of Psychiatry, WHO Collaborating Centre for Mental Health Research and Capacity Building, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Abebaw Fekadu
- Centre for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
- Global Health & Infection Department, Brighton and Sussex Medical School, Brighton, UK
- Department of Psychiatry, WHO Collaborating Centre for Mental Health Research and Capacity Building, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
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Prevalence of Schistosoma haematobium and Intestinal Helminth Infections among Nigerian School Children. Diagnostics (Basel) 2023; 13:diagnostics13040759. [PMID: 36832247 PMCID: PMC9955672 DOI: 10.3390/diagnostics13040759] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2022] [Revised: 02/03/2023] [Accepted: 02/14/2023] [Indexed: 02/19/2023] Open
Abstract
Schistosomiasis and soil-transmitted helminthiases (STH) are two parasitic diseases mainly affecting school children. The purpose of this study was to estimate the current prevalence and infection intensity, in addition to the associations of these infections with age and sex, in children aged 4-17 years living in Osun State, Nigeria. From each participant (250 children), one urine and one stool sample were taken for the study, for the microscopic detection of eggs or larvae in faeces by means of the Kato-Katz method and eggs in filtrated urine. The overall prevalence of urinary schistosomiasis was 15.20%, with light infection. The intestinal helminthic species identified (and their prevalence) were S. stercoralis (10.80%), S. mansoni (8%), A. lumbricoides (7.20%), hookworm (1.20%), and T. trichiura (0.4%), all of them being classified as light infections. Single infections (67.95%) are more frequent than multiple infections (32.05%). With this study, schistosomiasis and STH are still endemic in Osun State, but with a light to moderate prevalence and light infection intensity. Urinary infection was the most prevalent, with higher prevalence in children over 10 years. The >10 years age group had the highest prevalence for all of the intestinal helminths. There were no statistically significant associations between gender and age and urogenital or intestinal parasites.
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Street A. Make me a test and I will save the world: towards an anthropology of the possible in global health. JOURNAL OF THE ROYAL ANTHROPOLOGICAL INSTITUTE 2023. [DOI: 10.1111/1467-9655.13904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/10/2023]
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Euliano EM, Sklavounos AA, Wheeler AR, McHugh KJ. Translating diagnostics and drug delivery technologies to low-resource settings. Sci Transl Med 2022; 14:eabm1732. [PMID: 36223447 PMCID: PMC9716722 DOI: 10.1126/scitranslmed.abm1732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
Diagnostics and drug delivery technologies engineered for low-resource settings aim to meet their technical design specifications using strategies that are compatible with limited equipment, infrastructure, and operator training. Despite many preclinical successes, very few of these devices have been translated to the clinic. Here, we identify factors that contribute to the clinical success of diagnostics and drug delivery systems for low-resource settings, including the need to engage key stakeholders at an early stage, and provide recommendations for the clinical translation of future medical technologies.
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Affiliation(s)
- Erin M. Euliano
- Department of Bioengineering, Rice University; Houston, Texas 77005, USA
| | - Alexandros A. Sklavounos
- Department of Chemistry, University of Toronto; Toronto, Ontario M5S 3H6, Canada
- Donnelly Centre for Cellular and Biomolecular Research, University of Toronto; Toronto, Ontario M5S 3E1, Canada
| | - Aaron R. Wheeler
- Department of Chemistry, University of Toronto; Toronto, Ontario M5S 3H6, Canada
- Donnelly Centre for Cellular and Biomolecular Research, University of Toronto; Toronto, Ontario M5S 3E1, Canada
- Institute of Biomedical Engineering, University of Toronto; Toronto, Ontario M5S 3G9, Canada
| | - Kevin J. McHugh
- Department of Bioengineering, Rice University; Houston, Texas 77005, USA
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Choi HL, Ducker C, Braniff S, Argaw D, Solomon AW, Borisch B, Mubangizi D. Landscape analysis of NTD diagnostics and considerations on the development of a strategy for regulatory pathways. PLoS Negl Trop Dis 2022; 16:e0010597. [PMID: 35788571 PMCID: PMC9286218 DOI: 10.1371/journal.pntd.0010597] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 07/15/2022] [Accepted: 06/20/2022] [Indexed: 11/18/2022] Open
Abstract
Access to quality-assured, accurate diagnostics is critical to ensure that the 2021-2030 neglected tropical disease (NTD) road map targets can be achieved. Currently, however, there is limited regulatory oversight and few quality assurance mechanisms for NTD diagnostic tools. In attempting to address such challenges and the changing environment in regulatory requirements for diagnostics, a landscape analysis was conducted, to better understand the availability of NTD diagnostics and inform future regulatory frameworks. The list of commercially available diagnostics was compiled from various sources, including WHO guidance, national guidelines for case detection and management, diagnostic target product profiles and the published literature. The inventory was analyzed according to diagnostic type, intended use, regulatory status, and risk classification. To estimate the global need and size of the market for each type of diagnostic, annual procurement data were collected from WHO, procurement agencies, NGOs and international organizations, where available and global disease prevalence. Expert interviews were also conducted to ensure a better understanding of how diagnostics are procured and used. Of 125 diagnostic tools included in this analysis, rapid diagnostic tools accounted for 33% of diagnostics used for NTDs and very few diagnostics had been subjected to regulatory assessment. The number of tests needed for each disease was less than 1 million units per annum, except in the case of two diseases, suggesting limited commercial value. Despite the nature of the market, and presumed insufficient return on commercial investment, acceptable levels of assurance on performance, quality and safety of diagnostics are still required. Priority actions include setting up an agile, interim, stepwise risk assessment mechanism, in particular for diagnostics of lower risk, in order to support national NTD programmes and their partners with the selection and procurement of the diagnostics needed to control, eliminate and eradicate NTDs.
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Affiliation(s)
- Hye Lynn Choi
- World Health Organization, Geneva, Switzerland
- Institute of Global Health, University of Geneva, Geneva, Switzerland
| | | | | | | | | | - Bettina Borisch
- Institute of Global Health, University of Geneva, Geneva, Switzerland
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Ta-Tang TH, Febrer-Sendra B, Berzosa P, Rubio JM, Romay-Barja M, Ncogo P, Agudo D, Herrador Z, Fernández-Soto P, Muro A, Benito A. Comparison of three PCR-based methods to detect Loa loa and Mansonella perstans in long-term frozen storage dried blood spots. Trop Med Int Health 2022; 27:686-695. [PMID: 35653502 DOI: 10.1111/tmi.13786] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Loa loa and Mansonella perstans are two very common filarial species in Africa. Although microscopy is the traditional diagnostic method for human filariasis, several polymerase chain reaction (PCR) methods have emerged as an alternative approach for identifying filarial parasites. The aim of this study is to compare three molecular methods and decide which is the most suitable for diagnosing human loiasis and mansonellosis in non-endemic regions using dried blood spot (DBS) as a medium for sample collection and storage. METHODS A total of 100 DBS samples, with their corresponding thin and thick blood smears, were selected for this study. Microscopy was used as the reference method to diagnose and calculate the microfilaraemia. Filarial DNA was extracted using the saponin/Chelex method and the DNA isolated was assayed by Filaria-real time-PCR, filaria-nested PCR, and cytochrome oxidase I PCR. All PCR products were subsequently purified and sequenced. The statistical values for each molecular test were calculated and compared. RESULTS Overall, 64 samples were identified as negative by all tests and a further 36 samples were positive by at least one of the methods used. The sensitivity and specificity were similar for the different molecular methods, all of which demonstrated good agreement with microscopy. CONCLUSIONS Based on this study, and from a practical point of view (single and short amplification round), the optimal technique for diagnosing filarial infection in non-endemic regions is filaria-real time-PCR, which presents high sensitivity and specificity and is also able to detect a wide range of human filariae.
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Affiliation(s)
- Thuy-Huong Ta-Tang
- Malaria and Neglected Tropical Diseases Laboratory, National Centre of Tropical Medicine, Institute of Health Carlos III, Biomedical Research Networking Center of Infectious Diseases, Madrid, Spain.,Cooperative Research Network in Tropical Diseases, Madrid, Spain
| | - Begoña Febrer-Sendra
- Cooperative Research Network in Tropical Diseases, Madrid, Spain.,Infectious and Tropical Diseases Research Group (e-INTRO), Biomedical Research Institute of Salamanca-Research Centre for Tropical Diseases at the University of Salamanca, Faculty of Pharmacy, University of Salamanca, Salamanca, Spain
| | - Pedro Berzosa
- Malaria and Neglected Tropical Diseases Laboratory, National Centre of Tropical Medicine, Institute of Health Carlos III, Biomedical Research Networking Center of Infectious Diseases, Madrid, Spain.,Cooperative Research Network in Tropical Diseases, Madrid, Spain
| | - José Miguel Rubio
- Cooperative Research Network in Tropical Diseases, Madrid, Spain.,Malaria and Emerging Parasitic Diseases Laboratory, National Microbiology Center, Institute of Health Carlos III, Madrid, Spain
| | - María Romay-Barja
- Malaria and Neglected Tropical Diseases Laboratory, National Centre of Tropical Medicine, Institute of Health Carlos III, Biomedical Research Networking Center of Infectious Diseases, Madrid, Spain.,Cooperative Research Network in Tropical Diseases, Madrid, Spain
| | - Policarpo Ncogo
- Ministry of Health, Malabo, Equatorial Guinea.,Fundación Estatal, Salud, Infancia y Bienestar Social, Madrid, Spain
| | - Diego Agudo
- Facultad de Ciencias Biológicas, Universidad Complutense de Madrid, Madrid, Spain
| | - Zaida Herrador
- Malaria and Neglected Tropical Diseases Laboratory, National Centre of Tropical Medicine, Institute of Health Carlos III, Biomedical Research Networking Center of Infectious Diseases, Madrid, Spain.,Cooperative Research Network in Tropical Diseases, Madrid, Spain
| | - Pedro Fernández-Soto
- Cooperative Research Network in Tropical Diseases, Madrid, Spain.,Infectious and Tropical Diseases Research Group (e-INTRO), Biomedical Research Institute of Salamanca-Research Centre for Tropical Diseases at the University of Salamanca, Faculty of Pharmacy, University of Salamanca, Salamanca, Spain
| | - Antonio Muro
- Cooperative Research Network in Tropical Diseases, Madrid, Spain.,Infectious and Tropical Diseases Research Group (e-INTRO), Biomedical Research Institute of Salamanca-Research Centre for Tropical Diseases at the University of Salamanca, Faculty of Pharmacy, University of Salamanca, Salamanca, Spain
| | - Agustín Benito
- Malaria and Neglected Tropical Diseases Laboratory, National Centre of Tropical Medicine, Institute of Health Carlos III, Biomedical Research Networking Center of Infectious Diseases, Madrid, Spain.,Cooperative Research Network in Tropical Diseases, Madrid, Spain
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Okoyo C, Onyango N, Orowe I, Mwandawiro C, Medley G. Sensitivity Analysis of a Transmission Interruption Model for the Soil-Transmitted Helminth Infections in Kenya. Front Public Health 2022; 10:841883. [PMID: 35400031 PMCID: PMC8990131 DOI: 10.3389/fpubh.2022.841883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 02/28/2022] [Indexed: 12/03/2022] Open
Abstract
As the world rallies toward the endgame of soil-transmitted helminths (STH) elimination by the year 2030, there is a need for efficient and robust mathematical models that would enable STH programme managers to target the scarce resources and interventions, increase treatment coverage among specific sub-groups of the population, and develop reliable surveillance systems that meet sensitivity and specificity requirements for the endgame of STH elimination. However, the considerable complexities often associated with STH-transmission models underpin the need for specifying a large number of parameters and inputs, which are often available with considerable degree of uncertainty. Additionally, the model may behave counter-intuitive especially when there are non-linearities in multiple input-output relationships. In this study, we performed a global sensitivity analysis (GSA), based on a variance decomposition method: extended Fourier Amplitude Sensitivity Test (eFAST), to a recently developed STH-transmission model in Kenya (an STH endemic country) to; (1) robustly compute sensitivity index (SI) for each parameter, (2) rank the parameters in order of their importance (from most to least influential), and (3) quantify the influence of each parameter, singly and cumulatively, on the model output. The sensitivity analysis (SA) results demonstrated that the model outcome (STH worm burden elimination in the human host) was significantly sensitive to some key parameter groupings: combined effect of improved water source and sanitation (ϕ), rounds of treatment offered (τ), efficacy of the drug used during treatment (h), proportion of the adult population treated (ga: akin to community-wide treatment), mortality rate of the mature worms in the human host (μ), and the strength of the -dependence of worm egg production (γ). For STH control programmes to effectively reach the endgame (STH elimination in the entire community), these key parameter groupings need to be targeted since together they contribute to a strategic public health intervention.
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Affiliation(s)
- Collins Okoyo
- Eastern and Southern Africa Centre of International Parasite Control (ESACIPAC), Kenya Medical Research Institute (KEMRI), Nairobi, Kenya
- School of Mathematics, University of Nairobi, Nairobi, Kenya
- *Correspondence: Collins Okoyo
| | - Nelson Onyango
- School of Mathematics, University of Nairobi, Nairobi, Kenya
| | - Idah Orowe
- School of Mathematics, University of Nairobi, Nairobi, Kenya
| | - Charles Mwandawiro
- Eastern and Southern Africa Centre of International Parasite Control (ESACIPAC), Kenya Medical Research Institute (KEMRI), Nairobi, Kenya
| | - Graham Medley
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine (LSHTM), London, United Kingdom
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Li HM, Qian MB, Wang DQ, Lv S, Xiao N, Zhou XN. Potential Capacity of China's development assistance for health on neglected tropical diseases. Acta Trop 2022; 226:106245. [PMID: 34838784 DOI: 10.1016/j.actatropica.2021.106245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Revised: 10/19/2021] [Accepted: 11/04/2021] [Indexed: 11/01/2022]
Abstract
Neglected tropical diseases (NTDs) are important health problem in tropical and sub-tropical regions, which afflict more than a billion people worldwide and cause several million deaths every year, especially in Africa. The World Health Organization has called for global efforts to control and eliminate NTDs. China began its health assistance program from 1950s, especially on medical mission dispatched to more than 50 African countries. In this study, a SWOT analysis was used to analyze the current strengths, weaknesses, opportunities, and threats of China's health assistance relating to NTDs, in order to provide the recommendation to promote the activities on international assistance and cooperation on NTDs. Based on this analysis, interventions for NTDs and suggestions for future cooperation relating to NTDs are proposed. In the context of global health, China should strengthen and improve the capacity on health assistance for NTDs control.
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Ta-Tang TH, Luz SLB, Crainey JL, Rubio JM. An Overview of the Management of Mansonellosis. Res Rep Trop Med 2021; 12:93-105. [PMID: 34079424 PMCID: PMC8163967 DOI: 10.2147/rrtm.s274684] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Accepted: 04/30/2021] [Indexed: 02/02/2023] Open
Abstract
Mansonellosis is caused by three filarial parasite species from the genus Mansonella that commonly produce chronic human microfilaraemias: M. ozzardi, M. perstans and M. streptocerca. The disease is widespread in Africa, the Caribbean and South and Central America, and although it is typically asymptomatic it has been associated with mild pathologies including leg-chills, joint-pains, headaches, fevers, and corneal lesions. No robust mansonellosis disease burden estimates have yet been made and the impact the disease has on blood bank stocks and the monitoring of other filarial diseases is not thought to be of sufficient public health importance to justify dedicated disease management interventions. Mansonellosis´s Ceratopogonidae and Simuliidae vectors are not targeted by other control programmes and because of their small size and out-door biting habits are unlikely to be affected by interventions targeting other disease vectors like mosquitoes. The ivermectin and mebendazole-based mass drug administration (iMDA and mMDA) treatment regimens deployed by the WHO´s Elimination of Neglected Tropical Diseases (ESPEN) programme and its forerunners have, however, likely impacted significantly on the mansonellosis disease burden, principally by reducing the transmission of M. streptocerca in Africa. The increasingly popular plan of using iMDA to control malaria could also affect M. ozzardi parasite prevalence and transmission in Latin America in the future. However, a potentially far greater mansonellosis disease burden impact is likely to come from short-course curative anti-Wolbachia therapeutics, which are presently being developed for onchocerciasis and lymphatic filariasis treatment. Even if the WHO´s ESPEN programme does not choose to deploy these drugs in MDA interventions, they have the potential to dramatically increase the financial and logistical feasibility of effective mansonellosis management. There is, thus, now a fresh and urgent need to better characterise the disease burden and eco-epidemiology of mansonellosis so that effective management programmes can be designed, advocated for and implemented.
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Affiliation(s)
- Thuy-Huong Ta-Tang
- Malaria and NTDs Laboratory, National Centre of Tropical Medicine, Instituto de Salud Carlos III, Madrid, Spain
| | - Sergio L B Luz
- Laboratório de Ecologia de Doenças Transmissíveis na Amazônia, Instituto Leônidas e Maria Deane, Fundação Oswaldo Cruz, Manaus, Amazonas State, Brazil
| | - James L Crainey
- Laboratório de Ecologia de Doenças Transmissíveis na Amazônia, Instituto Leônidas e Maria Deane, Fundação Oswaldo Cruz, Manaus, Amazonas State, Brazil
| | - José M Rubio
- Malaria & Emerging Parasitic Diseases Laboratory, National Microbiology Center, Instituto de Salud Carlos III, Madrid, Spain
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Ta-Tang TH, Berzosa P, Rubio JM, Romay-Barja M, Ncogo P, Agudo D, Herrador Z, Cerrada-Gálvez L, Benito A. Evaluation of LAMP for the diagnosis of Loa loa infection in dried blood spots compared to PCR-based assays and microscopy. Mem Inst Oswaldo Cruz 2021; 116:e210210. [PMID: 35170676 PMCID: PMC8843042 DOI: 10.1590/0074-02760210210] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Accepted: 12/14/2021] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Loa loa is a filarial species found exclusively in West and Central Africa. Microscopy is the traditional diagnosis method for human loiasis. Several molecular methods have developed as an alternative approach for identification of L. loa filarial parasites. OBJECTIVES The aim of this study was to evaluate a Loa-Loop-mediated isothermal amplification (LAMP) assay to diagnose loiasis disease on dried blood spots (DBS) samples, compared to microscopy, filaria-real time-polymerase chain reaction (PCR) and nested-Loa PCR. METHODS A total of 100 DBS samples and 100 blood smears were used for this study. DNA was extracted using saponin/Chelex method. DNA isolated was assayed by a Loa-LAMP assay in parallel to microscopy, filaria-real time PCR and nested-Loa PCR. The sensitivities and specificities of Loa-LAMP assay was computed comparing to each one of the reference methods. FINDINGS Loa-LAMP’s sensitivity was more than 90% and specificity was nearly 100% when compared to molecular methods. On the other hand, sensitivity was decreased a bit when Loa-LAMP faced microscopy, but keeping the other statistical values high. MAIN CONCLUSIONS Loa-LAMP is an appropriate method for loiasis diagnosis in endemic areas. Though, it has disadvantages like the reagents’ high price at the moment and not to be able to detect more filarial species at once.
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Affiliation(s)
- Thuy-Huong Ta-Tang
- National Centre of Tropical Medicine, Spain; Cooperative Research Network on Tropical Diseases, Spain
| | - Pedro Berzosa
- National Centre of Tropical Medicine, Spain; Cooperative Research Network on Tropical Diseases, Spain
| | - José Miguel Rubio
- National Microbiology Centre, Spain; Cooperative Research Network on Tropical Diseases, Spain
| | - María Romay-Barja
- National Centre of Tropical Medicine, Spain; Cooperative Research Network on Tropical Diseases, Spain
| | - Policarpo Ncogo
- Ministry of Health, Equatorial Guinea; Fundación Estatal, Spain
| | | | - Zaida Herrador
- National Centre of Tropical Medicine, Spain; Cooperative Research Network on Tropical Diseases, Spain
| | | | - Agustín Benito
- National Centre of Tropical Medicine, Spain; Cooperative Research Network on Tropical Diseases, Spain
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