scholarly journals Detecting tuberculosis: rapid tools but slow progress

2019 ◽  
Vol 9 (3) ◽  
pp. 80-83
Author(s):  
K. England ◽  
T. Masini ◽  
E. Fajardo
Keyword(s):  
Point Of Care ◽  
Scale Up ◽  
Critical Issue ◽  
World Health ◽  
High Turnover ◽  
Low Resource Settings ◽  
Laboratory Staff ◽  
Low Resource ◽  
Point Of Care Test ◽  
Health Organization

The World Health Organization (WHO) currently recommends Xpert® MTB/RIF as the initial test for all people with presumptive tuberculosis (TB). A number of challenges have been reported, however, in using this technology, particularly in low-resource settings. Here we examine these challenges, and provide our perspective of the barriers to Xpert scale-up as assessed through a survey in 16 TB burden countries in which the Médecins Sans Frontières is present. We observed that the key barriers to scale-up include a lack of policy adoption and implementation of WHO recommendations for the use of Xpert, resulting from high costs, poor sensitisation of clinical staff and a high turnover of trained laboratory staff; insufficient service and maintenance provision provided by the manufacturer; and inadequate resources for sustainability and expansion. Funding is a critical issue as countries begin to transition out of support from the Global Fund. While it is clear that there is still an urgent need for research into and development of a rapid, affordable point-of-care test for TB that is truly adapted for use in low-resource settings, countries in the meantime need to develop functional and sustainable Xpert networks in order to close the existing diagnostic gap.

scholarly journals Investigating the Effective Factors on Implementation of World Health Organization Package of Essential Non communicable Disease Interventions for Primary Health Care in Low Resource Settings: A Scoping review

2020 ◽  
Author(s):  
Mina Aminpour ◽  
Aidin Aryankhesal ◽  
Nasrin Seyfori
Keyword(s):  
Health Care ◽  
Primary Health Care ◽  
Scoping Review ◽  
World Health ◽  
Factors Affecting ◽  
Effective Factors ◽  
Low Resource Settings ◽  
Low Resource ◽  
Primary Health ◽  
Health Organization

Abstract Background/objective: Due to the widespread prevalence of non-communicable diseases, the World Health Organization has designed a package of essential interventions for non-communicable diseases for primary health care in low-resource settings. This study aimed to investigate the factors affecting the implementation of the WHO PEN for primary health care in low-resource settings. Materials and Methods This research was conducted through a five-step process of scoping review. We first searched for the keywords Noncommunicable Diseases, NCD, WHO PEN, PEN and other synonyms for these words to find the suitable analytical studies in databases including PubMed / MEDLINE, Scopus Cochrane Library, Web of Science, Google Scholar. The articles were then selected based on the PRISMA 2009 Flow Diagram. Finally, to analyze the content from the results section of the selected articles, we used the framework analysis method to extract the study implementation outcome and the factors affecting it. Results A total of 26 articles were included. Most articles are from 2016 to 2018. Most of the articles were cross-sectional and most studies evaluated the outcomes of Appropriateness and Feasibility. Identified effective factors include target population coverage, staff training, patient motivation, patient follow-up, and observance of PEN protocols. Conclusion Using this study, policymakers and managers of the health system will be able to implement this package (WHO PEN) more successfully.

scholarly journals Point-Of-Care Urine LAM Tests for Tuberculosis Diagnosis: A Status Update

2019 ◽  
Vol 9 (1) ◽  
pp. 111 ◽  
Author(s):  
Michelle A. Bulterys ◽  
Bradley Wagner ◽  
Maël Redard-Jacot ◽  
Anita Suresh ◽  
Nira R. Pollock ◽  
...  
Keyword(s):  
First Generation ◽  
Treatment Initiation ◽  
Point Of Care ◽  
Scale Up ◽  
World Health ◽  
Next Generation ◽  
Tuberculosis Diagnosis ◽  
Health Organization ◽  
Low Sensitivity ◽  
Control Implementation

Most diagnostic tests for tuberculosis (TB) rely on sputum samples, which are difficult to obtain and have low sensitivity in immunocompromised patients, patients with disseminated TB, and children, delaying treatment initiation. The World Health Organization (WHO) calls for the development of a rapid, biomarker-based, non-sputum test capable of detecting all forms of TB at the point-of-care to enable immediate treatment initiation. Lipoarabinomannan (LAM) is the only WHO-endorsed TB biomarker that can be detected in urine, an easily collected sample. This status update discusses the characteristics of LAM as a biomarker, describes the performance of first-generation urine LAM tests and reasons for slow uptake, and presents considerations for developing the next generation of more sensitive and impactful tests. Next-generation urine LAM tests have the potential to reach adult and pediatric patients regardless of HIV status or site of infection and facilitate global TB control. Implementation and scale-up of existing LAM tests and development of next-generation assays should be prioritized.

scholarly journals Novel Coronavirus: What to Learn from a Microbiologist?

2020 ◽  
Vol 5 (03) ◽  
pp. 282-284
Author(s):  
Deepinder K. Chhina ◽  
Jyoti Chaudhary
Keyword(s):  
Point Of Care ◽  
Respiratory Illness ◽  
Standard Test ◽  
World Health ◽  
Antibody Detection ◽  
Enzyme Linked Immunosorbent Assay ◽  
Point Of Care Test ◽  
Novel Coronavirus ◽  
Health Organization ◽  
Antigen Testing

AbstractIn December 2019, an outbreak of coronavirus disease 2019 (COVID-19) caused by SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) was declared in Wuhan, city of China. Later on, the World Health Organization declared COVID-19 as a pandemic on March 11, 2020. The clinical course of the disease ranges from asymptomatic cases to fatal severe respiratory illness. Various laboratory tests are available for the diagnosis of disease. The gold standard test is real-time PCR (polymerase chain reaction), whereas antigen testing can be used as a point-of-care test. Antibody detection by ELISA (enzyme-linked immunosorbent assay) can be used for the surveillance of the immune response.

scholarly journals Multicentre pilot study evaluation of lung ultrasound for the management of paediatric pneumonia in low-resource settings: a study protocol

2018 ◽  
Vol 5 (1) ◽  
pp. e000340 ◽  
Author(s):  
Jennifer L Lenahan ◽  
Giovanni Volpicelli ◽  
Alessandro Lamorte ◽  
Fyezah Jehan ◽  
Quique Bassat ◽  
...  
Keyword(s):  
Lung Ultrasound ◽  
Integrated Management ◽  
Healthcare Providers ◽  
World Health ◽  
Phone Call ◽  
Low Resource Settings ◽  
Childhood Pneumonia ◽  
Low Resource ◽  
Study Results ◽  
Health Organization

IntroductionPneumonia is the leading infectious cause of death among children under 5 years of age worldwide. However, pneumonia is challenging to diagnose. Lung ultrasound (LUS) is a promising diagnostic technology. Further evidence is needed to better understand the role of LUS as a tool for the diagnosis of childhood pneumonia in low-resource settings.Methods and analysisThis study aims to pilot LUS in Mozambique and Pakistan and to generate evidence regarding the use of LUS as a diagnostic tool for childhood pneumonia. Children with cough <14 days with chest indrawing (n=230) and without chest indrawing (n=40) are enrolled. World Health Organization Integrated Management of Childhood Illness assessment is performed at enrolment, along with a chest radiograph and LUS examination. Respiratory and blood specimens are collected for viral and bacterial testing and biomarker assessment. Enrolled children are followed for 14 days (in person) and 30 days (phone call) post-enrolment with LUS examinations performed on Days 2, 6 and 14. Qualitative and quantitative data are also collected to assess feasibility, usability and acceptability of LUS among healthcare providers and caregivers. The primary outcome is LUS findings at enrolment with secondary outcomes including patient outcomes, repeat LUS findings, viral and bacterial test results, and patient status after 14 and 30 days of follow-up.Ethics and disseminationThis trial was approved by the Western Institutional Review Board as well as local ethics review committees at each site. We plan to disseminate study results in peer-reviewed journals and international conferences.Trial registration numberNCT03187067.

scholarly journals Development and evaluation of a Point-of-Care Test (POCT) in a low resource setting with high rates of Chlamydia trachomatis urogenital infections in Fiji

2021 ◽  
Author(s):  
Deborah Dean ◽  
Sumeetha Swaminathan ◽  
Mike Kama ◽  
Sophie Goemans ◽  
Daniel Faktaufon ◽  
...  
Keyword(s):  
Chlamydia Trachomatis ◽  
Trichomonas Vaginalis ◽  
Point Of Care ◽  
World Health ◽  
Sexually Transmitted ◽  
Point Of Care Test ◽  
Urogenital Infections ◽  
Resource Setting ◽  
Low Resource Setting ◽  
Health Organization

Rapid and precise detection of Chlamydia trachomatis—the leading global cause of sexually transmitted infections (STI)—at the point-of-care (POC) is required for treatment decisions to prevent transmission and sequelae including pelvic inflammatory disease, ectopic pregnancy, tubal-factor infertility and preterm birth. We developed a rapid POC test (POCT), termed LH-POCT, which uses Loop-mediated AMPlification (LAMP) of nucleic acids, and performed a head-to-head comparison with the Cepheid Xpert® CT/NG assay using clinician-collected de-identified paired vaginal samples from a parent study that consecutively enrolled symptomatic and asymptomatic females over age 18 years from the Ministry of Health and Medical Services Health Centers in Fiji. Samples were processed by the Xpert® CT/NG assay and LH-POCT, blinded to the comparator. Discrepant samples were resolved by qPCR. De-identified clinical data and tests for Trichomonas vaginalis, Candida and bacterial vaginosis (BV) were provided. There were a total of 353 samples from 327 females. C. trachomatis positivity was 16.7% (59/353) while the prevalence was 16.82% (55/327) after discrepant resolution. Seven discrepant samples resolved to: four false negatives, two false positives and one true positive for the LH-POCT. The sensitivity of the LH-POCT was 93.65% (95% CI: 84.53% to 98.24%) and specificity 99.31% (95% CI: 97.53% to 99.92%). Discrepant samples clustered among women with vaginal discharge and/or BV. The prototype LH-POCT workflow has excellent performance, meeting many World Health Organization ASSURED criteria for POC tests, including a sample-to-result time of 35 minutes. Our LH-POCT holds promise for improving clinical practice to prevent and control C. trachomatis STIs in diverse health care settings globally.

scholarly journals Point-of-Care Urine LAM Tests for Tuberculosis Diagnosis: A Mini-Review

2019 ◽  
Author(s):  
Michelle A. Bulterys ◽  
Bradley Wagner ◽  
Maël Redard-Jacot ◽  
Anita Suresh ◽  
Nira R. Pollock ◽  
...  
Keyword(s):  
First Generation ◽  
Treatment Initiation ◽  
Point Of Care ◽  
Scale Up ◽  
World Health ◽  
Next Generation ◽  
Tuberculosis Diagnosis ◽  
Health Organization ◽  
Low Sensitivity ◽  
Control Implementation

Most diagnostic tests for tuberculosis (TB) rely on sputum samples, which are difficult to obtain and have low sensitivity in immunocompromised patients, patients with disseminated TB, and children, delaying treatment initiation. The World Health Organization (WHO) calls for the development of a rapid, biomarker-based, non-sputum test capable of detecting all forms of TB at the point-of-care to enable immediate treatment initiation. Lipoarabinomannan (LAM) is the only WHO-endorsed TB biomarker which can be detected in urine, an easily collected sample. This review discusses the characteristics of LAM as a biomarker, describes the performance of first-generation urine LAM tests and reasons for slow uptake, and presents considerations for developing the next-generation of more sensitive and impactful tests. Next-generation urine LAM tests have the potential to reach adult and pediatric patients regardless of HIV status or site of infection and facilitate global TB control. Implementation and scale-up of existing LAM tests and development of next-generation assays should be prioritized.

scholarly journals A 3D-printed magnetic digital microfluidic diagnostic platform for rapid colorimetric sensing of carbapenemase-producing Enterobacteriaceae

2021 ◽  
Vol 7 (1) ◽  
Author(s):  
Pojchanun Kanitthamniyom ◽  
Pei Yun Hon ◽  
Aiwu Zhou ◽  
Mohammad Yazid Abdad ◽  
Zhi Yun Leow ◽  
...  
Keyword(s):  
Point Of Care ◽  
Resistance Mechanism ◽  
Turnaround Time ◽  
World Health ◽  
Colorimetric Sensing ◽  
Resource Limited ◽  
Reaction Chambers ◽  
Technological Platform ◽  
Health Organization ◽  
Digital Microfluidic

AbstractCarbapenemase-producing Enterobacteriaceae (CPE) are a group of drug-resistant Gram-negative pathogens that are classified as a critical threat by the World Health Organization (WHO). Conventional methods of detecting antibiotic-resistant pathogens do not assess the resistance mechanism and are often time-consuming and laborious. We have developed a magnetic digital microfluidic (MDM) platform, known as MDM Carba, for the identification of CPE by measuring their ability to hydrolyze carbapenem antibiotics. MDM Carba offers the ability to rapidly test CPE and reduce the amount of reagents used compared with conventional phenotypic testing. On the MDM Carba platform, tests are performed in droplets that function as reaction chambers, and fluidic operations are accomplished by manipulating these droplets with magnetic force. The simple droplet-based magnetic fluidic operation allows easy system automation and simplified hands-on operation. Because of the unique “power-free” operation of MDM technology, the MDM Carba platform can also be operated manually, showing great potential for point-of-care testing in resource-limited settings. We tested 27 bacterial isolates on the MDM Carba platform, and the results showed sensitivity and specificity that were comparable to those of the widely used Carba NP test. MDM Carba may shorten the overall turnaround time for CPE identification, thereby enabling more timely clinical decisions for better clinical outcomes. MDM Carba is a technological platform that can be further developed to improve diagnostics for other types of antibiotic resistance with minor modifications.

scholarly journals Derivation of the first clinical diagnostic models for dehydration severity in patients over five years with acute diarrhea

2021 ◽  
Vol 15 (3) ◽  
pp. e0009266
Author(s):  
Adam C. Levine ◽  
Meagan A. Barry ◽  
Monique Gainey ◽  
Sabiha Nasrin ◽  
Kexin Qu ◽  
...  
Keyword(s):  
Acute Diarrhea ◽  
Diarrheal Disease ◽  
Characteristic Curve ◽  
World Health ◽  
Simplified Model ◽  
Full Model ◽  
Low Resource Settings ◽  
Low Resource ◽  
Clinical Diagnostic ◽  
Diagnostic Models

Diarrheal diseases lead to an estimated 1.3 million deaths each year, with the majority of those deaths occurring in patients over five years of age. As the severity of diarrheal disease can vary widely, accurately assessing dehydration status remains the most critical step in acute diarrhea management. The objective of this study is to empirically derive clinical diagnostic models for assessing dehydration severity in patients over five years with acute diarrhea in low resource settings. We enrolled a random sample of patients over five years with acute diarrhea presenting to the icddr,b Dhaka Hospital. Two blinded nurses independently assessed patients for symptoms/signs of dehydration on arrival. Afterward, consecutive weights were obtained to determine the percent weight change with rehydration, our criterion standard for dehydration severity. Full and simplified ordinal logistic regression models were derived to predict the outcome of none (<3%), some (3–9%), or severe (>9%) dehydration. The reliability and accuracy of each model were assessed. Bootstrapping was used to correct for over-optimism and compare each model’s performance to the current World Health Organization (WHO) algorithm. 2,172 patients were enrolled, of which 2,139 (98.5%) had complete data for analysis. The Inter-Class Correlation Coefficient (reliability) was 0.90 (95% CI = 0.87, 0.91) for the full model and 0.82 (95% CI = 0.77, 0.86) for the simplified model. The area under the Receiver-Operator Characteristic curve (accuracy) for severe dehydration was 0.79 (95% CI: 0.76–0.82) for the full model and 0.73 (95% CI: 0.70, 0.76) for the simplified model. The accuracy for both the full and simplified models were significantly better than the WHO algorithm (p<0.001). This is the first study to empirically derive clinical diagnostic models for dehydration severity in patients over five years. Once prospectively validated, the models may improve management of patients with acute diarrhea in low resource settings.

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