scholarly journals Adapting CryoPen, a Non-Gas Based Cryotherapy System for Use in Low- and Middle-Income Countries

2016 ◽  
Vol 2 (3_suppl) ◽  
pp. 11s-12s ◽  
Author(s):  
Miriam Cremer ◽  
Mauricio Maza ◽  
Albert Zevallos ◽  
Manuel Alvarez ◽  
Luis Taxa ◽  
...  
Keyword(s):  
Conflicts Of Interest ◽  
Point Of Care ◽  
Intraepithelial Neoplasia ◽  
Convenience Sample ◽  
Middle Income ◽  
Middle Income Countries ◽  
Ablative Techniques ◽  
Ablative Procedures ◽  
Related Mortality ◽  
Low And Middle Income

Abstract 45 Background: Cervical cancer is a leading cause of cancer-related mortality among women in low- and middle-income countries (LMICs). Two point-of-care technologies that address the treatment gap are the LMIC-adapted CryoPen, with a core temperature of approximately −95°C, and the thermocoagulator, with a probe temperature of 100-120°C. Since there is scant data on the extent of CIN involvement in an underscreened population, determining mean cervical intraepithelial neoplasia (CIN) depth in an underscreened population will establish the depth of necrosis (DON) that ablative techniques need to achieve. The study aimed to establish the maximum depth of involvement of CIN3 and test whether the LMIC-adapted CryoPen and thermocoagulator reach the DON established as necessary for eradicating CIN3. Methods: A convenience sample of 107 CIN3 cases were reviewed by a pathologist at the National Cancer Institute (INEN, Peru) and a U.S. pathologist. Ten women had ablative procedures before non-cervical pathology indicated hysterectomy: a five-minute freeze with the CryoPen (n=5), or a 60-second, 100°C application of the thermocoagulator (n=5). The pathologists measured mean depth of involvement in the CIN3 cases and the local pathologist, blinded to ablative technique, measured maximum DON in both lips. Results: Mean depth of CIN3 involvement was 2.0mm among 107 cases. Mean depth was ≤3.0mm among 79.4%; ≤3.5mm among 89.7%; ≤4.0mm among 93.5%; and ≥5.0mm among 6.5%. The maximum DON achieved by the LMIC-adapted CryoPen was ≥3.0 in 80% of cases; ≥3.5mm in 80%; ≥4.0mm in 80%; ≥4.5mm in 40%; and ≥5.0mm in 20%. The maximum DON achieved by the thermocoagulator was ≥3.0mm in 80% of cases; ≥3.5mm in 80%; ≥4.0mm in 20%; and ≥4.5mm in 20%. Conclusion: The pathology review of CIN3 cases showed that 90% of CIN3 would be eradicated if DON reached at least 3.5mm. The mean DON of both the LMIC-adapted CryoPen and thermocoagulator exceeded 3.5mm. AUTHORS' DISCLOSURES OF POTENTIAL CONFLICTS OF INTEREST: Miriam Cremer No relationship to disclose Mauricio Maza No relationship to disclose Albert Zevallos No relationship to disclose Manuel Alvarez No relationship to disclose Luis Taxa No relationship to disclose Philip E. Castle Honoraria: Roche Cepheid Consulting or Advisory Role: Cepheid, GE Healthcare, Guided Therapeutics, ClearPath, Merck, Genticel, Teva, Inovio Pharmaceuticals, Hologic Todd Alonzo No relationship to disclose Juan Felix No relationship to disclose

A nanophotonic-based assay for point-of-care medical diagnostics of malaria in low and middle income countries

2019 ◽  
Author(s):  
Hoan T. Ngo ◽  
Pietro Strobbia ◽  
Priya Dukes ◽  
Elizabeth Freedman ◽  
Agampodi Swarnapali De Silva Indrasekara ◽  
...  
Keyword(s):  
Point Of Care ◽  
Medical Diagnostics ◽  
Middle Income ◽  
Middle Income Countries ◽  
Low And Middle Income

scholarly journals Formulating Design Recommendations for the Acceptance of the Use and Results of Point-of-Care Testing in Low- and Middle-Income Countries: A Literature Review

2019 ◽  
Vol 1 (1) ◽  
pp. 2795-2804
Author(s):  
Yvonne Jolanda Melanie Licher ◽  
Jan Simon Visser ◽  
G-Young Van ◽  
Jan Carel Diehl
Keyword(s):  
Healthcare Workers ◽  
Point Of Care ◽  
Waiting Times ◽  
Point Of Care Testing ◽  
Middle Income ◽  
Future Design ◽  
Middle Income Countries ◽  
Barriers And Opportunities ◽  
Point Of Care Tests ◽  
Low And Middle Income

AbstractIn low- and middle-income countries (LMIC), diagnostics are not always available in remote areas. Hospitals and healthcare centres are often too far from the community, and waiting times are up to a few hours even for relatively simple procedures. Moreover, travelling to the healthcare centre and taking the diagnostic test is frequently unaffordable. Point of Care Tests (POCTs) can improve the availability, accessibility and affordability of the diagnostics by providing the test at the time and place of patient care. Although many POCTs have been developed already, there remain challenges to enable the healthcare workers (HCW) and the patients to use the device in practice. In this paper, we aim to provide a systemic overview of the barriers and opportunities for the adoption of use and acceptance of the results of POCTs based on the literature. The barriers and opportunities were clustered into six themes and used to draw out recommendations for the future design.

scholarly journals Entry, Retention, and Virological Suppression in an HIV Cohort Study in India: Description of the Cascade of Care and Implications for Reducing HIV-Related Mortality in Low- and Middle-Income Countries

2013 ◽  
Vol 2013 ◽  
pp. 1-8 ◽  
Author(s):  
Gerardo Alvarez-Uria ◽  
Raghavakalyan Pakam ◽  
Manoranjan Midde ◽  
Praveen Kumar Naik
Keyword(s):  
Cohort Study ◽  
Total Mortality ◽  
Hiv Treatment ◽  
Virological Suppression ◽  
Timely Initiation ◽  
Middle Income ◽  
Middle Income Countries ◽  
Art Initiation ◽  
Related Mortality ◽  
Low And Middle Income

HIV treatment, care, and support programmes in low- and middle-income countries have traditionally focused more on patients remaining in care after the initiation of antiretroviral therapy (ART) than on earlier stages of care. This study describes the cumulative retention from HIV diagnosis to the achievement of virological suppression after ART initiation in an HIV cohort study in India. Of all patients diagnosed with HIV, 70% entered into care within three months. 65% of patients ineligible for ART at the first assessment were retained in pre-ART care. 67% of those eligible for ART initiated treatment within three months. 30% of patients who initiated ART died or were lost to followup, and 82% achieved virological suppression in the last viral load determination. Most attrition occurred the in pre-ART stages of care, and it was estimated that only 31% of patients diagnosed with HIV engaged in care and achieved virological suppression after ART initiation. The total mortality attributable to pre-ART attrition was considerably higher than the mortality for not achieving virological suppression. This study indicates that early entry into pre-ART care along with timely initiation of ART is more likely to reduce HIV-related mortality compared to achieving virological suppression.

scholarly journals Point-of-Care Testing for Infectious Diseases: Diversity, Complexity, and Barriers in Low- And Middle-Income Countries

PLoS Medicine ◽  
2012 ◽  
Vol 9 (9) ◽  
pp. e1001306 ◽  
Author(s):  
Nitika Pant Pai ◽  
Caroline Vadnais ◽  
Claudia Denkinger ◽  
Nora Engel ◽  
Madhukar Pai
Keyword(s):  
Infectious Diseases ◽  
Point Of Care ◽  
Point Of Care Testing ◽  
Middle Income ◽  
Middle Income Countries ◽  
Low And Middle Income

scholarly journals Bringing Data Analytics to the Design of Optimized Diagnostic Networks in Low- and Middle-Income Countries: Process, Terms and Definitions

Diagnostics ◽  
2020 ◽  
Vol 11 (1) ◽  
pp. 22
Author(s):  
Kameko Nichols ◽  
Sarah J. Girdwood ◽  
Andrew Inglis ◽  
Pascale Ondoa ◽  
Karla Therese L. Sy ◽  
...  
Keyword(s):  
Data Analytics ◽  
Point Of Care ◽  
Health Coverage ◽  
Health Security ◽  
Middle Income ◽  
Middle Income Countries ◽  
Limited Application ◽  
Manual Methods ◽  
Universal Health ◽  
Low And Middle Income

Diagnostics services are an essential component of healthcare systems, advancing universal health coverage and ensuring global health security, but are often unavailable or under-resourced in low- and middle-income (LMIC) countries. Typically, diagnostics are delivered at various tiers of the laboratory network based on population needs, and resource and infrastructure constraints. A diagnostic network additionally incorporates screening and includes point-of-care testing that may occur outside of a laboratory in the community and clinic settings; it also emphasizes the importance of supportive network elements, including specimen referral systems, as being critical for the functioning of the diagnostic network. To date, design and planning of diagnostic networks in LMICs has largely been driven by infectious diseases such as TB and HIV, relying on manual methods and expert consensus, with a limited application of data analytics. Recently, there have been efforts to improve diagnostic network planning, including diagnostic network optimization (DNO). The DNO process involves the collection, mapping, and spatial analysis of baseline data; selection and development of scenarios to model and optimize; and lastly, implementing changes and measuring impact. This review outlines the goals of DNO and steps in the process, and provides clarity on commonly used terms.

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