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Manten K, Katzenschlager S, Brümmer LE, Schmitz S, Gaeddert M, Erdmann C, Grilli M, Pollock NR, Macé A, Erkosar B, Carmona S, Ongarello S, Johnson CC, Sacks JA, Faehling V, Bornemann L, Weigand MA, Denkinger CM, Yerlikaya S. Clinical accuracy of instrument-based SARS-CoV-2 antigen diagnostic tests: a systematic review and meta-analysis. Virol J 2024; 21:99. [PMID: 38685117 PMCID: PMC11059670 DOI: 10.1186/s12985-024-02371-5] [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: 01/02/2024] [Accepted: 04/17/2024] [Indexed: 05/02/2024] Open
Abstract
BACKGROUND During the COVID-19 pandemic, antigen diagnostic tests were frequently used for screening, triage, and diagnosis. Novel instrument-based antigen tests (iAg tests) hold the promise of outperforming their instrument-free, visually-read counterparts. Here, we provide a systematic review and meta-analysis of the SARS-CoV-2 iAg tests' clinical accuracy. METHODS We systematically searched MEDLINE (via PubMed), Web of Science, medRxiv, and bioRxiv for articles published before November 7th, 2022, evaluating the accuracy of iAg tests for SARS-CoV-2 detection. We performed a random effects meta-analysis to estimate sensitivity and specificity and used the QUADAS-2 tool to assess study quality and risk of bias. Sub-group analysis was conducted based on Ct value range, IFU-conformity, age, symptom presence and duration, and the variant of concern. RESULTS We screened the titles and abstracts of 20,431 articles and included 114 publications that fulfilled the inclusion criteria. Additionally, we incorporated three articles sourced from the FIND website, totaling 117 studies encompassing 95,181 individuals, which evaluated the clinical accuracy of 24 commercial COVID-19 iAg tests. The studies varied in risk of bias but showed high applicability. Of 24 iAg tests from 99 studies assessed in the meta-analysis, the pooled sensitivity and specificity compared to molecular testing of a paired NP swab sample were 76.7% (95% CI 73.5 to 79.7) and 98.4% (95% CI 98.0 to 98.7), respectively. Higher sensitivity was noted in individuals with high viral load (99.6% [95% CI 96.8 to 100] at Ct-level ≤ 20) and within the first week of symptom onset (84.6% [95% CI 78.2 to 89.3]), but did not differ between tests conducted as per manufacturer's instructions and those conducted differently, or between point-of-care and lab-based testing. CONCLUSION Overall, iAg tests have a high pooled specificity but a moderate pooled sensitivity, according to our analysis. The pooled sensitivity increases with lower Ct-values (a proxy for viral load), or within the first week of symptom onset, enabling reliable identification of most COVID-19 cases and highlighting the importance of context in test selection. The study underscores the need for careful evaluation considering performance variations and operational features of iAg tests.
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Affiliation(s)
- Katharina Manten
- Department of Infectious Disease and Tropical Medicine, Heidelberg University Hospital, Im Neuenheimer Feld 324, 69120, Heidelberg, Germany
- Department of Anesthesiology, Heidelberg University Hospital, Heidelberg, Germany
| | - Stephan Katzenschlager
- Department of Infectious Disease and Tropical Medicine, Heidelberg University Hospital, Im Neuenheimer Feld 324, 69120, Heidelberg, Germany
| | - Lukas E Brümmer
- Department of Anesthesiology, Heidelberg University Hospital, Heidelberg, Germany
| | - Stephani Schmitz
- Department of Anesthesiology, Heidelberg University Hospital, Heidelberg, Germany
- Department of Developmental Biology, Erasmus Medical Center, Rotterdam, Netherlands
| | - Mary Gaeddert
- Department of Anesthesiology, Heidelberg University Hospital, Heidelberg, Germany
| | | | - Maurizio Grilli
- Library, University Medical Center Mannheim, Mannheim, Germany
| | - Nira R Pollock
- Department of Laboratory Medicine, Boston Children's Hospital, Boston, MA, USA
| | | | | | | | | | - Cheryl C Johnson
- Global HIV, Hepatitis and STIs Programmes, World Health Organization, Geneva, Switzerland
| | - Jilian A Sacks
- Department of Epidemic and Pandemic Preparedness and Prevention, World Health Organization, Geneva, Switzerland
| | - Verena Faehling
- Department of Anesthesiology, Heidelberg University Hospital, Heidelberg, Germany
| | - Linus Bornemann
- Institute of Virology, Faculty of Medicine, University Medical Centre, University of Freiburg, Freiburg, Germany
| | - Markus A Weigand
- Department of Infectious Disease and Tropical Medicine, Heidelberg University Hospital, Im Neuenheimer Feld 324, 69120, Heidelberg, Germany
| | - Claudia M Denkinger
- Department of Anesthesiology, Heidelberg University Hospital, Heidelberg, Germany
- German Center for Infection Research (DZIF), partner site Heidelberg University Hospital, Heidelberg, Germany
| | - Seda Yerlikaya
- Department of Anesthesiology, Heidelberg University Hospital, Heidelberg, Germany.
- German Center for Infection Research (DZIF), partner site Heidelberg University Hospital, Heidelberg, Germany.
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Lafort Y, Cornelissen L, Van Cauteren D, Verboven B, Drieskens S, Couvreur S, Hermans L, Straetmans K, Lernout T. Were SARS-CoV-2 self-tests used for their intended purpose? The experience in Belgium. BMC Health Serv Res 2023; 23:709. [PMID: 37386558 DOI: 10.1186/s12913-023-09704-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2022] [Accepted: 06/15/2023] [Indexed: 07/01/2023] Open
Abstract
BACKGROUND Self-testing has been promoted as a means of increasing COVID-19 test coverage. In Belgium, self-testing was recommended as a complement to the formal, provider-administered indications, such as out of courtesy before meeting others and when feared to be infected. More than a year after the introduction of self-testing their place in the test strategy was evaluated. METHODS We assessed trends in the number of self-tests sold, the number of positive self-tests reported, the proportion sold self-tests/total tests, and the proportion of all positive tests that were confirmed self-tests. To evaluate the reason why people use self-tests, we used the results of two online surveys among members of the general population: one among 27,397 people, held in April 2021, and one among 22,354 people, held in December 2021. RESULTS The use of self-tests became substantial from end 2021 onwards. In the period mid-November 2021 - end-of-June 2022, the average proportion of reported sold self-tests to all COVID-19 tests was 37% and 14% of all positive tests were positive self-tests. In both surveys, the main reported reasons for using a self-test were having symptoms (34% of users in April 2021 and 31% in December 2021) and after a risk contact (27% in both April and December). Moreover, the number of self-tests sold, and the number of positive self-tests reported closely followed the same trend as the provider-administered tests in symptomatic people and high risk-contacts, which reinforces the hypothesis that they were mainly used for these two indications. CONCLUSIONS From end 2021 onwards, self-testing covered a significant part of COVID-19 testing in Belgium, which increased without doubt the testing coverage. However, the available data seem to indicate that self-testing was mostly used for indications outside of official recommendations. If and how this affected the control of the epidemic remains unknown.
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Affiliation(s)
- Yves Lafort
- Department of Epidemiology and Public Health, Sciensano, Brussels, Belgium.
| | - Laura Cornelissen
- Department of Epidemiology and Public Health, Sciensano, Brussels, Belgium
| | | | | | - Sabine Drieskens
- Department of Epidemiology and Public Health, Sciensano, Brussels, Belgium
| | - Simon Couvreur
- Department of Epidemiology and Public Health, Sciensano, Brussels, Belgium
| | - Lize Hermans
- Department of Epidemiology and Public Health, Sciensano, Brussels, Belgium
| | | | - Tinne Lernout
- Department of Epidemiology and Public Health, Sciensano, Brussels, Belgium
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Akinbobola JS, Okaiyeto SO, Sackey AK, Allam L, Mohammed B, Dinga JN, Chukwuemeka PC, Cunningham L. Comparative performance evaluation of blood film microscopy for the diagnosis of bovine trypanosomosis by some laboratories in North-central Nigeria. Open Vet J 2023; 13:599-603. [PMID: 37304603 PMCID: PMC10257452 DOI: 10.5455/ovj.2023.v13.i5.12] [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: 10/13/2022] [Accepted: 04/12/2023] [Indexed: 06/13/2023] Open
Abstract
Background Due to its affordability in disease-affected communities and suitability for field application, microscopy has historically been considered the gold standard for field diagnosis of trypanosomosis in rural settings. Aim This works aims to compare the performance of microscopists on bovine trypanosome microscopy by organizing the first comparative assessment on a correct reading of slides by laboratory professionals using the read slide results and a structured interviewer-administered questionnaire in North-central Nigeria. Methods Ten participants were addressed, as they were sent a panel of two slides (Slide 1: No Trypanosome present; Slide 2: Trypanosome present) and a questionnaire. Results All participants greater than 41 years old reported correctly the presence and absence of parasites on slides. Only 3/8 of microscopists from routine diagnostic laboratories reported correctly the presence of the parasite. Conclusion Our study confirmed errors in reading slides. Therefore, training of microscopists besides a nationwide quality assessment is recommended.
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Affiliation(s)
- Jones Soladoye Akinbobola
- Department of Veterinary Medicine, Faculty of Veterinary Medicine, University of Abuja, Abuja, Nigeria
| | | | | | - Lushaikyaa Allam
- Veterinary Teaching Hospital, Ahmadu Bello University, Zaria, Nigeria
| | - Bisalla Mohammed
- Department of Veterinary Pathology, Ahmadu Bello University, Zaria, Nigeria
| | - Jerome Nyhalah Dinga
- Michael Gahnyam Gbeugvat Foundation, Buea, Cameroon
- Biotechnology Unit, Faculty of Science, University of Buea, Buea, Cameroon
| | - Prosper C. Chukwuemeka
- Department of Veterinary Medicine, Faculty of Veterinary Medicine, University of Abuja, Abuja, Nigeria
| | - Lucas Cunningham
- Department of Tropical Disease Biology, Biological Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
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Papenburg J, Campbell JR, Caya C, Dion C, Corsini R, Cheng MP, Menzies D, Yansouni CP. Adequacy of Serial Self-performed SARS-CoV-2 Rapid Antigen Detection Testing for Longitudinal Mass Screening in the Workplace. JAMA Netw Open 2022; 5:e2210559. [PMID: 35522284 PMCID: PMC9077488 DOI: 10.1001/jamanetworkopen.2022.10559] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
IMPORTANCE Longitudinal mass testing using rapid antigen detection tests (RADT) for serial screening of asymptomatic persons has been proposed for preventing SARS-CoV-2 community transmission. The feasibility of this strategy relies on accurate self-testing. OBJECTIVE To quantify the adequacy of serial self-performed SARS-CoV-2 RADT testing in the workplace, in terms of the frequency of correct execution of procedural steps and accurate interpretation of the range of possible RADT results. DESIGN, SETTING, AND PARTICIPANTS This prospective repeated cross-sectional study was performed from July to October 2021 at businesses with at least 2 active cases of SARS-CoV-2 infection in Montreal, Canada. Participants included untrained persons in their workplace, not meeting Public Health quarantine criteria (ie, required quarantine for 10 days after a moderate-risk contact with someone infected with SARS-CoV-2). Interpretation and performance were compared between participants who received instructions provided by the manufacturer vs those who received modified instructions that were informed by the most frequent or most critical errors we observed. Data were analyzed from October to November 2021. EXPOSURES RADT testing using a modified quick reference guide compared with the original manufacturer's instructions. MAIN OUTCOMES AND MEASURES The main outcome was the difference in correctly interpreted RADT results. Secondary outcomes included difference in proportions of correctly performed procedural steps. Additional analyses, assessed among participants with 2 self-testing visits, compared the second self-test visit with the first self-test visit using the same measures. RESULTS Overall, 1892 tests were performed among 647 participants, of whom 278 participants (median [IQR] age, 43 [31-55] years; 156 [56.1%] men) had at least 1 self-testing visit. For self-test visit 1, significantly better accuracy in test interpretation was observed among participants using the modified quick reference guide than those using the manufacturer's instructions for reading results that were weak positive (64 of 115 participants [55.6%] vs 20 of 163 participants [12.3%]; difference, 43.3 [95% CI, 33.0-53.8] percentage points), positive (103 of 115 participants [89.6%] vs 84 of 163 participants [51.5%]; difference, 38.1 [95% CI, 28.5-47.5] percentage points), strong positive (219 of 229 participants [95.6%] vs 274 of 326 participants [84.0%]; difference, 11.6 [95% CI, 6.8-16.3] percentage points), and invalid (200 of 229 participants [87.3%] vs 252 of 326 participants [77.3%]; difference, 10.0 [95% CI, 3.8-16.3] percentage points). Use of the modified guide was associated with improvements on self-test visit 2 for results that were weak positive (difference, 15.4 [95% CI, 0.7-30.1] percentage points), positive (difference, 19.0 [95% CI, 7.2-30.9] percentage points), and invalid (difference, 8.0 [95% CI, 0.8-15.4] percentage points). For procedural steps identified as critical for test validity, adherence to procedural testing steps did not differ meaningfully according to instructions provided or reader experience. CONCLUSIONS AND RELEVANCE In this cross-sectional study of self-performed SARS-CoV-2 RADT in an intended-use setting, a modified quick reference guide was associated with significantly improved accuracy in RADT interpretations.
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Affiliation(s)
- Jesse Papenburg
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Montreal Children’s Hospital, Montreal, Canada
- Division of Microbiology, Department of Clinical Laboratory Medicine, Optilab Montreal–McGill University Health Centre, Montreal, Canada
- McGill Interdisciplinary Initiative in Infection and Immunity, Montreal, Canada
- Department of Epidemiology, Biostatistics, and Occupational Health, School of Population and Global Health, McGill University, Montreal, Canada
| | - Jonathon R. Campbell
- Department of Epidemiology, Biostatistics, and Occupational Health, School of Population and Global Health, McGill University, Montreal, Canada
- Respiratory Epidemiology and Clinical Research Unit, Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, Canada
| | - Chelsea Caya
- McGill Interdisciplinary Initiative in Infection and Immunity, Montreal, Canada
| | - Cynthia Dion
- McGill Interdisciplinary Initiative in Infection and Immunity, Montreal, Canada
| | - Rachel Corsini
- McGill Interdisciplinary Initiative in Infection and Immunity, Montreal, Canada
| | - Matthew P. Cheng
- Division of Microbiology, Department of Clinical Laboratory Medicine, Optilab Montreal–McGill University Health Centre, Montreal, Canada
- McGill Interdisciplinary Initiative in Infection and Immunity, Montreal, Canada
- Division of Infectious Diseases, Department of Medicine, McGill University Health Centre, Montreal, Canada
| | - Dick Menzies
- Department of Epidemiology, Biostatistics, and Occupational Health, School of Population and Global Health, McGill University, Montreal, Canada
- Respiratory Epidemiology and Clinical Research Unit, Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, Canada
| | - Cédric P. Yansouni
- Division of Microbiology, Department of Clinical Laboratory Medicine, Optilab Montreal–McGill University Health Centre, Montreal, Canada
- McGill Interdisciplinary Initiative in Infection and Immunity, Montreal, Canada
- Division of Infectious Diseases, Department of Medicine, McGill University Health Centre, Montreal, Canada
- J.D. MacLean Centre for Tropical Diseases, McGill University, Montreal, Canada
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The use of dried tube specimens of Plasmodium falciparum in an external quality assessment programme to evaluate health worker performance for malaria rapid diagnostic testing in healthcare centres in Togo. Malar J 2021; 20:50. [PMID: 33472640 PMCID: PMC7819240 DOI: 10.1186/s12936-020-03569-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Accepted: 12/24/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The use of rapid diagnostic tests (RDTs) to diagnose malaria is common in sub-Saharan African laboratories, remote primary health facilities and in the community. Currently, there is a lack of reliable methods to ascertain health worker competency to accurately use RDTs in the testing and diagnosis of malaria. Dried tube specimens (DTS) have been shown to be a consistent and useful method for quality control of malaria RDTs; however, its application in National Quality Management programmes has been limited. METHODS A Plasmodium falciparum strain was grown in culture and harvested to create DTS of varying parasite density (0, 100, 200, 500 and 1000 parasites/µL). Using the dried tube specimens as quality control material, a proficiency testing (PT) programme was carried out in 80 representative health centres in Togo. Health worker competency for performing malaria RDTs was assessed using five blinded DTS samples, and the DTS were tested in the same manner as a patient sample would be tested by multiple testers per health centre. RESULTS All the DTS with 100 parasites/µl and 50% of DTS with 200 parasites/µl were classified as non-reactive during the pre-PT quality control step. Therefore, data from these parasite densities were not analysed as part of the PT dataset. PT scores across all 80 facilities and 235 testers was 100% for 0 parasites/µl, 63% for 500 parasites/µl and 93% for 1000 parasites/µl. Overall, 59% of the 80 healthcare centres that participated in the PT programme received a score of 80% or higher on a set of 0, 500 and 1000 parasites/ µl DTS samples. Sixty percent of health workers at these centres recorded correct test results for all three samples. CONCLUSIONS The use of DTS for a malaria PT programme was the first of its kind ever conducted in Togo. The ease of use and stability of the DTS illustrates that this type of samples can be considered for the assessment of staff competency. The implementation of quality management systems, refresher training and expanded PT at remote testing facilities are essential elements to improve the quality of malaria diagnosis.
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Visser T, Ramachandra S, Pothin E, Jacobs J, Cunningham J, Menach AL, Gatton ML, Dos Santos Souza S, Nelson S, Rooney L, Aidoo M. A comparative evaluation of mobile medical APPS (MMAS) for reading and interpreting malaria rapid diagnostic tests. Malar J 2021; 20:39. [PMID: 33435999 PMCID: PMC7805067 DOI: 10.1186/s12936-020-03573-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2020] [Revised: 12/23/2020] [Accepted: 12/28/2020] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND The World Health Organization recommends confirmatory diagnosis by microscopy or malaria rapid diagnostic test (RDT) in patients with suspected malaria. In recent years, mobile medical applications (MMAs), which can interpret RDT test results have entered the market. To evaluate the performance of commercially available MMAs, an evaluation was conducted by comparing RDT results read by MMAs to RDT results read by the human eye. METHODS Five different MMAs were evaluated on six different RDT products using cultured Plasmodium falciparum blood samples at five dilutions ranging from 20 to 1000 parasites (p)/microlitre (µl) and malaria negative blood samples. The RDTs were performed in a controlled, laboratory setting by a trained operator who visually read the RDT results. A second trained operator then used the MMAs to read the RDT results. Sensitivity (Sn) and specificity (Sp) for the RDTs were calculated in a Bayesian framework using mixed models. RESULTS The RDT Sn of the P. falciparum (Pf) test line, when read by the trained human eye was significantly higher compared to when read by MMAs (74% vs. average 47%) at samples of 20 p/µl. In higher density samples, the Sn was comparable to the human eye (97%) for three MMAs. The RDT Sn of test lines that detect all Plasmodium species (Pan line), when read by the trained human eye was significantly higher compared to when read by MMAs (79% vs. average 56%) across all densities. The RDT Sp, when read by the human eye or MMAs was 99% for both the Pf and Pan test lines across all densities. CONCLUSIONS The study results show that in a laboratory setting, most MMAs produced similar results interpreting the Pf test line of RDTs at parasite densities typically found in patients that experience malaria symptoms (> 100 p/µl) compared to the human eye. At low parasite densities for the Pf line and across all parasite densities for the Pan line, MMAs were less accurate than the human eye. Future efforts should focus on improving the band/line detection at lower band intensities and evaluating additional MMA functionalities like the ability to identify and classify RDT errors or anomalies.
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Affiliation(s)
| | | | - Emilie Pothin
- Swiss Tropical and Public Health Institute, Basel, Switzerland
| | - Jan Jacobs
- Institute of Tropical Medicine, Antwerp, Belgium.,Department of Microbiology and Immunology, KU Leuven, Leuven, Belgium
| | | | | | | | | | | | - Luke Rooney
- Clinton Health Access Initiative, Boston, USA
| | - Michael Aidoo
- Centers for Disease Control and Prevention, Atlanta, USA
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Kadam R, White W, Banks N, Katz Z, Dittrich S, Kelly-Cirino C. Target Product Profile for a mobile app to read rapid diagnostic tests to strengthen infectious disease surveillance. PLoS One 2020; 15:e0228311. [PMID: 31995628 PMCID: PMC6988927 DOI: 10.1371/journal.pone.0228311] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Accepted: 01/07/2020] [Indexed: 02/06/2023] Open
Abstract
The essential role of rapid diagnostic tests (RDTs) in disease control is compromised every time a test is not performed correctly or its result is not reported accurately and promptly. A mobile app that utilizes the camera and connectivity of a common smartphone can fill this role of supporting the test's proper execution and the automatic transmission of results. In a consensus process with 51 expert participants representing the needs of clinical users, healthcare programs, health information systems, surveillance systems, and global public health stakeholders, we developed a Target Product Profile describing the minimal and optimal characteristics of such an app. We collected feedback over two rounds and refined the characteristics to arrive at a preferred agreement level of greater than 75%, with an average of 92% agreement (range: 79-100%). As per this feedback, such an app should be compatible with many RDTs and mobile devices without needing accessories. The app should assist the user with RDT-specific instructions, include checks to facilitate quality control of the testing process and suggest results with ≥ 95% accuracy across common lighting conditions while allowing the user to determine the final result. Data from the app must be under the control of the health program that operates it, and the app should support at least one of the common data exchange formats HL7, FHIR, ASTM or JSON. The Target Product Profile also lays out the minimum data security and privacy requirements for the app.
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Affiliation(s)
- Rigveda Kadam
- Foundation for Innovative Diagnostics (FIND), Geneva, Switzerland
| | - Wallace White
- Foundation for Innovative Diagnostics (FIND), Geneva, Switzerland
| | - Nicholas Banks
- Foundation for Innovative Diagnostics (FIND), Geneva, Switzerland
| | - Zachary Katz
- Foundation for Innovative Diagnostics (FIND), Geneva, Switzerland
| | - Sabine Dittrich
- Foundation for Innovative Diagnostics (FIND), Geneva, Switzerland
- Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
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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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Vernelen K, Barbé B, Gillet P, Van Esbroeck M, China B, Jacobs J. Photo-based External Quality Assessment of Malaria rapid diagnostic tests in a non-endemic setting. PLoS One 2018; 13:e0201622. [PMID: 30169508 PMCID: PMC6118386 DOI: 10.1371/journal.pone.0201622] [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: 02/12/2018] [Accepted: 07/18/2018] [Indexed: 11/20/2022] Open
Abstract
Introduction In non-endemic settings, expertise in malaria microscopy is limited and rapid diagnostic tests (RDTs) are an adjunct to malaria diagnosis. Aim We performed an External Quality Assessment (EQA) on reading and interpretation of malaria RDTs in a non-endemic setting. Methods Participants were medical laboratories in Belgium and the Grand Duchy of Luxembourg using malaria RDTs; they received (i) 10 high-resolution photographs presenting test line combinations of RDTs with interpretations listed in a multiple choice format and (ii) a questionnaire about their practices of malaria diagnosis. Results Among 135 subscribing laboratories, 134 (99.3%) used 139 RDT products (11 different products from 8 brands). After exclusion of the results of one laboratory, analysis was done for 133 laboratories using 137 RDT products. Scores of 10/10, 9/10 and 8/10 were achieved for 58.4%, 13.1% and 8.0% of 137 RDT products respectively. For three-band P. falciparum–pan-Plasmodium RDTs (113 (82.5%) products, 6 brands), most frequent errors were (1) disregarding faint test lines (18.6%), (2) reporting invalid instead of P. falciparum (16.8%) and (3) reporting “Plasmodium spp., no further differentiation possible” without mentioning the presence or absence of P. falciparum (11.5%). For four-band RDTs (21 (15.3%) products, 1 brand), errors were (4) disregarding faint P. vivax test lines (47.6%) and (5) reporting “Plasmodium spp., no further differentiation possible” without mentioning the presence of P. falciparum and P. vivax (28.6%). Instructions for use (IFU) of only 4 out of 10 RDT products mentioned to interpret faint-intensity test lines as positive (conducive to errors 1 and 4) and IFU of 2 products displayed incorrect information (conducive to errors 2 and 5). Outside of office hours, 36.1% of participants relied on RDTs as the initial diagnostic test; 13.9% did not perform microscopic confirmation. Conclusion Reading and interpretation of malaria RDTs was satisfactory, but errors were embedded in the instructions for use of the products. Relying on RDTs alone for malaria diagnosis (about one third of participants) is not a recommended practice.
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Affiliation(s)
- Kris Vernelen
- Quality of Medical Laboratories, Institute of Public Health, Sciensano, Brussels, Belgium
- * E-mail:
| | | | | | | | - Bernard China
- Quality of Medical Laboratories, Institute of Public Health, Sciensano, Brussels, Belgium
| | - Jan Jacobs
- Institute of Tropical Medicine, Antwerp, Belgium
- KU Leuven, Department of Microbiology and Immunology, Leuven, Belgium
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10
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Building Laboratory Capacity to Strengthen Health Systems: The Partners In Health Experience. Clin Lab Med 2017; 38:101-117. [PMID: 29412874 DOI: 10.1016/j.cll.2017.10.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
The diagnostic laboratory is essential to patient care and to the achievement of health equity. Through the development of quality laboratories in settings burdened by poverty and weak health systems, Partners In Health has demonstrated the critical contributions of clinical laboratories to the care of patients with HIV, tuberculosis, and cancer, among other conditions. The lessons learned through the organization's experience include the importance of well-trained and well-supported staff; reliable access to supplies, reagents, and diagnostic equipment; adequate facilities to provide diagnostic services; the integration of laboratories into networks of care; and accompaniment of the public health sector.
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11
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Carter JY. External quality assessment in resource-limited countries. Biochem Med (Zagreb) 2017; 27:97-109. [PMID: 28392732 PMCID: PMC5382860 DOI: 10.11613/bm.2017.013] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2016] [Accepted: 10/09/2016] [Indexed: 01/22/2023] Open
Abstract
Introduction Health laboratory services are a critical component of national health systems but face major operational challenges in resource-limited (RL) settings. New funding for health systems strengthening in RL countries has increased the demand for diagnostics and provided opportunities to address these constraints. An approach to sustainably strengthen national laboratory systems in sub-Saharan African countries is the Strengthening Laboratory Management Toward Accreditation (SLMTA) programme. External Quality Assessment (EQA) is a requirement for laboratory accreditation. EQA comprises proficiency testing (PT), rechecking of samples and on-site evaluation. Materials and methods A systematic literature search was conducted to identify studies addressing laboratory EQA and quality monitoring in RL countries. Unpublished reports were also sought from national laboratory authorities and personnel. Results PT schemes in RL countries are provided by commercial companies, institutions in developed countries and national programmes. Most government-supported PT schemes address single diseases using a vertical approach. Regional approaches to delivering PT have also been implemented across RL countries. Rechecking schemes address mainly tuberculosis (TB), malaria and human immunodeficiency virus (HIV); integrated rechecking programmes have been piloted. Constraints include sample transportation, communication of results, unknown proficiency of referee staff and limited resources for corrective action. Global competency assessment standards for malaria microscopists have been established. Conclusions EQA is vital for monitoring laboratory performance and maintaining quality of laboratory services, and is a valuable tool for identifying and assessing technology in use, identifying gaps in laboratory performance and targeting training needs. Accreditation of PT providers and competency of EQA personnel must be ensured.
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12
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Kashosi TM, Mutuga JM, Byadunia DS, Mutendela JK, Mulenda B, Mubagwa K. Performance of SD Bioline Malaria Ag Pf/Pan rapid test in the diagnosis of malaria in South-Kivu, DR Congo. Pan Afr Med J 2017; 27:216. [PMID: 28979618 PMCID: PMC5622830 DOI: 10.11604/pamj.2017.27.216.11430] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2016] [Accepted: 06/26/2017] [Indexed: 11/13/2022] Open
Abstract
Introduction Use of malaria rapid diagnostic tests (RDTs) has improved the management of this disease. We evaluated the validity of the SD-Bioline Malaria-Ag-Pf/Pan™ (Batch 60952) RDT supplied by the Malaria Control Program of the DRCongo. Methods cChildren (n = 460) aged below 5 years seen in curative care (CC) for suspected malaria and in pre-school consultation (PSC) in two rural centers underwent clinical evaluation and capillary blood collection for microscopic reading of thick smear (TS) and thin film (BF), and for RDT. Sensitivity (Se), specificity (Sp), positive (PPV) and negative (NPV) predictive values of the RDT, and the corresponding accuracy and Youden indices were determined using microscopic data as reference. Results were compared using the Chi-square test. Results Microscopy showed malaria infection in 53.8% of CC and in 10.8% of PSC children. Similar results were obtained using the RDT (CC: 47.1%; PSC: 18.3%; P > 0.05 vs. microscopy). Se of the RDT was 82.1%, Sp 92.0%, PPV 88.5% and NPV 87.4%. RDT positivity was significantly (p < 0.01) associated with some symptoms (chills, profuse sweating) and with a recent history of malaria attack. In addition, Se of the RDT depended on parasitemia and decreased at low parasite denstity. Conclusion SD-Bioline Malaria-Ag-Pf/Pan™ RDT has a relatively good sensitivity and specificity but seems useful only for high parasitemia. Negative SD Bioline Malaria Ag Pf/Pan™ RDT should be complemented with microscopy when clinical signs suggest malaria.
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Affiliation(s)
- Théophile Mitima Kashosi
- Laboratory of Biomedical Research and Public Health, Faculty of Medicine & Community Health, Université Evangélique en Afrique (UEA), Bukavu, DR Congo.,Department of Laboratory Technologies, Institut Supérieur des Techniques Médicales (ISTM), Bukavu, DR Congo
| | | | - Devotte Sifa Byadunia
- Department of Laboratory Technologies, Institut Supérieur des Techniques Médicales (ISTM), Bukavu, DR Congo
| | | | - Basimike Mulenda
- WHO, Malaria Capacity Development/Strategic Planning & Prevention, Regional Office for Africa, Libreville, Gabon
| | - Kanigula Mubagwa
- International Center for Advanced Research and Training (ICART), Bukavu, DR Congo, and Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium.,Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium
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13
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Gibson DG, Pereira A, Farrenkopf BA, Labrique AB, Pariyo GW, Hyder AA. Mobile Phone Surveys for Collecting Population-Level Estimates in Low- and Middle-Income Countries: A Literature Review. J Med Internet Res 2017; 19:e139. [PMID: 28476725 PMCID: PMC5438460 DOI: 10.2196/jmir.7428] [Citation(s) in RCA: 63] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Revised: 03/11/2017] [Accepted: 03/11/2017] [Indexed: 11/29/2022] Open
Abstract
Background National and subnational level surveys are important for monitoring disease burden, prioritizing resource allocation, and evaluating public health policies. As mobile phone access and ownership become more common globally, mobile phone surveys (MPSs) offer an opportunity to supplement traditional public health household surveys. Objective The objective of this study was to systematically review the current landscape of MPSs to collect population-level estimates in low- and middle-income countries (LMICs). Methods Primary and gray literature from 7 online databases were systematically searched for studies that deployed MPSs to collect population-level estimates. Titles and abstracts were screened on primary inclusion and exclusion criteria by two research assistants. Articles that met primary screening requirements were read in full and screened for secondary eligibility criteria. Articles included in review were grouped into the following three categories by their survey modality: (1) interactive voice response (IVR), (2) short message service (SMS), and (3) human operator or computer-assisted telephone interviews (CATI). Data were abstracted by two research assistants. The conduct and reporting of the review conformed to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Results A total of 6625 articles were identified through the literature review. Overall, 11 articles were identified that contained 19 MPS (CATI, IVR, or SMS) surveys to collect population-level estimates across a range of topics. MPSs were used in Latin America (n=8), the Middle East (n=1), South Asia (n=2), and sub-Saharan Africa (n=8). Nine articles presented results for 10 CATI surveys (10/19, 53%). Two articles discussed the findings of 6 IVR surveys (6/19, 32%). Three SMS surveys were identified from 2 articles (3/19, 16%). Approximately 63% (12/19) of MPS were delivered to mobile phone numbers collected from previously administered household surveys. The majority of MPS (11/19, 58%) were panel surveys where a cohort of participants, who often were provided a mobile phone upon a face-to-face enrollment, were surveyed multiple times. Conclusions Very few reports of population-level MPS were identified. Of the MPS that were identified, the majority of surveys were conducted using CATI. Due to the limited number of identified IVR and SMS surveys, the relative advantages and disadvantages among the three survey modalities cannot be adequately assessed. The majority of MPS were sent to mobile phone numbers that were collected from a previously administered household survey. There is limited evidence on whether a random digit dialing (RDD) approach or a simple random sample of mobile network provided list of numbers can produce a population representative survey.
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Affiliation(s)
- Dustin G Gibson
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Amanda Pereira
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Brooke A Farrenkopf
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Alain B Labrique
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - George W Pariyo
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Adnan A Hyder
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States.,Berman Institute of Bioethics, Johns Hopkins University, Baltimore, MD, United States
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14
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Houzé S. [Rapid diagnostic test for malaria]. BULLETIN DE LA SOCIETE DE PATHOLOGIE EXOTIQUE (1990) 2017; 110:49-54. [PMID: 28176239 DOI: 10.1007/s13149-017-0549-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/16/2016] [Accepted: 01/14/2017] [Indexed: 01/24/2023]
Abstract
The rapid diagnostic tests (RDTs) whose main interest lies in their implementation without special equipment by unskilled personnel have grown significantly over the past fifteen years to diagnose malaria. They rely on the detection of specific Plasmodium proteins, PfHRP2, pLDH and aldolase. If the detection of PfHRP2 has very good sensitivity for the diagnosis of Plasmodium falciparum malaria, the detection of pLDH or aldolase is less efficient for other species, leaving its place to the reference microscopic diagnosis. RDT could not generally be used to monitor therapeutic efficacy because they can remain positive after clinical and parasitological cure. Furthermore, the development of the use of these tests has highlighted the need for quality assurance programs to monitor their production as their use.
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Affiliation(s)
- S Houzé
- Laboratoire de parasitologie-mycologie, CNR du paludisme, AP-HP, CHU Bichat-C Bernard, 46 rue Henri Huchard, 75018, Paris, France.
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15
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Ezennia IJ, Nduka SO, Ekwunife OI. Cost benefit analysis of malaria rapid diagnostic test: the perspective of Nigerian community pharmacists. Malar J 2017; 16:7. [PMID: 28049466 PMCID: PMC5210296 DOI: 10.1186/s12936-016-1648-0] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2016] [Accepted: 12/15/2016] [Indexed: 11/23/2022] Open
Abstract
Background
In 2010, the World Health Organization issued a guideline that calls for a shift from presumptive to test-based treatment. However, test-based treatment is still unpopular in community pharmacies. This could be due to unwillingness of customers to spend extra finance on rapid diagnostic test (RDT). It could also result from lack of interest from community pharmacists since they may perceive no financial gain attached to this service. This study assessed the cost-benefit of test-based malaria treatment to community pharmacists.
Methods The study was a community pharmacy-based cross sectional survey. Potential benefit of RDT was determined using customers’ willingness-to-pay (WTP) for service. Average WTP was estimated using contingent valuation. Binary logistic regression was used to assess correlates of WTP acceptance while multiple linear regression was used to model the relationship between the independent variables and WTP amount. Cost associated with provision of RDT was estimated from provider’s perspective. Probabilistic sensitivity analysis was used to capture parameter uncertainty. Benefit-cost ratio (BCR) was calculated to determine study objective. Results A total of 135 out of 235 participants (57.4%) responded to the WTP question. Of this subset, 111 participants (82.2%) preferred RDT before malaria treatment. Average WTP [minimum–maximum] was US$1.23 [US$0.0–US$5.03]. Educated participants had 1.8 times higher odds of WTP for RDT. Participants that understood RDT as described in the questionnaire had 18.3 times higher odds of WTP for RDT compared to participants that did not understand RDT as described in the questionnaire. Additionally, a unit increase in level of education (e.g. from primary to secondary school) led to US$0.298 increase in WTP amount for RDT. Also, a unit increase in malaria frequency (e.g. from ‘never’ to ‘rarely’) led to US$0.293 decrease in WTP amount for RDT. Average cost [minimum–maximum] of RDT test kit and pharmacist time spent in administering the test were US$0.15 [US$0.13–US$0.17] and US$0.41 [US$0.18–US$0.52], respectively. BCR of test-based malaria treatment was 6.7 (95% CI 6.4–7.0). Conclusion Test-based malaria treatment is cost-beneficial for pharmacy practitioners. This finding could be used as an advocacy tool to increase community pharmacists’ interest and uptake of test-based malaria treatment. Electronic supplementary material The online version of this article (doi:10.1186/s12936-016-1648-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
| | - Sunday Odunke Nduka
- Department of Clinical Pharmacy and Pharmacy Management, Nnamdi Azikiwe University, Awka, Nigeria
| | - Obinna Ikechukwu Ekwunife
- Department of Clinical Pharmacy and Pharmacy Management, Nnamdi Azikiwe University, Awka, Nigeria. .,Collaborative Research Group for Evidence-Based Public Health, Department of Prevention and Evaluation, Leibniz Institute for Prevention Research and Epidemiology - BIPS / University of Bremen, Bremen, Germany.
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16
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Bell D, Bwanika JB, Cunningham J, Gatton M, González IJ, Hopkins H, Kibira SPS, Kyabayinze DJ, Mayxay M, Ndawula B, Newton PN, Phommasone K, Streat E, Umlauf R, Malaria Rdt Positive Control Well Field Study Group. Prototype Positive Control Wells for Malaria Rapid Diagnostic Tests: Prospective Evaluation of Implementation Among Health Workers in Lao People's Democratic Republic and Uganda. Am J Trop Med Hyg 2016; 96:319-329. [PMID: 27895267 PMCID: PMC5303030 DOI: 10.4269/ajtmh.16-0498] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2016] [Accepted: 09/11/2016] [Indexed: 01/22/2023] Open
Abstract
Rapid diagnostic tests (RDTs) are widely used for malaria diagnosis, but lack of quality control at point of care restricts trust in test results. Prototype positive control wells (PCW) containing recombinant malaria antigens have been developed to identify poor-quality RDT lots. This study assessed community and facility health workers' (HW) ability to use PCWs to detect degraded RDTs, the impact of PCW availability on RDT use and prescribing, and preferred strategies for implementation in Lao People's Democratic Republic (Laos) and Uganda. A total of 557 HWs participated in Laos (267) and Uganda (290). After training, most (88% to ≥ 99%) participants correctly performed the six key individual PCW steps; performance was generally maintained during the 6-month study period. Nearly all (97%) reported a correct action based on PCW use at routine work sites. In Uganda, where data for 127,775 individual patients were available, PCW introduction in health facilities was followed by a decrease in antimalarial prescribing for RDT-negative patients ≥ 5 years of age (4.7-1.9%); among community-based HWs, the decrease was 12.2% (P < 0.05) for all patients. Qualitative data revealed PCWs as a way to confirm RDT quality and restore confidence in RDT results. HWs in malaria-endemic areas are able to use prototype PCWs for quality control of malaria RDTs. PCW availability can improve HWs' confidence in RDT results, and benefit malaria diagnostic programs. Lessons learned from this study may be valuable for introduction of other point-of-care diagnostic and quality-control tools. Future work should evaluate longer term impacts of PCWs on patient management.
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Affiliation(s)
- David Bell
- The Global Good Fund/Intellectual Ventures Lab, Bellevue, Washington
| | | | - Jane Cunningham
- World Health Organization Global Malaria Programme, Geneva, Switzerland
| | - Michelle Gatton
- Queensland University of Technology (QUT), Brisbane, Australia
| | - Iveth J González
- Foundation for Innovative New Diagnostics (FIND), Geneva, Switzerland
| | - Heidi Hopkins
- Foundation for Innovative New Diagnostics (FIND), Kampala, Uganda.,Foundation for Innovative New Diagnostics (FIND), Geneva, Switzerland
| | | | | | - Mayfong Mayxay
- Centre for Tropical Medicine and Global Health, Churchill Hospital, University of Oxford, Oxford, United Kingdom.,Faculty of Postgraduate Studies, University of Health Sciences, Vientiane, Lao People's Democratic Republic.,Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit (LOMWRU), Microbiology Laboratory, Mahosot Hospital, Vientiane, Lao People's Democratic Republic
| | - Bbaale Ndawula
- Foundation for Innovative New Diagnostics (FIND), Kampala, Uganda
| | - Paul N Newton
- Centre for Tropical Medicine and Global Health, Churchill Hospital, University of Oxford, Oxford, United Kingdom.,Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit (LOMWRU), Microbiology Laboratory, Mahosot Hospital, Vientiane, Lao People's Democratic Republic
| | - Koukeo Phommasone
- Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit (LOMWRU), Microbiology Laboratory, Mahosot Hospital, Vientiane, Lao People's Democratic Republic
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Abstract
Rapid diagnostic tests have the potential to reduce the overtreatment of malaria by 95%, but time and extensive logistical, behavioural, and technical interventions may be required to achieve this, argue Eleanor Ochodo and colleagues
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Affiliation(s)
- Eleanor Ochodo
- Centre for Evidence-Based Health Care, Faculty of Medicine and Health Sciences, Stellenbosch University, PO Box 241, Cape Town 8000, South Africa
| | - Paul Garner
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | - David Sinclair
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
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18
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Performance of Microscopy for the Diagnosis of Malaria and Human African Trypanosomiasis by Diagnostic Laboratories in the Democratic Republic of the Congo: Results of a Nation-Wide External Quality Assessment. PLoS One 2016; 11:e0146450. [PMID: 26788725 PMCID: PMC4720473 DOI: 10.1371/journal.pone.0146450] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2015] [Accepted: 12/17/2015] [Indexed: 11/19/2022] Open
Abstract
The present External Quality Assessment (EQA) assessed microscopy of blood parasites among diagnostic laboratories in the Democratic Republic of the Congo. The EQA addressed 445 participants in 10/11 provinces (October 2013-April 2014). Participants were sent a panel of five slides and asked to return a routinely stained slide which was assessed for quality of preparation and staining. Response rate was 89.9% (400/445). For slide 1 (no parasites), 30.6% participants reported malaria, mostly Plasmodium falciparum. Only 11.0% participants reported slide 2 (Plasmodium malariae) correctly, 71.0% reported "malaria" or "Plasmodium falciparum" (considered acceptable). Slide 3 contained Plasmodium falciparum (109/μl) and Trypanosoma brucei brucei trypomastigotes: they were each reported by 32.5% and 16.5% participants respectively, 6.0% reported both. Slide 4 (Trypanosoma) was recognised by 44.9% participants. Slide 5 (Plasmodium ovale) was correctly reported by 6.2% participants, another 68.8% replied "malaria" or "Plasmodium falciparum" (considered acceptable). Only 13.6% of routine slides returned were correctly prepared and stained. The proportion of correct/acceptable scores for at least 4/5 slides was higher among EQA-experienced participants compared to first time participants (40.9% versus 22.4%, p = 0.001) and higher among those being trained < 2 years ago compared to those who were not (42.9% versus 26.3%, p = 0.01). Among diagnostic laboratories in Democratic Republic of the Congo, performance of blood parasite microscopy including non-falciparum species and Trypanosoma was poor. Recent training and previous EQA participation were associated with a better performance.
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19
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Gatton ML, Rees-Channer RR, Glenn J, Barnwell JW, Cheng Q, Chiodini PL, Incardona S, González IJ, Cunningham J. Pan-Plasmodium band sensitivity for Plasmodium falciparum detection in combination malaria rapid diagnostic tests and implications for clinical management. Malar J 2015; 14:115. [PMID: 25889624 PMCID: PMC4371878 DOI: 10.1186/s12936-015-0629-z] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2014] [Accepted: 03/01/2015] [Indexed: 11/15/2022] Open
Abstract
Background Malaria rapid diagnostic tests (RDTs) are appropriate for case management, but persistent antigenaemia is a concern for HRP2-detecting RDTs in endemic areas. It has been suggested that pan-pLDH test bands on combination RDTs could be used to distinguish persistent antigenaemia from active Plasmodium falciparum infection, however this assumes all active infections produce positive results on both bands of RDTs, an assertion that has not been demonstrated. Methods In this study, data generated during the WHO-FIND product testing programme for malaria RDTs was reviewed to investigate the reactivity of individual test bands against P. falciparum in 18 combination RDTs. Each product was tested against multiple wild-type P. falciparum only samples. Antigen levels were measured by quantitative ELISA for HRP2, pLDH and aldolase. Results When tested against P. falciparum samples at 200 parasites/μL, 92% of RDTs were positive; 57% of these on both the P. falciparum and pan bands, while 43% were positive on the P. falciparum band only. There was a relationship between antigen concentration and band positivity; ≥4 ng/mL of HRP2 produced positive results in more than 95% of P. falciparum bands, while ≥45 ng/mL of pLDH was required for at least 90% of pan bands to be positive. Conclusions In active P. falciparum infections it is common for combination RDTs to return a positive HRP2 band combined with a negative pan-pLDH band, and when both bands are positive, often the pan band is faint. Thus active infections could be missed if the presence of a HRP2 band in the absence of a pan band is interpreted as being caused solely by persistent antigenaemia.
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Affiliation(s)
- Michelle L Gatton
- School of Public Health and Social Work, Queensland University of Technology, GPO Box 2434, Brisbane, Qld 4001, Australia.
| | - Roxanne R Rees-Channer
- National Institute for Health Research University College London Hospitals Biomedical Research Centre, Hospital for Tropical Diseases, London, UK.
| | - Jeffrey Glenn
- Malaria Branch, Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Center for Global Health, Atlanta, USA.
| | - John W Barnwell
- Malaria Branch, Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Center for Global Health, Atlanta, USA.
| | - Qin Cheng
- Drug Resistance and Diagnostics, Australian Army Malaria Institute, Brisbane, Australia.
| | - Peter L Chiodini
- National Institute for Health Research University College London Hospitals Biomedical Research Centre, Hospital for Tropical Diseases, London, UK. .,London School of Hygiene and Tropical Medicine, London, UK.
| | - Sandra Incardona
- FIND (Foundation for Innovative New Diagnostics), Geneva, Switzerland.
| | - Iveth J González
- FIND (Foundation for Innovative New Diagnostics), Geneva, Switzerland.
| | - Jane Cunningham
- Global Malaria Programme, World Health Organization, Geneva, Switzerland.
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20
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Mukadi P, Gillet P, Barbé B, Luamba J, Lukuka A, Likwela J, Mumba D, Muyembe JJ, Lutumba P, Jacobs J. SMS photograph-based external quality assessment of reading and interpretation of malaria rapid diagnostic tests in the Democratic Republic of the Congo. Malar J 2015; 14:26. [PMID: 25626915 PMCID: PMC4318196 DOI: 10.1186/s12936-014-0535-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2014] [Accepted: 12/27/2014] [Indexed: 11/10/2022] Open
Abstract
Background The present External Quality Assessment (EQA) assessed reading and interpretation of malaria rapid diagnostic tests (RDTs) in the Democratic Republic of the Congo (DRC). Methods The EQA consisted of (i) 10 high-resolution printed photographs displaying cassettes with real-life results and multiple choice questions (MCQ) addressing individual health workers (HW), and (ii) a questionnaire on RDT use addressing the laboratory of health facilities (HF). Answers were transmitted through short message services (SMS). Results The EQA comprised 2344 HW and 1028 HF covering 10/11 provinces in DRC. Overall, median HW score (sum of correct answers on 10 MCQ photographs for each HW) was 9.0 (interquartile range 7.5 – 10); MCQ scores (the % of correct answers for a particular photograph) ranged from 54.8% to 91.6%. Most common errors were (i) reading or interpreting faint or weak line intensities as negative (3.3%, 7.2%, 24.3% and 29.1% for 4 MCQ photographs), (ii) failure to distinguish the correct Plasmodium species (3.4% to 7.0%), (iii) missing invalid test results (8.4% and 23.6%) and (iv) missing negative test results (10.0% and 12.4%). HW who were trained less than 12 months ago had best MCQ scores for 7/10 photographs as well as a significantly higher proportion of 10/10 scores, but absolute differences in MCQ scores were small. HW who had participated in a previous EQA performed significantly better for 4/10 photographs compared to those who had not. Except for two photographs, MCQ scores were comparable for all levels of the HF hierarchy and non-laboratory staff (HW from health posts) had similar performance as to laboratory staff. Main findings of the questionnaire were (i) use of other RDT products than recommended by the national malaria control programme (nearly 20% of participating HF), (ii) lack of training for a third (33.6%) of HF, (iii) high proportions (two-thirds, 66.5%) of HF reporting stock-outs. Conclusions The present EQA revealed common errors in RDT reading and interpretation by HW in DRC. Performances of non-laboratory and laboratory staff were similar and dedicated training was shown to improve HW competence although to a moderate extent. Problems in supply, distribution and training of RDTs were detected.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Jan Jacobs
- Institute of Tropical Medicine, Department of Clinical Sciences, Antwerp, Belgium.
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Brinkel J, Krämer A, Krumkamp R, May J, Fobil J. Mobile phone-based mHealth approaches for public health surveillance in sub-Saharan Africa: a systematic review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2014; 11:11559-82. [PMID: 25396767 PMCID: PMC4245630 DOI: 10.3390/ijerph111111559] [Citation(s) in RCA: 75] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/08/2014] [Revised: 10/24/2014] [Accepted: 10/28/2014] [Indexed: 11/17/2022]
Abstract
Whereas mobile phone-based surveillance has the potential to provide real-time validated data for disease clustering and prompt respond and investigation, little evidence is available on current practice in sub-Sahara Africa. The objective of this review was to examine mobile phone-based mHealth interventions for Public Health surveillance in the region. We conducted electronic search in MEDLINE, EMBASE, IEE Xplore, African Index Medicus (AIM), BioMed Central, PubMed Central (PMC), the Public Library of Science (PLoS) and IRIS for publications used in the review. In all, a total of nine studies were included which focused on infectious disease surveillance of malaria (n = 3), tuberculosis (n = 1) and influenza-like illnesses (n = 1) as well as on non-infectious disease surveillance of child malnutrition (n = 2), maternal health (n = 1) and routine surveillance of various diseases and symptoms (n = 1). Our review revealed that mobile phone-based surveillance projects in the sub-Saharan African countries are on small scale, fragmented and not well documented. We conclude by advocating for a strong drive for more research in the applied field as well as a better reporting of lessons learned in order to create an epistemic community to help build a more evidence-based field of practice in mHealth surveillance in the region.
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Affiliation(s)
- Johanna Brinkel
- Department of Public Health Medicine, School of Public Health, University of Bielefeld, P.O. Box 100131, D-33501 Bielefeld, Germany.
| | - Alexander Krämer
- Department of Public Health Medicine, School of Public Health, University of Bielefeld, P.O. Box 100131, D-33501 Bielefeld, Germany.
| | - Ralf Krumkamp
- Infectious Disease Epidemiology Unit, Bernhard Nocht Institute for Tropical Medicine, Bernhard Nocht-Str. 74, D-20359 Hamburg, Germany.
| | - Jürgen May
- Infectious Disease Epidemiology Unit, Bernhard Nocht Institute for Tropical Medicine, Bernhard Nocht-Str. 74, D-20359 Hamburg, Germany.
| | - Julius Fobil
- Department of Biological, Environmental, Occupational Health Sciences, School of Public Health, University of Ghana, P.O. Box LG13, Legon, Ghana.
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Tesfaye M, Hanlon C, Tessema F, Prince M, Alem A. Common mental disorder symptoms among patients with malaria attending primary care in Ethiopia: a cross-sectional survey. PLoS One 2014; 9:e108923. [PMID: 25268347 PMCID: PMC4182507 DOI: 10.1371/journal.pone.0108923] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2013] [Accepted: 09/05/2014] [Indexed: 01/02/2023] Open
Abstract
Background Common Mental Disorders (CMDs) are frequent among patients attending primary care. In Africa, CMDs are often misdiagnosed as physical illnesses because many of the patients complain of somatic symptoms of mental distress. We explored whether there was difference in the levels of CMD symptoms between patients with thick film confirmed and clinical cases of malaria with negative thick film in primary care. Methods A cross-sectional comparative study was conducted on 300 adults with a clinical diagnosis of malaria in primary care centres in Jimma, Ethiopia. Patients were recruited consecutively until 100 cases of ‘malaria’ with a negative thick film and 200 cases of malaria with a positive thick film consented to participate. The 20-item Self-Reporting Questionnaire (SRQ-20) was used to measure CMD. The non-parametric Wilcoxon rank-sum test was used to explore the association between thick film result and CMD. Results Participants had a mean age of 28.2 (S.D = 10.9) years and the majority (57.3%) were women. The prevalence of high CMD symptoms (six or more symptoms on the SRQ-20) was 24.5%. Suicidal ideation was reported by 13.8% of the participants. CMD symptoms were significantly higher in patients who had taken medication prior to visiting the primary care (p = 0.012) and in those whose symptoms had been present for seven days or more (p = 0.041). There was no statistically significant association between level of CMD symptoms and having a negative thick film result (OR 0.98; 95%CI 0.92, 1.04) or objective presence of fever (OR 1.04; 95%CI 0.93, 1.15). Conclusions CMD symptoms among cases of malaria did not appear to be associated with a negative thick film result. The high levels of CMD symptoms, including suicidal ideation, calls for further studies to investigate the persistence and progression of these symptoms following resolution of the acute malarial episode.
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Affiliation(s)
- Markos Tesfaye
- Department of Psychiatry, College of Public Health & Medical Sciences, Jimma University, Jimma, Ethiopia
- * E-mail:
| | - Charlotte Hanlon
- Department of Psychiatry, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
- Centre for Global Mental Health, Health Services and Population Research Department, Institute of Psychiatry, King’s College London, London, United Kingdom
| | - Fasil Tessema
- Department of Epidemiology and Biostatistics, College of Public Health & Medical Sciences, Jimma University, Jimma, Ethiopia
| | - Martin Prince
- Centre for Global Mental Health, Health Services and Population Research Department, Institute of Psychiatry, King’s College London, London, United Kingdom
| | - Atalay Alem
- Department of Psychiatry, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
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