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Jaggernath M, Naicker R, Madurai S, Brockman MA, Ndung’u T, Gelderblom HC. Diagnostic Accuracy of the HemoCue Hb 301, STAT-Site MHgb and URIT-12 Point-of-Care Hemoglobin Meters in a Central Laboratory and a Community Based Clinic in Durban, South Africa. PLoS One 2016; 11:e0152184. [PMID: 27046200 PMCID: PMC4821624 DOI: 10.1371/journal.pone.0152184] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2015] [Accepted: 03/10/2016] [Indexed: 12/14/2022] Open
Abstract
In South Africa, various point-of-care hemoglobin meters are used. However, the regulatory framework for approval, implementation and oversight of use of point-of-care hemoglobin meters is suboptimal. We assessed the diagnostic accuracy of the HemoCue Hb 301, STAT-Site MHgb and URIT-12 point-of-care hemoglobin meters, compared to a central laboratory based reference assay, in a central laboratory and a community based clinic in Durban, South Africa. Differences in performance of the point-of-care assays, compared to the reference assay, were more pronounced in the community based clinic. Results were reasonable for the HemoCue Hb 301, but poor for the STAT-Site MHgb and the URIT-12. Poor test performance of point-of-care hemoglobin meters, and inadequate evaluations and oversight in South Africa, leads to suboptimal clinical care and clinical research, and increased costs. There is a need for proper evaluation and quality assurance of point-of-care tests, the results of which should be made widely available to key stakeholders.
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Affiliation(s)
- Manjeetha Jaggernath
- HIV Pathogenesis Programme, Doris Duke Medical Research Institute, University of KwaZulu-Natal, Durban, South Africa
| | | | | | - Mark A. Brockman
- Simon Fraser University, Burnaby, BC, Canada
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada
- Ragon Institute of MGH, MIT and Harvard, Charlestown, MA, United States of America
| | - Thumbi Ndung’u
- HIV Pathogenesis Programme, Doris Duke Medical Research Institute, University of KwaZulu-Natal, Durban, South Africa
- KwaZulu-Natal Research Institute for Tuberculosis and HIV, University of KwaZulu-Natal, Durban, South Africa
- Ragon Institute of MGH, MIT and Harvard, Charlestown, MA, United States of America
- Max Planck Institute for Infection Biology, Berlin, Germany
| | - Huub C. Gelderblom
- HIV Pathogenesis Programme, Doris Duke Medical Research Institute, University of KwaZulu-Natal, Durban, South Africa
- International AIDS Vaccine Initiative (IAVI), New York, NY, United States of America
- * E-mail:
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Drexler JF, Kupfer B, Petersen N, Grotto RMT, Rodrigues SMC, Grywna K, Panning M, Annan A, Silva GF, Douglas J, Koay ESC, Smuts H, Netto EM, Simmonds P, Pardini MIDMC, Roth WK, Drosten C. A novel diagnostic target in the hepatitis C virus genome. PLoS Med 2009; 6:e31. [PMID: 19209955 PMCID: PMC2637920 DOI: 10.1371/journal.pmed.1000031] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2008] [Accepted: 12/24/2008] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Detection and quantification of hepatitis C virus (HCV) RNA is integral to diagnostic and therapeutic regimens. All molecular assays target the viral 5'-noncoding region (5'-NCR), and all show genotype-dependent variation of sensitivities and viral load results. Non-western HCV genotypes have been under-represented in evaluation studies. An alternative diagnostic target region within the HCV genome could facilitate a new generation of assays. METHODS AND FINDINGS In this study we determined by de novo sequencing that the 3'-X-tail element, characterized significantly later than the rest of the genome, is highly conserved across genotypes. To prove its clinical utility as a molecular diagnostic target, a prototype qualitative and quantitative test was developed and evaluated multicentrically on a large and complete panel of 725 clinical plasma samples, covering HCV genotypes 1-6, from four continents (Germany, UK, Brazil, South Africa, Singapore). To our knowledge, this is the most diversified and comprehensive panel of clinical and genotype specimens used in HCV nucleic acid testing (NAT) validation to date. The lower limit of detection (LOD) was 18.4 IU/ml (95% confidence interval, 15.3-24.1 IU/ml), suggesting applicability in donor blood screening. The upper LOD exceeded 10(-9) IU/ml, facilitating viral load monitoring within a wide dynamic range. In 598 genotyped samples, quantified by Bayer VERSANT 3.0 branched DNA (bDNA), X-tail-based viral loads were highly concordant with bDNA for all genotypes. Correlation coefficients between bDNA and X-tail NAT, for genotypes 1-6, were: 0.92, 0.85, 0.95, 0.91, 0.95, and 0.96, respectively; X-tail-based viral loads deviated by more than 0.5 log10 from 5'-NCR-based viral loads in only 12% of samples (maximum deviation, 0.85 log10). The successful introduction of X-tail NAT in a Brazilian laboratory confirmed the practical stability and robustness of the X-tail-based protocol. The assay was implemented at low reaction costs (US$8.70 per sample), short turnover times (2.5 h for up to 96 samples), and without technical difficulties. CONCLUSION This study indicates a way to fundamentally improve HCV viral load monitoring and infection screening. Our prototype assay can serve as a template for a new generation of viral load assays. Additionally, to our knowledge this study provides the first open protocol to permit industry-grade HCV detection and quantification in resource-limited settings.
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Affiliation(s)
- Jan Felix Drexler
- Clinical Virology Group, Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany
- Institute of Virology, University of Bonn, Bonn, Germany
- Infectious Diseases Research Laboratory, University Hospital Prof. Edgard Santos, Federal University of Bahia, Salvador, Brazil
| | - Bernd Kupfer
- Institute of Virology, University of Bonn, Bonn, Germany
| | - Nadine Petersen
- Clinical Virology Group, Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany
| | - Rejane Maria Tommasini Grotto
- University of São Paulo State (UNESP), Botucatu Medical School, Blood Transfusion Centre - Molecular Biology Laboratory and Internal Medicine Department, Botucatu, São Paulo, Brazil
| | - Silvia Maria Corvino Rodrigues
- University of São Paulo State (UNESP), Botucatu Medical School, Blood Transfusion Centre - Molecular Biology Laboratory and Internal Medicine Department, Botucatu, São Paulo, Brazil
| | - Klaus Grywna
- Clinical Virology Group, Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany
| | - Marcus Panning
- Clinical Virology Group, Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany
| | - Augustina Annan
- Clinical Virology Group, Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany
| | - Giovanni Faria Silva
- University of São Paulo State (UNESP), Botucatu Medical School, Blood Transfusion Centre - Molecular Biology Laboratory and Internal Medicine Department, Botucatu, São Paulo, Brazil
| | - Jill Douglas
- Virus Evolution Group, Centre for Infectious Diseases, University of Edinburgh, Edinburgh, United Kingdom
| | - Evelyn S. C Koay
- Department of Pathology, Yong Loo Lin School of Medicine, National University of Singapore
- Molecular Diagnosis Centre, National University Hospital, Singapore
| | - Heidi Smuts
- Division Medical Virology/National Health Laboratory Service, Department of Clinical Laboratory Sciences, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Eduardo M Netto
- Infectious Diseases Research Laboratory, University Hospital Prof. Edgard Santos, Federal University of Bahia, Salvador, Brazil
| | - Peter Simmonds
- Virus Evolution Group, Centre for Infectious Diseases, University of Edinburgh, Edinburgh, United Kingdom
| | - Maria Inês de Moura Campos Pardini
- University of São Paulo State (UNESP), Botucatu Medical School, Blood Transfusion Centre - Molecular Biology Laboratory and Internal Medicine Department, Botucatu, São Paulo, Brazil
| | | | - Christian Drosten
- Institute of Virology, University of Bonn, Bonn, Germany
- * To whom correspondence should be addressed. E-mail:
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