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Ebbs D, Taricia M, Funaro MC, O’Daniel M, Cappello M. Prehospital use of point-of-care tests by community health workers: a scoping review. Front Public Health 2024; 12:1360322. [PMID: 38721545 PMCID: PMC11076783 DOI: 10.3389/fpubh.2024.1360322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Accepted: 03/06/2024] [Indexed: 05/15/2024] Open
Abstract
Introduction Point-of-Care Tests (POCTs) are utilized daily in resource abundant regions, however, are limited in the global south, particularly in the prehospital setting. Few studies exist on the use of non-malarial POCTs by Community Health Workers (CHWs). The purpose of this scoping review is to delineate the current diversity in and breadth of POCTs evaluated in the prehospital setting. Methods A medical subject heading (MeSH) analysis of known key articles was done by an experienced medical librarian and scoping searches were performed in each database to capture "point of care testing" and "community health workers." This review was guided by the PRISMA Extension for scoping reviews. Results 2735 publications were returned, 185 were nominated for full-text review, and 110 studies were confirmed to meet study criteria. Majority focused on malaria (74/110; 67%) or HIV (25/110; 23%); 9/110 (8%) described other tests administered. Results from this review demonstrate a broad geographic range with significant heterogeneity in terminology for local CHWs. Conclusion The use of new POCTs is on the rise and may improve early risk stratification in limited resource settings. Current evidence from decades of malaria POCTs can guide future implementation strategies.
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Affiliation(s)
- Daniel Ebbs
- Department of Pediatrics, Yale University, New Haven, CT, United States
| | - Max Taricia
- Department of Pediatrics, Yale University, New Haven, CT, United States
| | - Melissa C. Funaro
- Department of Medicine, Harvey Cushing/John Hay Whitney Medical Library, New Haven, CT, United States
| | - Maggie O’Daniel
- University of North Carolina at Greensboro, Greensboro, NC, United States
| | - Michael Cappello
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT, United States
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Ramani S, Kohar HT, Pratt O, Denon YE, Reed CM, Thomas P, Powell SE, Aidoo M. Stability testing of dried Plasmodium falciparum positive quality control samples for malaria rapid diagnostic tests in Liberia and Benin. Malar J 2020; 19:288. [PMID: 32787959 PMCID: PMC7424989 DOI: 10.1186/s12936-020-03364-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Accepted: 08/05/2020] [Indexed: 11/15/2022] Open
Abstract
Background Malaria rapid diagnostic tests (RDTs) are largely responsible for the gains made in the proportion of malaria cases confirmed with a parasitological test. However, quality assurance programs to support their use remain a challenge. A dried tube specimen (DTS) method was developed that showed potential for use as a stable source of quality control (QC) sample for RDTs and for use in external quality assessments or proficiency testing (PT). DTS was further assessed with focus on sample stability under field settings in Benin and Liberia. Methods DTS were prepared using Plasmodium falciparum 3D7 or W2 strains at concentrations of 1000, 500 or 0 parasites/µL and tested for baseline reactivity at the Centers for Disease Control and Prevention, Atlanta before shipping. In Benin and Liberia, DTS were stored under refrigeration in a reference laboratory (RL) or in health centres under ambient temperatures. Seven rounds of testing were performed at 4-week intervals during which DTS were tested on RDTs stored at the RL or at health centres. Observed DTS reactivity at the RL and health centres were compared to expected reactivity to determine DTS stability. DTS were also assembled into a PT panel and tested by health facility staff at the mid and end time-points of the study. Daily maximum and minimum storage temperatures for RDTs and DTS were recorded. Results In Benin, DTS, irrespective of storage conditions, produced the expected reactivity at all time points. However, evidence of degradation was observed at weeks 20 and 24 for DTS stored at ambient temperatures at the health centres and not those stored under refrigeration at the RL. In Liberia, sample degradation was observed starting at week 8 especially among DTS stored at the health facilities. The degradation was associated with prolonged storage of DTS under ambient temperature prior to study commencement and less than optimal storage temperatures at the RL. Use of DTS in a PT enabled identification of health worker errors in performing the tests. Conclusion DTS is a feasible tool for use as QC material and for PT under field conditions. Long-term (> 5 months) storage of DTS requires refrigeration.
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Affiliation(s)
| | - Henry T Kohar
- National Malaria Control Programme, Monrovia, Liberia
| | - Oliver Pratt
- National Malaria Control Programme, Monrovia, Liberia
| | | | - Christie M Reed
- US President's Malaria Initiative, Division of Parasitic Diseases and Malaria, Center for Global Health, Centers for Disease Control and Prevention, Monrovia, Liberia
| | - Peter Thomas
- US President's Malaria Initiative, Division of Parasitic Diseases and Malaria, Center for Global Health, Centers for Disease Control and Prevention, Cotonou, Benin
| | - Suzanne E Powell
- US President's Malaria Initiative, Division of Parasitic Diseases and Malaria, Center for Global Health, Centers for Disease Control and Prevention, 1600 Clifton Road, Atlanta, GA, 30333, USA
| | - Michael Aidoo
- US President's Malaria Initiative, Division of Parasitic Diseases and Malaria, Center for Global Health, Centers for Disease Control and Prevention, 1600 Clifton Road, Atlanta, GA, 30333, USA.
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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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Morang'a C, Ayieko C, Awinda G, Achilla R, Moseti C, Ogutu B, Waitumbi J, Wanja E. Stabilization of RDT target antigens present in dried Plasmodium falciparum-infected samples for validating malaria rapid diagnostic tests at the point of care. Malar J 2018; 17:10. [PMID: 29310651 PMCID: PMC5759799 DOI: 10.1186/s12936-017-2155-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2017] [Accepted: 12/23/2017] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND Malaria rapid diagnostic tests (RDTs) are a great achievement in implementation of parasite based diagnosis as recommended by World Health Organization. A major drawback of RDTs is lack of positive controls to validate different batches/lots at the point of care. Dried Plasmodium falciparum-infected samples with the RDT target antigens have been suggested as possible positive control but their utility in resource limited settings is hampered by rapid loss of activity over time. METHODS This study evaluated the effectiveness of chemical additives to improve long term storage stability of RDT target antigens (HRP2, pLDH and aldolase) in dried P. falciparum-infected samples using parasitized whole blood and culture samples. Samples were treated with ten selected chemical additives mainly sucrose, trehalose, LDH stabilizer and their combinations. After baseline activity was established, the samples were air dried in bio-safety cabinet and stored at room temperatures (~ 25 °C). Testing of the stabilized samples using SD Bioline, BinaxNOW, CareStart, and First Response was done at intervals for 53 weeks. RESULTS Stability of HRP2 at ambient temperature was reported at 21-24 weeks while that of PAN antigens (pLDH and aldolase) was 2-18 weeks of storage at all parasite densities. The ten chemical additives increased the percentage stability of HRP2 and PAN antigens. Sucrose alone and its combinations with Alsever's solution or biostab significantly increased stability of HRP2 by 56% at 2000 p/µL (p < 0.001). Trehalose and its combinations with biostab, sucrose or glycerol significantly increased stability of HRP2 by 57% (p < 0.001). Unlike sucrose, the stability of the HRP2 was significantly retained by trehalose at lower concentrations (500, and 200 p/µL). Trehalose in combination biostab stabilizer increased the percentage stability of PAN antigens by 42, and 32% at 2000 and 500 p/µL respectively (p < 0.01). This was also the chemical combination with the shortest reconstitution time (~ < 20 min). CONCLUSIONS These findings confirm that stabilizing RDT target antigens in dried P. falciparum-infected samples using chemical additives provides field-stable positive controls for malaria RDTs.
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Affiliation(s)
- Collins Morang'a
- Maseno University, P.O Box Private Bag, Maseno, Kenya. .,United States Army Medical Research Directorate, P.O Box 54, Kisumu, 40100, Kenya.
| | - Cyrus Ayieko
- Maseno University, P.O Box Private Bag, Maseno, Kenya
| | - George Awinda
- United States Army Medical Research Directorate, P.O Box 54, Kisumu, 40100, Kenya
| | - Rachel Achilla
- United States Army Medical Research Directorate, P.O Box 54, Kisumu, 40100, Kenya
| | - Caroline Moseti
- United States Army Medical Research Directorate, P.O Box 54, Kisumu, 40100, Kenya
| | - Bernhards Ogutu
- Kenya Medical Research Institute, P.O. Box 54840-00200, Nairobi, Kenya
| | - John Waitumbi
- United States Army Medical Research Directorate, P.O Box 54, Kisumu, 40100, Kenya
| | - Elizabeth Wanja
- United States Army Medical Research Directorate-Armed Forces Research Institute of Medical Sciences, Bangkok, 10400, Thailand
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