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Ansu-Mensah M, Kuupiel D, Bawontuo V, Ginindza TG. Availability, stock levels and usage of In-vitro diagnostics in the Bono region, Ghana: A cross-sectional study. Afr J Prim Health Care Fam Med 2023; 15:e1-e10. [PMID: 37916723 PMCID: PMC10623501 DOI: 10.4102/phcfm.v15i1.4114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 07/21/2023] [Accepted: 07/28/2023] [Indexed: 11/03/2023] Open
Abstract
BACKGROUND Point-of-care (POC) diagnostic tests play essential roles in diagnosis, surveillance, and disease management in health settings. Nevertheless, implementation challenges may hamper POC test accessibility. This study evaluated the availability and stock levels of the World Health Organization (WHO) prequalified existing in-vitro diagnostics (IVDs) for use in health facilities without laboratories. AIM To evaluate the availability, stock levels, and usage of POC diagnostic tests. SETTING Bono Region, Ghana. METHODS This cross-sectional survey involved 102 randomly selected Community Health-based and Planning Services (CHPS), 12 district health depots, and a regional medical depot. Using a survey tool, data were collected on clinic staffing, availability and stock levels of tests, and funding sources. STATA 17 was employed for data analysis. RESULTS Majority (37.3%) of the respondents were community health nurses, with 4.4 mean years of work experience and 38 working hours per week. Of the 18 existing WHO prequalified POC tests for use at facilities without laboratories, 10 (56%), 2 (11%) and 0 (0%) were found at CHPS, regional, and district depots, respectively. Majority (183 out of 301) stock levels were low. Of the 10 available tests found, 7 scored 111 (36%) of 'high use'. Supply chain management compliance was 5 (31%) out of 16. All CHPS received government funding with 25.5% of them receiving additional donor or internally generated funding. CONCLUSION This study found poor supply chain management compliance, and low availability of POC tests in the Bono Region of Ghana.Contribution: The study outlines POC tests availability and usage in low-resourced setting.
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Affiliation(s)
- Monica Ansu-Mensah
- Discipline of Public Health Medicine, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa; and, Health Economics and HIV and AIDS Research Division (HEARD), University of KwaZulu-Natal, Durban, South Africa; and, Clinic, Sunyani Technical University, Sunyani.
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Chan JTN, Nguyen V, Tran TN, Nguyen NV, Do NTT, van Doorn HR, Lewycka S. Point-of-care testing in private pharmacy and drug retail settings: a narrative review. BMC Infect Dis 2023; 23:551. [PMID: 37612636 PMCID: PMC10463283 DOI: 10.1186/s12879-023-08480-w] [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: 03/21/2023] [Accepted: 07/23/2023] [Indexed: 08/25/2023] Open
Abstract
BACKGROUND Point-of-care testing (POCT) using rapid diagnostic tests for infectious disease can potentially guide appropriate use of antimicrobials, reduce antimicrobial resistance, and economise use of healthcare resources. POCT implementation in private retail settings such as pharmacies and drug shops could lessen the burden on public healthcare. We performed a narrative review on studies of POCTs in low- and middle-income countries (LMICs), and explored uptake, impact on treatment, and feasibility of implementation. METHODS We searched MEDLINE/PubMed for interventional studies on the implementation of POCT for infectious diseases performed by personnel in private retail settings. Data were extracted and analysed by two independent reviewers. RESULTS Of the 848 studies retrieved, 23 were included in the review. Studies were on malaria (19/23), malaria and pneumonia (3/23) or respiratory tract infection (1/23). Nine randomised controlled studies, four controlled, non-randomised studies, five uncontrolled interventions, one interventional pre-post study, one cross-over interventional study and three retrospective analyses of RCTs were included. Study quality was poor. Overall, studies showed that POCT can be implemented successfully, leading to improvements in appropriate treatment as measured by outcomes like adherence to treatment guidelines. Despite some concerns by health workers, customers and shop providers were welcoming of POCT implementation in private retail settings. Main themes that arose from the review included the need for well-structured training with post-training certification covering guidelines for test-negative patients, integrated waste management, community sensitization and demand generation activities, financial remuneration and pricing schemes for providers, and formal linkage to healthcare and support. CONCLUSION Our review found evidence that POCT can be implemented successfully in private retail settings in LMICs, but comprehensive protocols are needed. High-quality randomised studies are needed to understand POCTs for infectious diseases other than malaria.
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Affiliation(s)
| | - Van Nguyen
- Doctor of Medicine Programme, Duke National University of Singapore (NUS) Medical School, Singapore, Singapore
| | - Thuy Ngan Tran
- Oxford University Clinical Research Unit, Hanoi, Vietnam
- Family Medicine and Population Health (FAMPOP), Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | | | | | - H Rogier van Doorn
- Oxford University Clinical Research Unit, Hanoi, Vietnam
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Sonia Lewycka
- Oxford University Clinical Research Unit, Hanoi, Vietnam
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
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Dawkins M, Bishop L, Walker P, Otmaskin D, Ying J, Schmidt R, Harnett G, Abraham T, Gaydos CA, Schoolnik G, DiBenedetto K. Clinical Integration of a Highly Accurate Polymerase Chain Reaction Point-of-Care Test Can Inform Immediate Treatment Decisions for Chlamydia, Gonorrhea, and Trichomonas. Sex Transm Dis 2022; 49:262-267. [PMID: 34813579 DOI: 10.1097/olq.0000000000001586] [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: 11/27/2022]
Abstract
BACKGROUND Accurate same-day sexually transmitted infection (STI) diagnostic testing is generally unavailable, leading to syndromic management with high rates of overtreatment and undertreatment. We analyzed the ease of integration of the Visby STI Panel into clinical practice, studied acceptance by patients and clinic personnel, and assessed the potential to inform accurate treatment decisions. METHODS In a cross-sectional single-visit study of 55 women aged 18 to 56 years, women self-collected vaginal swab samples that were analyzed using the Visby STI Panel for Chlamydia trachomatis, Neisseria gonorrhoeae (NG), and Trichomonas vaginalis (TV). Results were compared with standard-of-care clinic results from send-out laboratory polymerase chain reaction tests. Surveys assessed patient and device operator experiences with the Visby STI Panel and clinicians' perceived need for and acceptance of the device. Time parameters were measured to evaluate the impact on clinical workflow, and syndromic treatment decisions were compared with anticipated treatment based on the Visby STI Panel results. RESULTS Patients strongly agreed that sample self-collection was easy, and operators reported the device easy to use. Clinicians valued the rapid return of results, and patients were comfortable waiting up to 30 minutes to receive them. In 13 of 15 cases, the Visby STI Panel correctly identified undertreated patients as infected and correctly identified all 33 incidences of overtreatment. CONCLUSIONS Clinical adoption of the Visby STI Panel into primary care clinics and doctors' offices could reduce overtreatment and undertreatment of STIs. If integrated efficiently into the clinical workflow, the test would have minimal impact on staff time and visit duration for patients.
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Affiliation(s)
- Megan Dawkins
- From the Premier Health Urgent Care, Baton Rouge, LA
| | - Lisa Bishop
- From the Premier Health Urgent Care, Baton Rouge, LA
| | | | | | | | | | | | | | - Charlotte A Gaydos
- Division of Infectious Diseases, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
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Kairu A, Masson L, Passmore JAS, Cunnama L, Sinanovic E. Rapid Point-of-Care Testing for Genital Tract Inflammatory Cytokine Biomarkers to Diagnose Asymptomatic Sexually Transmitted Infections and Bacterial Vaginosis in Women: Cost Estimation and Budget Impact Analysis. Sex Transm Dis 2022; 49:237-243. [PMID: 34596633 PMCID: PMC8820766 DOI: 10.1097/olq.0000000000001565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Accepted: 09/10/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND Screening for genital inflammation can reveal asymptomatic cases of sexually transmitted infections (STIs) and bacterial vaginosis (BV), useful in settings where only syndromic management is available. This study aimed to estimate the incremental cost of screening using a new cytokine biomarker rapid test and determine the budget impact of providing this service in primary health facilities in South Africa. METHODS Costs of adding genital inflammation screening to existing family planning services were estimated for women (15-49 years) attending 3 different family planning clinics in US $2016. The predicted unit cost per patient screened from a provider's perspective was calculated using bottom-up and top-down approaches and was used to analyze the budget impact of scaling up and providing this service in primary health facilities countrywide. Univariate sensitivity analyses tested the robustness of the findings. RESULTS The incremental cost per woman screened for genital inflammation ranged between US $3.19 and US $4.79. The scaled-up costs ranged between US $7,245,775 and US $22,212,636 countrywide, annually. This was based on the number of women of reproductive age currently seeking contraceptive care at all primary health care facilities, as a proxy for those most susceptible to asymptomatic STIs/BV. The cost estimates were sensitive to changes in personnel costs, utilization rate, and population coverage rates. CONCLUSIONS This screening tool is likely to increase case detection, contributing to better STI/BV management and control, in addition to reducing women's risk of HIV acquisition. The incremental cost estimates could make implementation affordable.
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Affiliation(s)
- Angela Kairu
- From the Health Economics Unit, School of Public Health and Family Medicine, Faculty of Health Sciences, University of Cape Town
| | - Lindi Masson
- Division of Medical Virology, Institute of Infectious Diseases and Molecular Medicine, University of Cape Town Medical School
| | - Jo-Ann S. Passmore
- Division of Medical Virology, Institute of Infectious Diseases and Molecular Medicine, University of Cape Town Medical School
- National Health Laboratory Service, Cape Town, South Africa
| | - Lucy Cunnama
- From the Health Economics Unit, School of Public Health and Family Medicine, Faculty of Health Sciences, University of Cape Town
| | - Edina Sinanovic
- From the Health Economics Unit, School of Public Health and Family Medicine, Faculty of Health Sciences, University of Cape Town
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Bassey GB, Clarke AIL, Elhelu OK, Lee CM. Trichomoniasis, a new look at a common but neglected STI in African descendance population in the United States and the Black Diaspora. A review of its incidence, research prioritization, and the resulting health disparities. J Natl Med Assoc 2022; 114:78-89. [PMID: 35042602 DOI: 10.1016/j.jnma.2021.12.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2021] [Revised: 09/21/2021] [Accepted: 12/17/2021] [Indexed: 11/17/2022]
Abstract
Structural racism plays a significant role in limited access to higher education, financial resources, employment opportunities, and high-quality healthcare for African Americans. The lack of healthcare equity and infrastructure has directly contributed to overall poor healthcare outcomes for the Black community. Studies have shown that adverse health outcomes such as sexually transmitted diseases (STDs) are more prevalent in African Americans, regardless of their socioeconomic factors and lifestyles. For example, trichomoniasis, transmitted sexually by its etiological agent, Trichomonas vaginalis (T. vaginalis), predisposes those infected to co-infections with other STDs, such as human immunodeficiency virus (HIV), herpes, and other related infections. Our review showcases the impact of trichomoniasis on the health of the Black community with an emphasis on African American women. A critical examination of the socio-demographic history of Black people in the United States (US) is vital to illustrate the origin of past and current racial health disparities. Further, we expand the complex and nuanced conversation on the intersectionality of racism, health equity, and innovative epidemiological and biomedical research strategies needed to eradicate this global public health threat.
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Affiliation(s)
| | | | | | - Clarence M Lee
- Howard University, Department of Biology, Washington, DC, USA
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Fuller SS, Clarke E, Harding-Esch EM. Molecular chlamydia and gonorrhoea point of care tests implemented into routine practice: Systematic review and value proposition development. PLoS One 2021; 16:e0259593. [PMID: 34748579 PMCID: PMC8575247 DOI: 10.1371/journal.pone.0259593] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Accepted: 10/21/2021] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Sexually Transmitted Infections, including Neisseria gonorrhoeae (NG) and Chlamydia trachomatis (CT), continue to be a global health problem. Increased access to point-of-care-tests (POCTs) could help detect infection and lead to appropriate management of cases and contacts, reducing transmission and development of reproductive health sequelae. Yet diagnostics with good clinical effectiveness evidence can fail to be implemented into routine care. Here we assess values beyond clinical effectiveness for molecular CT/NG POCTs implemented across diverse routine practice settings. METHODS We conducted a systematic review of peer-reviewed primary research and conference abstract publications in Medline and Embase reporting on molecular CT/NG POCT implementation in routine clinical practice until 16th February 2021. Results were extracted into EndNote software and initially screened by title and abstract by one author according to the inclusion and exclusion criteria. Articles that met the criteria, or were unclear, were included for full-text assessment by all authors. Results were synthesised to assess the tests against guidance criteria and develop a CT/NG POCT value proposition for multiple stakeholders and settings. FINDINGS The systematic review search returned 440 articles; 28 were included overall. The Cepheid CT/NG GeneXpert was the only molecular CT/NG POCT implemented and evaluated in routine practice. It did not fulfil all test guidance criteria, however, studies of test implementation showed multiple values for test use across various healthcare settings and locations. Our value proposition highlights that the majority of values are setting-specific. Sexual health services and outreach services have the least overlap, with General Practice and other non-sexual health specialist services serving as a "bridge" between the two. CONCLUSIONS Those wishing to improve CT/NG diagnosis should be supported to identify the values most relevant to their settings and context, and prioritise implementation of tests that are most closely aligned with those values.
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Affiliation(s)
- Sebastian S. Fuller
- Institute for Infection and Immunity, Applied Diagnostic Research and Evaluation Unit, St George’s University of London, London, United Kingdom
- Nuffield Department of Medicine, Health Systems Collaborative, University of Oxford, Headington, Oxford, United Kingdom
| | - Eleanor Clarke
- Clinical Research Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Emma M. Harding-Esch
- Institute for Infection and Immunity, Applied Diagnostic Research and Evaluation Unit, St George’s University of London, London, United Kingdom
- Clinical Research Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom
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Diagnostic tests for detecting Chlamydia trachomatis and Neisseria gonorrhoeae in rectal and pharyngeal specimens. J Clin Microbiol 2021; 60:e0021121. [PMID: 34731021 DOI: 10.1128/jcm.00211-21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
Chlamydia trachomatis and Neisseria gonorrhoeae are two of the most often reported bacterial infections in the United States. The rectum and oropharynx are important anatomic sites of infection and can contribute to ongoing transmission. Nucleic acid amplification tests (NAATs) are the mainstays for the detection of C. trachomatis and N. gonorrhoeae infections owing to their high sensitivity and specificity. Several NAATs have been evaluated for testing in rectal and pharyngeal infections. A few assays recently received clearance by the Food and Drug Administration, including one point-of-care test. Those assays can be used for testing in symptomatic individuals, as well as for asymptomatic screening in certain patient populations. Routine screening for C. trachomatis in pharyngeal specimens is not recommended by the Centers for Disease Control and Prevention, though is often performed due to the use of multiplex assays. While expanding the types of settings for screening and using self-collected rectal and pharyngeal specimens can help to increase access and uptake of testing, additional research is needed to determine the potential benefits and costs associated with increased screening for rectal and pharyngeal C. trachomatis and N. gonorrhoeae infections on a population level.
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Morris SR, Bristow CC, Wierzbicki MR, Sarno M, Asbel L, French A, Gaydos CA, Hazan L, Mena L, Madhivanan P, Philip S, Schwartz S, Brown C, Styers D, Waymer T, Klausner JD. Performance of a single-use, rapid, point-of-care PCR device for the detection of Neisseria gonorrhoeae, Chlamydia trachomatis, and Trichomonas vaginalis: a cross-sectional study. THE LANCET. INFECTIOUS DISEASES 2021; 21:668-676. [PMID: 33242473 PMCID: PMC9884536 DOI: 10.1016/s1473-3099(20)30734-9] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 08/13/2020] [Accepted: 08/26/2020] [Indexed: 02/01/2023]
Abstract
BACKGROUND Timely detection and treatment are important for the control of Chlamydia trachomatis, Neisseria gonorrhoeae, and Trichomonas vaginalis. The objective of this study was to measure the performance of the Visby Medical Sexual Health Test, a single-use, point-of-care PCR device. METHODS Women aged 14 years and older who presented consecutively to ten clinical sites across seven US states were enrolled for a cross-sectional, single-visit study. Patients who consented to participate, and who had not used any exclusionary products in the genital area in the previous 48 h, provided self-collected vaginal swabs for testing with the investigational device. Untrained operators received the specimens and ran the device using the guide provided. Specimens had to be run within 2 h of collection to be considered valid. For comparison, patient-infected status was derived by testing clinician-collected vaginal specimens with the Hologic Aptima Combo 2 Assay and Aptima Trichomonas vaginalis Assay, as well as the BD ProbeTec CT/GC Qx Amplified DNA Assay and BD ProbeTec Trichomonas vaginalis Qx Assay. If the results of those assays did not match, the BD MAX CT/GC/TV was used as a tiebreaker. The primary outcomes were the sensitivity and specificity of the investigational device for the detection of C trachomatis, N gonorrhoeae, and T vaginalis compared with patient-infected status. FINDINGS Between Feb 25, 2019, and Jan 6, 2020, 1585 participants aged between 14 years and 80 years (mean 34·8 [SD 14·2]) were enrolled. 1555 participants had tests run with the investigational device, of whom 1532 (98·5%) had a valid result on either the first or repeat test. Among the patients with evaluable results (including a determinate patient-infected status), the device had a sensitivity of 97·6% (95% CI 93·2-99·2) and specificity of 98·3% (97·5-98·9) for C trachomatis (n=1457), sensitivity of 97·4% (86·5-99·5) and specificity of 99·4% (98·9-99·7) for N gonorrhoeae (n=1468), and sensitivity of 99·2% (95·5-99·9) and specificity of 96·9% (95·8-97·7) for T vaginalis (n=1449). INTERPRETATION This innovative, rapid, easy-to-use, single-use, point-of-care device to detect C trachomatis, N gonorrhoeae, and T vaginalis infections showed excellent sensitivity and specificity, and could represent an important advance in the development of rapid diagnostics for sexually transmitted infections and other infectious diseases. FUNDING Division of Microbiology and Infectious Diseases, National Institute of Allergy and Infectious Diseases.
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Affiliation(s)
- Sheldon R Morris
- Department of Medicine, University of California San Diego, San Diego, CA, USA; Department of Family Medicine and Public Health, University of California San Diego, San Diego, CA, USA.
| | - Claire C Bristow
- Department of Medicine, University of California San Diego, San Diego, CA, USA
| | | | - Mark Sarno
- Vision Clinical Research, San Marcos, CA, USA
| | - Lenore Asbel
- Philadelphia Department of Public Health, Philadelphia, PA, USA
| | - Audrey French
- Ruth M Rothstein CORE Center-Cook County Health, Chicago, IL, USA
| | | | | | - Leandro Mena
- University of Mississippi Medical Center, Jackson, MS, USA
| | | | - Susan Philip
- San Francisco Department of Public Health, San Francisco, CA, USA
| | | | | | | | - Toni Waymer
- Social & Scientific Systems, Silver Spring, MD, USA
| | - Jeffrey D Klausner
- Department of Medicine, University of California Los Angeles, Los Angeles, CA, USA; Department of Epidemiology, University of California Los Angeles, Los Angeles, CA, USA
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Adamson PC, Loeffelholz MJ, Klausner JD. Point-of-Care Testing for Sexually Transmitted Infections: A Review of Recent Developments. Arch Pathol Lab Med 2020; 144:1344-1351. [PMID: 32810868 DOI: 10.5858/arpa.2020-0118-ra] [Citation(s) in RCA: 52] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/26/2020] [Indexed: 11/06/2022]
Abstract
CONTEXT.— Sexually transmitted infections (STIs) are among the most common communicable diseases globally and are associated with significant morbidity and mortality worldwide. Point-of-care tests have the potential to revolutionize the prevention and control of STIs by enabling rapid diagnosis and early treatment of infections, thus interrupting transmission and preventing the sequelae of untreated infections. Currently, there are several point-of-care (POC) tests available for the diagnosis of Treponema pallidum, Chlamydia trachomatis, Neisseria gonorrhoeae, and Trichomonas vaginalis infections, although these tests differ with regard to their performance, turnaround time, and cost. OBJECTIVE.— To provide an updated review of the POC tests available and under development for the diagnosis of T pallidum, C trachomatis, N gonorrhoeae, and T vaginalis infections, to discuss the context for which these tests might be used, and to highlight future directions for test development. DATA SOURCES.— We reviewed the literature pertaining to the recent development and performance evaluations of POC tests for the diagnosis of syphilis, chlamydia, gonorrhea, and trichomonas. CONCLUSIONS.— Recently, there has been rapid development of new POC tests for STIs. Although there are inexpensive, rapid, and accurate POC tests available for syphilis, there are few such tests available for the diagnosis of chlamydia, gonorrhea, or trichomonas, and currently none with the ability to detect antimicrobial resistance in N gonorrhoeae. Research evaluating implementation strategies for the currently available tests and the development of additional POC tests that are rapid, accurate, and affordable are urgently needed to address the rising number of STIs worldwide.
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Affiliation(s)
- Paul C Adamson
- From the Division of Infectious Diseases, David Geffen School of Medicine at UCLA, Los Angeles, California (Adamson, Klausner)
| | | | - Jeffrey D Klausner
- From the Division of Infectious Diseases, David Geffen School of Medicine at UCLA, Los Angeles, California (Adamson, Klausner).,and the Fielding School of Public Health, University of California, Los Angeles (Klausner)
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Engel N, Wolffs PFG. Aligning diagnostics to the point-of-care: lessons for innovators, evaluators and decision-makers from tuberculosis and HIV. BMJ Glob Health 2020; 5:e003457. [PMID: 33208314 PMCID: PMC7677375 DOI: 10.1136/bmjgh-2020-003457] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 10/03/2020] [Accepted: 10/06/2020] [Indexed: 11/18/2022] Open
Abstract
Diagnostics, including those that work at point-of-care, are an essential part of successful public health responses to infectious diseases and pandemics. Yet, they are not always used or fit intended use settings. This paper reports on key insights from a qualitative study on how those engaged with developing and implementing new point-of-care (POC) diagnostics for tuberculosis (TB) and HIV ensure these technologies work at POC. Ethnographic fieldwork between 2015 and 2017 consisting of 53 semistructured interviews with global stakeholders and visits to workshops, companies, and conferences was combined with 15 semistructured interviews with stakeholders in India including providers, decision-makers, scientists and developers and visits to companies, clinics and laboratories. Our results show how developers and implementer of HIV and TB POC diagnostics aim to know and align their diagnostics to elements in more settings than just intended use, but also the setting of the developer, the global intermediaries, the bug/disease and the competitor. Actors and elements across these five settings define what a good diagnostic is, yet their needs might conflict or change and they are difficult to access. Aligning diagnostics to the POC requires continuous needs assessment throughout development and implementation phases as well as substantive, ongoing investment in relationships with users. The flexibility required for such continuous realigning and iteration clashes with established evaluation procedures and business models in global health and risks favouring certain products over others. The paper concludes with suggestions to strengthen this alignment work and applies this framework to research needs in the wake of COVID-19.
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Affiliation(s)
- Nora Engel
- Health, Ethics & Society/Care and Public Health Research Institute, Maastricht University Faculty of Health Medicine and Life Sciences, Maastricht, The Netherlands
| | - Petra F G Wolffs
- Department of Medical Microbiology, Care and Public Health Research Institute, Maastricht University Medical Centre, Maastricht, The Netherlands
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Frackelton R, Jones K, Hamer B, Jones S, Hitchings E, Harrison J, Hughes-McGreal C, Clarke E. Managing contacts of chlamydia: should clinics implement a test and wait process? Int J STD AIDS 2020; 32:38-44. [PMID: 33121362 DOI: 10.1177/0956462420956852] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
British guidelines recommend epidemiological treatment for all chlamydia contacts during the look back period. Some UK sexual health clinics follow a test and wait process for chlamydia contacts presenting after 14 days of exposure. The aim of this retrospective service evaluation was to determine the potential impact of implementing such a process for chlamydia contacts at our clinic. We reviewed the patient records of 548 chlamydia contacts over a 1-year period, and 588 patients with chlamydia over a 5-month period. Demographic and clinical characteristics data were collected.Chlamydia prevalence was 46% (254/548) in contacts, with prevalence varying by age (p=.008) and sexual risk (p=.04), but not by time since exposure (p=.29). For patients with chlamydia, there was a mean of 1.9 days between results notification and attending for treatment; a mean of 2.2 attempts were required to contact patients to return for treatment. Chlamydia prevalence in contacts is high. Not giving empirical treatment to contacts presenting after 14 days of exposure would result in 13.1% of the cohort needing to return for treatment. Patients found to have chlamydia returned promptly once informed of positive results.
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Affiliation(s)
| | - Kathy Jones
- Axess Sexual Health, Liverpool University Hospitals NHS Foundation Trust, Royal Liverpool University Hospital, Liverpool, UK
| | - Beth Hamer
- Axess Sexual Health, Liverpool University Hospitals NHS Foundation Trust, Royal Liverpool University Hospital, Liverpool, UK
| | - Sian Jones
- School of Medicine, University of Liverpool, Liverpool, UK
| | - Elizabeth Hitchings
- Axess Sexual Health, Liverpool University Hospitals NHS Foundation Trust, Royal Liverpool University Hospital, Liverpool, UK
| | - Joanne Harrison
- Axess Sexual Health, Liverpool University Hospitals NHS Foundation Trust, Royal Liverpool University Hospital, Liverpool, UK
| | - Catherine Hughes-McGreal
- Axess Sexual Health, Liverpool University Hospitals NHS Foundation Trust, Royal Liverpool University Hospital, Liverpool, UK
| | - Emily Clarke
- Axess Sexual Health, Liverpool University Hospitals NHS Foundation Trust, Royal Liverpool University Hospital, Liverpool, UK
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Ferreyra C, Osborn J, Moussy F, Alirol E, Lahra M, Whiley D, Shafer W, Unemo M, Klausner J, Kelly Cirino C, Wi T. Developing target product profiles for Neisseria gonorrhoeae diagnostics in the context of antimicrobial resistance: An expert consensus. PLoS One 2020; 15:e0237424. [PMID: 32870912 PMCID: PMC7462286 DOI: 10.1371/journal.pone.0237424] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Accepted: 06/17/2020] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND There is a need for a rapid diagnostic point of care test to detect Neisseria gonorrhoeae (NG) infection to prevent incorrect, lack or excess of treatment resulting from current syndromic management in low-resource settings. An assay to identify NG antimicrobial resistance (AMR) is also highly desirable to facilitate antibiotic stewardship. Here we describe the development of two target product profiles (TPPs): one for a test for etiological diagnosis of NG and Chlamydia trachomatis (CT) (TPP1) and one for the detection of NG AMR/susceptibility (TPP2). METHODS Draft TPPs were initially developed based on a landscape analysis of existing diagnostics and expert input. TPPs were refined via an online Delphi survey with two rounds of input from 68 respondents. TPP characteristics on which <75% of non-industry respondents agreed were further discussed and revised by an expert working group. RESULTS The need for a test to identify NG in patients with urethral or vaginal discharge was identified as a minimal requirement of TPP1, with a test that can diagnose NG in asymptomatic patients as the optimal requirement. A sensitivity of 80% was considered acceptable, either in context of syndromic management or screening high-risk populations. For TPP2, the agreed minimal requirement was for a test to be used at level 2 healthcare facilities and above, with an optimal requirement of level 1 or above. A lateral flow format was preferred for TPP1, while it was considered likely that TPP2 would require a molecular format. A total of 31 test characteristics were included in TPP1 and 27 in TPP2. CONCLUSIONS Following the working group revisions, TPPs were posted online for public feedback for two months, and are now finalized. The final TPPs are currently guiding the development of new diagnostics that meet the defined characteristics to reach the market within two years.
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Affiliation(s)
- Cecilia Ferreyra
- Foundation for Innovative New Diagnostics (FIND), Geneva, Switzerland
| | - Jennifer Osborn
- Foundation for Innovative New Diagnostics (FIND), Geneva, Switzerland
| | | | - Emilie Alirol
- Global Antibiotic R&D Partnership (GARDP), Geneva, Switzerland
| | - Monica Lahra
- WHO Collaborating Centre for Sexually Transmitted Infections and Antimicrobial Resistance, New South Wales Health Pathology, Microbiology, The Prince of Wales Hospital, Randwick, Australia
- Faculty of Medicine, The University of New South Wales, Sydney, New South Wales, Australia
| | - David Whiley
- Centre for Clinical Research, The University of Queensland, Brisbane, Queensland, Australia
| | - William Shafer
- Department of Microbiology and Immunology, Emory University School of Medicine, Atlanta, Georgia, USA and Veterans Affairs Medical Center, Decatur, Georgia, United States of America
| | - Magnus Unemo
- WHO Collaborating Centre for Gonorrhoea and Other STIs, National Reference Laboratory for STIs, Örebro University Hospital, Örebro, Sweden
| | - Jeffrey Klausner
- Division of Infectious Diseases, University of California and David Geffen School of Medicine Los Angeles, Los Angeles, CA, United States of America
| | | | - Teodora Wi
- World Health Organization (WHO), Geneva, Switzerland
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13
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Ford N, Wi T, Easterbrook P, Penazzato M, Vitoria M. Global public health efforts to address HIV and related communicable disease syndemics. Curr Opin HIV AIDS 2020; 15:261-265. [PMID: 32496325 DOI: 10.1097/coh.0000000000000636] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW To review recent progress in public health efforts to address HIV, and the extent to which key approaches can be applied to three key epidemics that commonly co-occur with HIV: TB, viral hepatitis, and STIs. RECENT FINDINGS The public health approach to tackling HIV in low-income and middle-income settings relied on standardized treatment regimens and monitoring approaches, task sharing and community involvement, and decentralized and integrated service delivery. These approaches can all be applied to three key epidemics that commonly co-occur with HIV: TB, viral hepatitis, and STIs. SUMMARY HIV, viral hepatitis, and STIs share common routes of infection, and HIV weakens the immune system, increasing the risk of TB. A public health approach can be applied to address these syndemics.
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Affiliation(s)
- Nathan Ford
- Department of HIV, STIs, and Global Hepatitis Programme, World Health Organization, Geneva, Switzerland
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14
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Engel N, Krumeich A. Valuing Simplicity: Developing a Good Point of Care Diagnostic. FRONTIERS IN SOCIOLOGY 2020; 5:37. [PMID: 33869444 PMCID: PMC8022531 DOI: 10.3389/fsoc.2020.00037] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Accepted: 04/27/2020] [Indexed: 06/12/2023]
Abstract
Point-of-care testing promises laboratory-based precision in settings that do not have easy access to laboratories or where processing tests takes too long or is too costly. Developers and global health actors stress values and norms such as simplicity, rapidity and accuracy for realizing diagnostic innovations that work at point of care and are aligned to the specific requirements of point-of-care settings. This paper uses fieldwork among diagnostic manufacturers, scientists, donors, members of civil society, industry consultants, international organizations, regulators, policymakers, programme officers, lab technicians, and clinicians involved in development and implementation of tuberculosis and HIV diagnostics, to examine how norms and values of what constitutes a good point-of-care diagnostic are operating in practice through both top-down and bottom-up dynamics. It draws the link between design, evidence and adoption of diagnostics and how the different actors interpret the values underpinning the new practice. The analysis draws on literature on valuation practices, evidence-making and technology design in science and technology studies and medical sociology. The findings reveal how these values constitute innovation, implementation, and evaluation practices across global and local (India) sites, with important consequences for funding of health infrastructure, capacity, and training resources for addressing some of the existing structural inequalities. Dominant values currently defining point of care diagnostics risk exacerbating health inequalities between those who do and do not have the necessary social and financial resources to access better equipped and functioning healthcare facilities, especially in resource constrained settings.
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Affiliation(s)
- Nora Engel
- Department of Health, Ethics & Society, Care and Public Health Research Institute, Maastricht University, Maastricht, Netherlands
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15
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Highly sensitive vertical flow based point-of-care immunokit for rapid and early detection of human CRP as a cardiovascular risk factor. Biomed Microdevices 2020; 22:28. [DOI: 10.1007/s10544-020-00480-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
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16
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Taylor-Robinson D, Horner P, Pallecaros A. Diagnosis of some genital-tract infections: part 2. Molecular tests and the new challenges. Int J STD AIDS 2020; 31:198-207. [PMID: 32009570 DOI: 10.1177/0956462419890526] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Promptly and accurately diagnosing genital-tract infections is key to instituting appropriate treatment and control of sexually transmitted infections (STIs). Ano-genital tract testing for STIs in the last two decades has not entirely moved away from insensitive methods but it is now at least dominated by highly sensitive molecular methods. These tests can be ordered through the internet for use at home, with self-taken specimens then returned, usually by post, to a clinic or laboratory for testing. The increasing ease of access of the public to this situation, together with increasing on-line health-seeking behaviour, has resulted in a gap between commercial and NHS management pathways for STIs. Crucially, patients who order multiplex test kits on-line for use at home, and other non-specialists, may not realize that it is worthwhile testing only for Neisseria gonorrhoeae, Chlamydia trachomatis, and possibly Trichomonas vaginalis, and Mycoplasma genitalium if the person is symptomatic or their current partner is infected. The detection and recommended treatment of micro-organisms which to some extent are part of the genital-tract microbiome, such as Mycoplasma hominis, Ureaplasma spp. or Gardnerella vaginalis, which do not cause symptoms in the majority of those infected, cannot be recommended. We argue that a shift from specialist-led to patient- and non-specialist-led STI management, in the presence of a clinical leadership vacuum, has increased the risk of inappropriate and unnecessary treatment which will drive macrolide, tetracycline and metronidazole antimicrobial resistance. However, in the past 5–6 years several groups have been able to show the value of on-line testing as a consequence of targeting the most important micro-organisms and using molecular tests to allow rapid and appropriately informed treatment. This should herald a brighter future, although there is still a need for leadership to expertly guide commercial and NHS sectors alike. In turn, this requires dedicated genito-urinary medicine commissioning to be maintained at a time when it appears to be most under threat.
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Affiliation(s)
- David Taylor-Robinson
- Section of Infectious Diseases, Wright-Fleming Institute, Faculty of Medicine, Imperial College London, London, UK
| | - Patrick Horner
- Population Health Sciences, University of Bristol, Bristol, UK.,National Institute for Health Research Health Protection Research Unit (NIHR HPRU) in Evaluation of Interventions in partnership with Public Health England, University of Bristol, Bristol, UK.,Unity Sexual Health, University Hospitals Bristol NHS Trust, Bristol, UK
| | - Anna Pallecaros
- Department of Genito-urinary Medicine, Princess Grace Hospital, London, UK
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17
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Mabbott S, Fernandes SC, Schechinger M, Cote GL, Faulds K, Mace CR, Graham D. Detection of cardiovascular disease associated miR-29a using paper-based microfluidics and surface enhanced Raman scattering. Analyst 2020; 145:983-991. [DOI: 10.1039/c9an01748h] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
A paper-based microfluidics self-testing device capable of colorimetric and SERS-based sensing of cardiovascular disease associated miR-29a has been developed for improving patient care and triage.
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Affiliation(s)
- Samuel Mabbott
- Department of Pure and Applied Chemistry
- Technology and Innovation Centre
- University of Strathclyde
- Glasgow
- UK
| | | | - Monika Schechinger
- Department of Biomedical Engineering
- Texas A&M University
- USA
- Health Technology and Innovation Building
- Texas A&M University
| | - Gerard L. Cote
- Department of Biomedical Engineering
- Texas A&M University
- USA
- Health Technology and Innovation Building
- Texas A&M University
| | - Karen Faulds
- Department of Pure and Applied Chemistry
- Technology and Innovation Centre
- University of Strathclyde
- Glasgow
- UK
| | | | - Duncan Graham
- Department of Pure and Applied Chemistry
- Technology and Innovation Centre
- University of Strathclyde
- Glasgow
- UK
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18
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Ogale Y, Yeh PT, Kennedy CE, Toskin I, Narasimhan M. Self-collection of samples as an additional approach to deliver testing services for sexually transmitted infections: a systematic review and meta-analysis. BMJ Glob Health 2019; 4:e001349. [PMID: 31139454 PMCID: PMC6509609 DOI: 10.1136/bmjgh-2018-001349] [Citation(s) in RCA: 55] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Revised: 03/28/2019] [Accepted: 03/30/2019] [Indexed: 11/20/2022] Open
Abstract
Background Self-collection of samples for diagnostic testing offers the advantages of patient autonomy, confidentiality and convenience. Despite data showing their feasibility and accuracy, there is a need to better understand how to implement such interventions for sexually transmitted infections (STIs). To support WHO guidelines on self-care interventions, we conducted a systematic review to investigate whether self-collection of samples should be made available as an additional approach to deliver STI testing services. Methods Peer-reviewed studies were included if they compared individuals who self-collected samples for chlamydia, gonorrhoea, syphilis and/or trichomonas testing to individuals who had samples collected by clinicians on the following outcomes: uptake/frequency of STI testing, social harms/adverse events, positive yield (case finding), linkage to clinical assessment/treatment and reported sexual risk behaviour. We searched PubMed, CINAHL, LILACS and EMBASE for articles published through July 2018. Risk of bias was assessed using the Cochrane tool for randomised controlled trials (RCTs) and the Evidence Project tool for non-RCTs. Meta-analysis was conducted using random effects models to generate pooled estimates of relative risk (RR). Results Eleven studies, including five RCTs and six observational studies with a total of 202 745 participants, met inclusion criteria. Studies were conducted in Australia, Denmark and the USA. Meta-analysis found that programmes offering self-collection of samples increased overall uptake of STI testing services (RR: 2.941, 95% CI 1.188 to 7.281) and case finding (RR: 2.166, 95% CI 1.043 to 4.498). No studies reported measuring STI testing frequency, social harms/adverse events, linkage to care or sexual risk behaviour. Discussion While greater diversity in study designs, outcomes and settings would strengthen the evidence base, findings from this review suggest that self-collection of STI samples could be an effective additional strategy to increase STI testing uptake. Prospero registration number PROSPERO CRD42018114866.
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Affiliation(s)
- Yasmin Ogale
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Ping Teresa Yeh
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Caitlin E Kennedy
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Igor Toskin
- Department of Reproductive Health and Research, Organisation mondiale de la Santé, Geneve, Switzerland
| | - Manjulaa Narasimhan
- Department of Reproductive Health and Research, Organisation mondiale de la Santé, Geneve, Switzerland
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19
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Toskin I, Blondeel K, Peeling RW, Deal C, Kiarie J. Advancing point of care diagnostics for the control and prevention of STIs: the way forward. Sex Transm Infect 2018; 93:S81-S88. [PMID: 29223966 DOI: 10.1136/sextrans-2016-053073] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2017] [Revised: 06/06/2017] [Accepted: 06/23/2017] [Indexed: 01/01/2023] Open
Abstract
WHO recognises the global impact of sexually transmitted infections (STIs) on global public health and individual sexual and reproductive health and well-being. As a component of the WHO Global Health Sector Strategy for the control and prevention of STIs, there has been a growing recognition of the importance of integrating point-of-care tests (POCTs) into overall strategic planning. The process of integrating STI POCTs, in addition to providing a definitive diagnosis and appropriate treatment in a single visit, also includes innovative delivery options, such as on-site delivery, community-based testing (including screening), as well as self-testing at home after purchase of a test online or over-the-counter. WHO organised two technical consultations in May 2014 and July 2015. This article summarises the discussions of the meeting participants on advancing the use of POCTs to control and prevent STIs. The following priorities were identified: the need for pathogens' target discovery; encouragement of multiplexing, miniaturisation, simplification and connectivity; promotion of standardisation of evaluation of new diagnostic platforms across all stages of the evaluation pipeline; the need for an investment case, modelling and scenarios to ensure buy-in among key stakeholders, including developers and the private sector; the need for norms and standards, including guidelines, to support introduction of STI POCTs in programmes; anticipating potential tensions between different parties at the implementation level; and leveraging on the global initiative, Sustainable Development Goals (SDGs)/global health sector STI strategy, to sustain investment in STI POCT programmes. There is a rich pipeline of diagnostic products, but some have stalled in development. An approach to accelerate the evaluation of new diagnostics is to set up a competent network of evaluation sites ahead of time, harmonise regulatory approval processes with development of models to estimate cost-effectiveness, informed by better STI data. This should result in accelerating policy development. Although it may be some time before good POCTs can be widely implemented in low resource settings, it is important to be a catalyst for continued development and use of these essential tools as an integral part of both the WHO Global Health Sector Strategy and the agenda for 2030.
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Affiliation(s)
- Igor Toskin
- Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Karel Blondeel
- Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland.,Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Rosanna W Peeling
- Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, UK
| | - Carolyn Deal
- Division of Microbiology and Infectious Diseases, National Institute of Allergy and Infectious Diseases, Rockville, USA
| | - James Kiarie
- Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland
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