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Gils T, Kamele M, Madonsela T, Bosman S, Ngubane T, Joseph P, Reither K, Bresser M, Vlieghe E, Decroo T, Ayakaka I, Lynen L, Van Heerden A. Implementation of the advanced HIV disease care package with point-of-care CD4 testing during tuberculosis case finding: A mixed-methods evaluation. PLoS One 2023; 18:e0296197. [PMID: 38134020 PMCID: PMC10745215 DOI: 10.1371/journal.pone.0296197] [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] [Received: 09/25/2023] [Accepted: 11/12/2023] [Indexed: 12/24/2023] Open
Abstract
During TB-case finding, we assessed the feasibility of implementing the advanced HIV disease (AHD) care package, including VISITECT CD4 Advanced Disease (VISITECT), a semiquantitative test to identify a CD4≤200cells/μl. Adult participants with tuberculosis symptoms, recruited near-facility in Lesotho and South-Africa between 2021-2022, were offered HIV testing (capillary blood), Xpert MTB/RIF and Ultra, and MGIT culture (sputum). People living with HIV (PLHIV) were offered VISITECT (venous blood) and Alere tuberculosis-lipoarabinomannan (AlereLAM, urine) testing. AHD was defined as a CD4≤200cells/μl on VISITECT or a positive tuberculosis test. A CD4≤200cells/μl on VISITECT triggered Immy cryptococcal antigen (Immy CrAg, plasma) testing. Participants were referred with test results. To evaluate feasibility, we assessed i) acceptability and ii) intervention delivery of point-of-care diagnostics among study staff using questionnaires and group discussions, iii) process compliance, and iv) early effectiveness (12-week survival and treatment status) in PLHIV. Predictors for 12-week survival were assessed with logistic regression. Thematic content analysis and triangulation were performed. Among PLHIV (N = 676, 48.6% of 1392 participants), 7.8% were newly diagnosed, 81.8% on ART, and 10.4% knew their HIV status but were not on ART. Among 676 PLHIV, 41.7% had AHD, 29.9% a CD4≤200cells/μl and 20.6% a tuberculosis diagnosis. Among 200 PLHIV tested with Immy CrAg, 4.0% were positive. The procedures were acceptable for study staff, despite intervention delivery challenges related to supply and the long procedural duration (median: 73 minutes). At 12 weeks, among 276 PLHIV with AHD and 328 without, 3.3% and 0.9% had died, 84.8% and 92.1% were alive and 12.0% and 7.0% had an unknown status, respectively. Neither AHD nor tuberculosis status were associated with survival. Implementing AHD care package diagnostics was feasible during tuberculosis-case finding. AHD was prevalent, and not associated with survival, which is likely explained by the low specificity of VISITECT. Challenges with CD4 testing and preventive treatment uptake require addressing.
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Affiliation(s)
- Tinne Gils
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
- Global Health Institute, University of Antwerp, Wilrijk, Belgium
| | | | - Thandanani Madonsela
- Centre for Community Based Research, Human Sciences Research Council, Pietermaritzburg, South Africa
| | - Shannon Bosman
- Centre for Community Based Research, Human Sciences Research Council, Pietermaritzburg, South Africa
| | - Thulani Ngubane
- Centre for Community Based Research, Human Sciences Research Council, Pietermaritzburg, South Africa
| | - Philip Joseph
- Centre for Community Based Research, Human Sciences Research Council, Pietermaritzburg, South Africa
| | - Klaus Reither
- Clinical Research Unit, Swiss Tropical and Public Health Institute, Allschwil, Switzerland
- Medical Outpatient Department, University of Basel, Basel, Switzerland
| | - Moniek Bresser
- Clinical Research Unit, Swiss Tropical and Public Health Institute, Allschwil, Switzerland
- Medical Outpatient Department, University of Basel, Basel, Switzerland
| | - Erika Vlieghe
- Global Health Institute, University of Antwerp, Wilrijk, Belgium
| | - Tom Decroo
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Irene Ayakaka
- SolidarMed, Partnerships for Health, Butha-Buthe, Lesotho
| | - Lutgarde Lynen
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Alastair Van Heerden
- Centre for Community Based Research, Human Sciences Research Council, Pietermaritzburg, South Africa
- MRC/Wits Developmental Pathways for Health Research Unit, University of the Witwatersrand, Johannesburg, South Africa
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Meya DB, Meintjes G. HIV-related CNS infections: translating DREAMM into reality. Lancet HIV 2023; 10:e627-e628. [PMID: 37802564 DOI: 10.1016/s2352-3018(23)00232-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Accepted: 08/29/2023] [Indexed: 10/10/2023]
Affiliation(s)
- David B Meya
- Infectious Diseases Institute, College of Health Sciences, Makerere University, Kampala PO Box 22418, Uganda; Department of Medicine and International Health, University of Minnesota, Minneapolis, MN, USA.
| | - Graeme Meintjes
- Wellcome Trust Centre for Infectious Diseases Research in Africa, Institute of Infectious Disease and Molecular Medicine, University of Cape Town, South Africa; Department of Medicine, Faculty of Health Sciences, University of Cape Town, South Africa
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Lehman A, Ellis J, Nalintya E, Bahr NC, Loyse A, Rajasingham R. Advanced HIV disease: A review of diagnostic and prophylactic strategies. HIV Med 2023; 24:859-876. [PMID: 37041113 PMCID: PMC10642371 DOI: 10.1111/hiv.13487] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Accepted: 03/13/2023] [Indexed: 04/13/2023]
Abstract
BACKGROUND Despite expanded access to antiretroviral therapy (ART) and the rollout of the World Health Organization's (WHO) 'test-and-treat' strategy, the proportion of people with HIV (PWH) presenting with advanced HIV disease (AHD) remains unchanged at approximately 30%. Fifty percent of persons with AHD report prior engagement to care. ART failure and insufficient retention in HIV care are major causes of AHD. People living with AHD are at high risk for opportunistic infections and death. In 2017, the WHO published guidelines for the management of AHD that included a comprehensive package of care for screening and prophylaxis of major opportunistic infections (OIs). In the interim, ART regimens have evolved: integrase inhibitors are first-line therapy globally, and the diagnostic landscape is evolving. The objective of this review is to highlight novel point-of-care (POC) diagnostics and treatment strategies that can facilitate OI screening and prophylaxis for persons with AHD. METHODS We reviewed the WHO guidelines for recommendations for persons with AHD. We summarized the scientific literature on current and emerging diagnostics, along with emerging treatment strategies for persons with AHD. We also highlight the key research and implementation gaps together with potential solutions. RESULTS While POC CD4 testing is being rolled out in order to identify persons with AHD, this alone is insufficient; implementation of the Visitect CD4 platform has been challenging given operational and test interpretation issues. Numerous non-sputum POC TB diagnostics are being evaluated, many with limited sensitivity. Though imperfect, these tests are designed to provide rapid results (within hours) and are relatively affordable for resource-poor settings. While novel POC diagnostics are being developed for cryptococcal infection, histoplasmosis and talaromycosis, implementation science studies are urgently needed to understand the clinical benefit of these tests in the routine care. CONCLUSIONS Despite progress with HIV treatment and prevention, a persistent 20%-30% of PWH present to care with AHD. Unfortunately, these persons with AHD continue to carry the burden of HIV-related morbidity and mortality. Investment in the development of additional POC or near-bedside CD4 platforms is urgently needed. Implementation of POC diagnostics theoretically could improve HIV retention in care and thereby reduce mortality by overcoming delays in laboratory testing and providing patients and healthcare workers with timely same-day results. However, in real-world scenarios, people with AHD have multiple comorbidities and imperfect follow-up. Pragmatic clinical trials are needed to understand whether these POC diagnostics can facilitate timely diagnosis and treatment, thereby improving clinical outcomes such as HIV retention in care.
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Affiliation(s)
- Alice Lehman
- Division of Infectious Diseases and International Medicine, University of Minnesota, Minneapolis, Minnesota, USA
| | - Jayne Ellis
- London School of Hygiene and Tropical Medicine, London, UK
| | | | - Nathan C. Bahr
- Division of Infectious Diseases, University of Kansas, Kansas City, Kansas, USA
| | - Angela Loyse
- Division of Infection and Immunity Research Institute, St George’s University of London, London, UK
| | - Radha Rajasingham
- Division of Infectious Diseases and International Medicine, University of Minnesota, Minneapolis, Minnesota, USA
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Riegler AN, Larsen N, Amerson-Brown MH. Point-of-Care Testing for Sexually Transmitted Infections. Clin Lab Med 2023; 43:189-207. [PMID: 37169442 DOI: 10.1016/j.cll.2023.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
Point-of-care testing for sexually transmitted infections is essential for controlling transmission and preventing sequelae in high-risk populations. Since the World Health Organization published the ASSURED criteria, point-of-care testing has improved for use in large population screening and rapid testing that prevents loss of clinical follow-up. Recent advancements have been advantageous for low-resource areas allowing testing at a minimal cost without reliable electricity or refrigeration. Point-of-care nucleic acid detection and amplification techniques are recommended, but are often inaccessible in low-resource areas. Future advancements in point-of-care diagnostic testing should focus on improving antibody-based assays, monitoring viral loads, and detecting antimicrobial resistance.
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Affiliation(s)
- Ashleigh N Riegler
- Department of Pathology, The University of Alabama at Birmingham, Marnix E. Heersink School of Medicine, 619 East 19th Street South, WP240J, Birmingham, AL 35249-7331, USA
| | - Natalie Larsen
- Department of Pathology, The University of Alabama at Birmingham, Marnix E. Heersink School of Medicine, 619 East 19th Street South, WP240J, Birmingham, AL 35249-7331, USA
| | - Megan H Amerson-Brown
- Department of Pathology, The University of Alabama at Birmingham, Marnix E. Heersink School of Medicine, 619 East 19th Street South, WP240J, Birmingham, AL 35249-7331, USA.
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Izco S, Garcia-Basteiro AL, Denning DW, Boulware DR, Penn-Nicholson A, Letang E. Management of advanced HIV disease in Africa. Lancet HIV 2023:S2352-3018(23)00078-4. [PMID: 37105215 DOI: 10.1016/s2352-3018(23)00078-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Revised: 03/25/2023] [Accepted: 03/29/2023] [Indexed: 04/29/2023]
Affiliation(s)
- Santiago Izco
- National Program of STD/HIV/AIDS, Tuberculosis and Viral Hepatitis, Ministry of Health and Social Welfare, Malabo 399, Equatorial Guinea.
| | - Alberto L Garcia-Basteiro
- Centro de Investigação em Saúde de Manhiça, Maputo, Mozambique; Barcelona Institute for Global Health, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain; Biomédica en Red de Enfermedades Infecciosas, Barcelona, Spain
| | | | - David R Boulware
- Department of Medicine, University of Minnesota Microbiology Research Facility, Minneapolis, MN, USA
| | | | - Emilio Letang
- Universitat de Barcelona, Faculty of Medicine, Barcelona, Spain
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Lechiile K, Leeme TB, Tenforde MW, Bapabi M, Magwenzi J, Maithamako O, Mulenga F, Mohammed T, Ngidi J, Mokomane M, Lawrence DS, Mine M, Jarvis JN. Laboratory Evaluation of the VISITECT Advanced Disease Semiquantitative Point-of-Care CD4 Test. J Acquir Immune Defic Syndr 2022; 91:502-507. [PMID: 36084198 PMCID: PMC9646408 DOI: 10.1097/qai.0000000000003092] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Accepted: 07/15/2022] [Indexed: 02/04/2023]
Abstract
BACKGROUND Advanced HIV disease (AHD; CD4 counts <200 cells/µL) remains common in many low- and middle-income settings. An instrument-free point-of-care test to rapidly identify patients with AHD would facilitate implementation of the World Health Organization (WHO) recommended package of care. We performed a laboratory-based validation study to evaluate the performance of the VISITECT CD4 Advanced Disease assay in Botswana. SETTING A laboratory validation study. METHODS Venous blood samples from people living with HIV having baseline CD4 testing in Gaborone, Botswana, underwent routine testing using flow cytometry, followed by testing with the VISITECT CD4 Advanced Disease assay by a laboratory scientist blinded to the flow cytometry result with a visual read to determine whether the CD4 count was below 200 cells/µL. A second independent investigator conducted a visual read blinded to the results of flow cytometry and the initial visual read. The sensitivity and specificity of the VISITECT for detection of AHD were determined using flow cytometry as a reference standard, and interrater agreement in VISITECT visual reads assessed. RESULTS One thousand fifty-three samples were included in the analysis. The VISITECT test correctly identified 112/119 samples as having a CD4 count <200 cells/µL, giving a sensitivity of 94.1% (95% confidence interval: 88.3% to 97.6%) and specificity of 85.9% (95% confidence interval: 83.5% to 88.0%) compared with flow cytometry. Interrater agreement between the 2 independent readers was 97.5%, Kappa 0.92 ( P < 0.001). CONCLUSIONS The VISITECT CD4 advanced disease reliably identified individuals with low CD4 counts and could facilitate implementation of the WHO recommended package of interventions for AHD.
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Affiliation(s)
- Kwana Lechiile
- Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana
| | - Tshepo B. Leeme
- Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana
| | | | - Mbabi Bapabi
- Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana
| | - Julita Magwenzi
- Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana
| | | | - Fredah Mulenga
- Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana
| | | | - Julia Ngidi
- Botswana National Health Laboratory, Gaborone, Botswana
| | | | - David S. Lawrence
- Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana
- Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Madisa Mine
- Botswana National Health Laboratory, Gaborone, Botswana
| | - Joseph N. Jarvis
- Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana
- Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
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Falconer J, Diaconu K, O’May F, Gummaraju A, Victor-Uadiale I, Matragrano J, Njanpop-Lafourcade BM, Ager A. Cholera diagnosis in human stool and detection in water: A systematic review and meta-analysis. PLoS One 2022; 17:e0270860. [PMID: 35793330 PMCID: PMC9258865 DOI: 10.1371/journal.pone.0270860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Accepted: 06/19/2022] [Indexed: 11/30/2022] Open
Abstract
Background Cholera continues to pose a problem for low-resource, fragile and humanitarian contexts. Evidence suggests that 2.86 million cholera cases and 95,000 deaths due to cholera are reported annually. Without quick and effective diagnosis and treatment, case-fatality may be 50%. In line with the priorities of the Global Task Force on Cholera Control, we undertook a systematic review and meta-analysis of diagnostic test accuracy and other test characteristics of current tests for cholera detection in stool and water. Methods We searched 11 bibliographic and grey literature databases. Data was extracted on test sensitivity, specificity and other product information. Meta-analyses of sensitivity and specificity were conducted for tests reported in three or more studies. Where fewer studies reported a test, estimates were summarised through narrative synthesis. Risk of Bias was assessed using QUADAS-2. Results Searches identified 6,637 records; 41 studies reporting on 28 tests were included. Twenty-two tests had both sensitivities and specificities reported above 95% by at least one study, but there was, overall, wide variation in reported diagnostic accuracy across studies. For the three tests where meta-analyses were possible the highest sensitivity meta-estimate was found in the Cholera Screen test (98.6%, CI: 94.7%-99.7%) and the highest specificity meta-estimate in the Crystal VC on enriched samples (98.3%, CI: 92.8%-99.6%). There was a general lack of evidence regarding field use of tests, but where presented this indicated trends for lower diagnostic accuracy in field settings, with lesser-trained staff, and without the additional process of sample enrichment. Where reported, mean test turnaround times ranged from over 50% to 130% longer than manufacturer’s specification. Most studies had a low to unclear risk of bias. Conclusions Currently available Rapid Diagnostic Tests can potentially provide high diagnostic and detection capability for cholera. However, stronger evidence is required regarding the conditions required to secure these levels of accuracy in field use, particularly in low-resource settings. Registration PROSPERO (CRD42016048428).
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Affiliation(s)
- Jennifer Falconer
- Institute for Global Health and Development, Queen Margaret University, Edinburgh, Scotland
- * E-mail:
| | - Karin Diaconu
- Institute for Global Health and Development, Queen Margaret University, Edinburgh, Scotland
| | - Fiona O’May
- Institute for Global Health and Development, Queen Margaret University, Edinburgh, Scotland
| | - Advaith Gummaraju
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | | | | | | | - Alastair Ager
- Institute for Global Health and Development, Queen Margaret University, Edinburgh, Scotland
- Mailman School of Public Health, Columbia University, New York, New York, United States of America
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Murray LP, Mace CR. Paper-Based Cytometer for the Detection and Enumeration of White Blood Cells According to Their Immunophenotype. Anal Chem 2022; 94:10443-10450. [PMID: 35696545 DOI: 10.1021/acs.analchem.2c01635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Total and differential white blood cell (WBC) counts are vital metrics used routinely by clinicians to aid in the identification of diseases. However, the equipment necessary to perform WBC counts restricts their operation to centralized laboratories, greatly limiting their accessibility. Established solutions for the development of point-of-care assays, namely lateral flow tests and paper-based microfluidic devices, are inherently limited in their ability to support the detection of WBCs─the pore sizes of materials used to fabricate these devices (e.g., membranes or chromatography papers) do not permit passive WBC transport via wicking. Herein, we identify a material capable of the unimpeded transport of WBCs in both lateral and vertical directions: a coffee filter. Through in situ labeling with an enzyme-labeled affinity reagent, our paper-based cytometer detects WBCs according to their immunophenotype. Using two cultured leukocyte lines (Jurkat D1.1 T cells and MAVER-1 B cells), we demonstrate the specific, colorimetric enumeration of each target cell population across the expected physiological range for total lymphocytes, 1000-4000 cells μL-1. Additionally, we highlight a potential application of this type of device as a screening tool for detecting abnormal cell counts outside the normal physiological range and in subclasses of cell types, which could aid in the identification of certain diseases (e.g., CD4+ T lymphocytes, an important biomarker for HIV disease/AIDS). These results pave the way for a new class of paper-based devices─those capable of controlled white blood cell transport, labeling, capture, and detection─thus expanding the opportunities for low-cost, point-of-care cytometers.
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Affiliation(s)
- Lara P Murray
- Department of Chemistry, Laboratory for Living Devices, Tufts University, Medford, Massachusetts 02155, United States
| | - Charles R Mace
- Department of Chemistry, Laboratory for Living Devices, Tufts University, Medford, Massachusetts 02155, United States
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Srishyla D, Saemisch G, Turya F, Nalintya E, Jjunju S, Kagimu E, Rutakingirwa MK, Skipper CP, Boulware DR, Meya DB, Rajasingham R. Determinants of cryptococcal antigen (CrAg) screening uptake in Kampala, Uganda: An assessment of health center characteristics. Med Mycol 2022; 60:myac013. [PMID: 35353190 PMCID: PMC8973400 DOI: 10.1093/mmy/myac013] [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: 08/16/2021] [Revised: 11/22/2021] [Indexed: 11/13/2022] Open
Abstract
Cryptococcal antigen (CrAg) screening and pre-emptive antifungal therapy for people with CD4 cell counts <100 cells/μl are recommended by the World Health Organization and several national HIV guidelines. We sought to evaluate CrAg screening program implementation across Uganda, in relation to health center level and distance from the capital. We conducted a cross-sectional study of 22 health centers across southern Uganda from April to June 2019. We reviewed laboratory records regarding number of CD4 cell count tests performed, proportion of outpatients with CD4 counts <200 cells/μl, and number of CrAg screening tests performed. We administered surveys to health center staff to understand barriers to advanced HIV care. We observed no significant difference in health center level and performance of CrAg screening; with each subsequent health center level, there was 1.17-fold (95% CI: 0.92-1.41) higher odds of CrAg screening performed per level. CrAg screening uptake was not associated with distance from the capital city (odds ratio = 0.96, 95% CI: 0.89-1.04). Qualitative data from surveys indicated that limitations to uptake of CrAg screening were secondary to dysfunctional CD4 machines, lack of provider awareness of CrAg screening guidelines, and inadequate/intermittent supply of CrAg tests. There were no significant associations between CrAg screening uptake and level of health center or distance of health center from the capital city. We identified systemic barriers to CrAg screening related to inadequate CD4 testing, insufficient knowledge regarding national screening guidelines, and irregular laboratory testing supplies. LAY SUMMARY The objective of this study was to evaluate cryptococcal antigen (CrAg) screening program implementation in Uganda, by type of healthcare center and by distance from the capital city. CrAg screening uptake was not associated with distance from the capital city, or the type of healthcare center.
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Affiliation(s)
- Diksha Srishyla
- Department of Medicine, University of Minnesota, Minneapolis, 55455, MN, USA
| | - Gabriel Saemisch
- Department of Medicine, University of Minnesota, Minneapolis, 55455, MN, USA
| | - Fred Turya
- Infectious Diseases Institute, Kampala, Uganda
| | | | | | | | | | - Caleb P Skipper
- Department of Medicine, University of Minnesota, Minneapolis, 55455, MN, USA
| | - David R Boulware
- Department of Medicine, University of Minnesota, Minneapolis, 55455, MN, USA
| | | | - Radha Rajasingham
- Department of Medicine, University of Minnesota, Minneapolis, 55455, MN, USA
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Pham MD, Stoove M, Crowe S, Luchters S, Anderson D. A profile of the Visitect® CD4 and Visitect® CD4 advanced disease for management of people living with HIV. Expert Rev Mol Diagn 2022; 22:247-252. [PMID: 35226590 DOI: 10.1080/14737159.2022.2048372] [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] [Indexed: 11/04/2022]
Abstract
INTRODUCTION CD4 testing plays an important role in clinical management and epidemiological surveillance of HIV disease. Rapid, point-of-care (POC) CD4 tests can improve patients' access to CD4 testing, enabling decentralization of HIV services. AREAS COVERED We conducted a profile review of the Visitect®CD4 and the Visitect®CD4 Advanced Disease (Omega Diagnostics, UK) - the two lateral flow, equipment-free POC CD4 tests, which can be used to identify people with HIV who have CD4 of less than 350 and 200 cells/μl, respectively. Using published data from independent studies, we discussed the performance and utility of these tests, highlighting the advantages as well as their limitations. EXPERT OPINION The tests are user-friendly, acceptable to health care workers, and feasible to implement in primary health care settings and can provide reliable results for clinical decision-making. Hands-on training with pictorial instructions for use is needed to enhance test's operator confidence in interpretation of test results. Quality assurance program should be in place to ensure the quality of testing. Development of a next-generation test with a cutoff of 100 cells/μl is recommended to identify patients with advanced immunosuppression for initiation of prophylaxis to reduce HIV-related death. Operational research is also needed to identify cost-effective implementation strategies in real-world settings.
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Affiliation(s)
- Minh D Pham
- Burnet Institute, Melbourne, Australia.,Department of Epidemiology and Preventive Medicine, Faculty of Medicine Nursing and Health Science, Monash University, Melbourne, Victoria Australia
| | - Mark Stoove
- Burnet Institute, Melbourne, Australia.,Department of Epidemiology and Preventive Medicine, Faculty of Medicine Nursing and Health Science, Monash University, Melbourne, Victoria Australia
| | - Suzanne Crowe
- Burnet Institute, Melbourne, Australia.,Central Clinical School, Faculty of Medicine Nursing and Health Science, Monash University, Melbourne, Victoria, Australia
| | - Stanley Luchters
- Department of Epidemiology and Preventive Medicine, Faculty of Medicine Nursing and Health Science, Monash University, Melbourne, Victoria Australia.,Institute of Human Development, Aga Khan University, Kenya.,Department of Public Health and Primary Care, Ghent University, Belgium
| | - David Anderson
- Burnet Institute, Melbourne, Australia.,Department of Microbiology, Faculty of Medicine Nursing and Health Science, Monash University, Melbourne, Victoria, Australia
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Gils T, Lynen L, Muhairwe J, Mashaete K, Lejone TI, Joseph P, Ngubane T, Keter AK, Reither K, van Heerden A. Feasibility of implementing the advanced HIV disease care package as part of community-based HIV/TB activities: a mixed-methods study protocol. BMJ Open 2022; 12:e057291. [PMID: 35131835 PMCID: PMC8823294 DOI: 10.1136/bmjopen-2021-057291] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Accepted: 01/20/2022] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Although the advanced HIV disease (AHD) care package reduces morbidity and mortality in people with AHD (defined in people living with HIV as WHO stage 3 or 4, CD4 count <200 cells/µL or age <5 years), it is barely implemented in many countries. A novel point-of-care CD4 test rapidly identifies AHD. We evaluate the feasibility of implementing the AHD care package as part of community-based HIV/tuberculosis services. METHODS AND ANALYSIS This two-phased study is guided by the Medical Research Council framework for evaluation of complex interventions. Stage 1 is a stakeholder consultation to define tools and indicators to assess feasibility of the AHD care package. Stage 2 is the implementation of the AHD care package during a facility-based tuberculosis diagnostic accuracy study in high-burden HIV/tuberculosis settings. Consenting adults with tuberculosis symptoms in two sites in Lesotho and South Africa are eligible for inclusion. HIV-positive participants are included in the feasibility study and are offered a CD4 test, a tuberculosis-lipoarabinomannan assay and those with CD4 count of ≤200 cells/µL a cryptococcal antigen lateral flow assay. Participants are referred for clinical management following national guidelines. The evaluation includes group discussions, participant observation (qualitative strand) and a semistructured questionnaire to assess acceptability among implementers. The quantitative strand also evaluates process compliance (process rating and process cascade) and early outcomes (vital and treatment status after twelve weeks). Thematic content analysis, descriptive statistics and data triangulation will be performed. ETHICS AND DISSEMINATION The National Health Research and Ethics Committee, Lesotho, the Human Sciences Research Council Research Ethics Committee and Provincial Department of Health, South Africa and the Ethikkommission Nordwest- und Zentralschweiz, Switzerland, approved the protocol. Dissemination will happen locally and internationally at scientific conferences and in peer-reviewed journals. TRIAL REGISTRATION NUMBER NCT04666311.
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Affiliation(s)
- Tinne Gils
- Clinical Sciences, Institute of Tropical Medicine, Antwerpen, Belgium
| | - Lutgarde Lynen
- Clinical Sciences, Institute of Tropical Medicine, Antwerpen, Belgium
| | - Josephine Muhairwe
- SolidarMed, Partnerships for Health, Maseru, Lesotho
- Institute of Global Health, University of Geneva, Geneva, Switzerland
| | | | | | - Philip Joseph
- Centre for Community Based Research, Human Sciences Research Council, Pietermaritzburg, South Africa
| | - Thulani Ngubane
- Centre for Community Based Research, Human Sciences Research Council, Pietermaritzburg, South Africa
| | | | - Klaus Reither
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- Medical Outpatient Department, University of Basel, Basel, Switzerland
| | - Alastair van Heerden
- Centre for Community Based Research, Human Sciences Research Council, Pietermaritzburg, South Africa
- Developmental Pathways for Health Research Unit, University of the Witwatersrand, Johannesburg, South Africa
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User experience of home-based AbC-19 SARS-CoV-2 antibody rapid lateral flow immunoassay test. Sci Rep 2022; 12:1173. [PMID: 35064150 PMCID: PMC8782985 DOI: 10.1038/s41598-022-05097-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Accepted: 12/29/2021] [Indexed: 01/01/2023] Open
Abstract
The urgent need to scale up testing capacity during the COVID-19 pandemic has prompted the rapid development of point-of-care diagnostic tools such as lateral flow immunoassays (LFIA) for large-scale community-based rapid testing. However, studies of how the general public perform when using LFIA tests in different environmental settings are scarce. This user experience (UX) study of 264 participants in Northern Ireland aimed to gather a better understanding of how self-administered LFIA tests were performed by the general public at home. The UX performance was assessed via analysis of a post-test questionnaire including 30 polar questions and 11 7-point Likert scale questions, which covers the multidimensional aspects of UX in terms of ease of use, effectiveness, efficiency, accuracy and satisfaction. Results show that 96.6% of participants completed the test with an overall average UX score of 95.27% [95% confidence interval (CI) 92.71–97.83%], which suggests a good degree of user experience and effectiveness. Efficiency was assessed based on the use of physical resources and human support received, together with the mental effort of self-administering the test measured via NASA Task Load Index (TLX). The results for six TLX subscales show that the participants scored the test highest for mental demand and lowest for physical demand, but the average TLX score suggests that the general public have a relatively low level of mental workload when using LFIA self-testing at home. Five printed LFIA testing results (i.e. the ‘simulated’ results) were used as the ground truth to assess the participant’s performance in interpreting the test results. The overall agreement (accuracy) was 80.63% [95% CI 75.21–86.05%] with a Kappa score 0.67 [95% CI 0.58–0.75] indicating substantial agreement. The users scored lower in confidence when interpreting test results that were weak positive cases (due to the relatively low signal intensity in the test-line) compared to strong positive cases. The end-users also found that the kit was easier to use than they expected (p < 0.001) and 231 of 264 (87.5%) reported that the test kit would meet their requirements if they needed an antibody testing kit. The overall findings provide an insight into the opportunities for improving the design of self-administered SARS-CoV-2 antibody testing kits for the general public and to inform protocols for future UX studies of LFIA rapid test kits.
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13
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Herrmann Y, Lainati F, Castro MDM, Mwamba CP, Kumwenda M, Muyoyeta M, Broger T, Heinrich N, Olbrich L, Corbett EL, McMahon SA, Engel N, Denkinger CM. User perspectives and preferences on a novel TB LAM diagnostic (Fujifilm SILVAMP TB LAM)-a qualitative study in Malawi and Zambia. PLOS GLOBAL PUBLIC HEALTH 2022; 2:e0000672. [PMID: 36962216 PMCID: PMC10021253 DOI: 10.1371/journal.pgph.0000672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/25/2021] [Accepted: 05/30/2022] [Indexed: 11/18/2022]
Abstract
Widely available tuberculosis (TB) diagnostics use sputum samples. However, many patients, particularly children and patients living with HIV (PLHIV), struggle to provide sputum. Urine diagnostics are a promising approach to circumvent this challenge while delivering reliable and timely diagnosis. This qualitative study in two high TB/HIV burden countries assesses values and preferences of end-users, along with potential barriers for the implementation of the novel Fujifilm SILVAMP TB-LAM (FujiLAM, Fujifilm, Japan) urine test. Between September 2020 and March 2021, we conducted 42 semi-structured interviews with patients, health care providers (HCPs) and decision makers (DMs) (e.g., in national TB programs) in Malawi and Zambia. Interviews were transcribed verbatim and analyzed using a framework approach supported by NVIVO. Findings aligned with the pre-existing Health Equity Implementation Framework, which guided the presentation of results. The ease and convenience of urine-based testing was described as empowering among patients and HCPs who lamented the difficulty of sputum collection, however HCPs expressed concerns that a shift in agency to the patient may affect clinic workflows (e.g., due to less control over collection). Implementation facilitators, such as shorter turnaround times, were welcomed by operators and patients alike. The decentralization of diagnostics was considered possible with FujiLAM by HCPs and DMs due to low infrastructure requirements. Finally, our findings support efforts for eliminating the CD4 count as an eligibility criterion for LAM testing, to facilitate implementation and benefit a wider range of patients. Our study identified barriers and facilitators relevant to scale-up of urine LAM tests in Malawi and Zambia. FujiLAM could positively impact health equity, as it would particularly benefit patient groups currently underserved by existing TB diagnostics. Participants view the approach as a viable, acceptable, and likely sustainable option in low- and middle-income countries, though adaptations may be required to current health care processes for deployment. Trial registration: German Clinical Trials Register, DRKS00021003. URL: https://www.drks.de/drks_web/setLocale_EN.do.
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Affiliation(s)
- Yannis Herrmann
- Division of Clinical Infectious Disease and Tropical Medicine, Centre for Infectious Diseases, Heidelberg University Hospital, Heidelberg, Germany
| | - Federica Lainati
- Division of Clinical Infectious Disease and Tropical Medicine, Centre for Infectious Diseases, Heidelberg University Hospital, Heidelberg, Germany
| | - María Del Mar Castro
- Division of Clinical Infectious Disease and Tropical Medicine, Centre for Infectious Diseases, Heidelberg University Hospital, Heidelberg, Germany
| | - Chanda P Mwamba
- Centre for Infectious Disease Research in Zambia, Social & Behavioural Science Group, Lusaka, Zambia
| | - Moses Kumwenda
- Malawi-Liverpool-Wellcome Clinical Research Programme (MLW), Public Health Group, Blantyre, Malawi
| | - Monde Muyoyeta
- Centre for Infectious Disease Research in Zambia, Tuberculosis Department, Lusaka, Zambia
| | - Tobias Broger
- Division of Clinical Infectious Disease and Tropical Medicine, Centre for Infectious Diseases, Heidelberg University Hospital, Heidelberg, Germany
| | - Norbert Heinrich
- Division for Infectious Diseases, LMU Hospital, Munich, Germany
- German Centre for Infection Research (DZIF), Partner Site Munich, Munich, Germany
| | - Laura Olbrich
- Division for Infectious Diseases, LMU Hospital, Munich, Germany
- German Centre for Infection Research (DZIF), Partner Site Munich, Munich, Germany
| | - Elizabeth L Corbett
- London School of Hygiene and Tropical Medicine, Infectious and Tropical Diseases, London, United Kingdom
| | - Shannon A McMahon
- Heidelberg University Hospital, Heidelberg Institute of Global Health, Heidelberg, Germany
- International Health Department, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America
| | - Nora Engel
- Maastricht University, Department of Health, Ethics & Society, Research School for Public Health and Primary Care, Maastricht, The Netherlands
| | - Claudia M Denkinger
- Division of Clinical Infectious Disease and Tropical Medicine, Centre for Infectious Diseases, Heidelberg University Hospital, Heidelberg, Germany
- German Centre for Infection Research (DZIF), Partner Site Heidelberg University Hospital, Heidelberg, Germany
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14
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Izco S, Murias‐Closas A, Jordan AM, Greene G, Catorze N, Chiconela H, Garcia JI, Blanco‐Arevalo A, Febrer A, Casellas A, Saavedra B, Chiller T, Nhampossa T, Garcia‐Basteiro A, Letang E. Improved detection and management of advanced HIV disease through a community adult TB-contact tracing intervention with same-day provision of the WHO-recommended package of care including ART initiation in a rural district of Mozambique. J Int AIDS Soc 2021; 24:e25775. [PMID: 34347366 PMCID: PMC8336616 DOI: 10.1002/jia2.25775] [Citation(s) in RCA: 4] [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: 12/15/2020] [Revised: 06/02/2021] [Accepted: 07/05/2021] [Indexed: 11/08/2022] Open
Abstract
INTRODUCTION AIDS-mortality remains unacceptably high in sub-Saharan Africa, largely driven by advanced HIV disease (AHD). We nested a study in an existing tuberculosis (TB) contact-tracing intervention (Xpatial-TB). The aim was to assess the burden of AHD among high-risk people living with HIV (PLHIV) identified and to evaluate the provision of the WHO-recommended package of care to this population. METHODS All PLHIV ≥14 years old identified between June and December 2018 in Manhiça District by Xpatial-TB were offered to participate in the study if ART naïve or had suboptimal ART adherence. Consenting individuals were screened for AHD. Patients with AHD (CD4 < 200 cells/μL or WHO stage 3 or 4) were offered a package of interventions in a single visit, including testing for cryptococcal antigen (CrAg) and TB-lipoarabinomannan (TB-LAM), prophylaxis and treatment for opportunistic infections, adherence support or accelerated ART initiation. We collected information on follow-up visits carried out under routine programmatic conditions for six months. RESULTS A total of 2881 adults were identified in the Xpatial TB-contact intervention. Overall, 23% (673/2881) were HIV positive, including 351 TB index (64.2%) and 322 TB contacts (13.8%). Overall, 159/673 PLHIV (24%) were ART naïve or had suboptimal ART adherence, of whom 155 (97%, 124 TB index and 31 TB-contacts) consented to the study and were screened for AHD. Seventy percent of TB index-patients (87/124) and 16% of TB contacts (5/31) had CD4 < 200 cells/µL. Four (13%) of the TB contacts had TB, giving an overall AHD prevalence among TB contacts of 29% (9/31). Serum-CrAg was positive in 4.6% (4/87) of TB-index patients and in zero TB contacts. All ART naïve TB contacts without TB initiated ART within 48 hours of HIV diagnosis. Among TB cases, ART timing was tailored to the presence of TB and cryptococcosis. Six-month mortality was 21% among TB-index cases and zero in TB contacts. CONCLUSIONS A TB contact-tracing outreach intervention identified undiagnosed HIV and AHD in TB patients and their contacts, undiagnosed cryptococcosis among TB patients, and resulted in an adequate provision of the WHO-recommended package of care in this rural Mozambican population. Same-day and accelerated ART initiation was feasible and safe in this population including among those with AHD.
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Affiliation(s)
- Santiago Izco
- ISGlobal, Hospital Clínic‐Universitat de BarcelonaBarcelonaSpain
- Centro de Investigação em Saude de Manhiça (CISM)ManhiçaMozambique
| | | | - Alexander M Jordan
- Mycotic Diseases BranchUnited States Centers for Disease Control and Prevention (CDC)AtlantaGAUSA
| | - Gregory Greene
- Mycotic Diseases BranchUnited States Centers for Disease Control and Prevention (CDC)AtlantaGAUSA
| | - Nteruma Catorze
- Centro de Investigação em Saude de Manhiça (CISM)ManhiçaMozambique
| | | | - Juan Ignacio Garcia
- ISGlobal, Hospital Clínic‐Universitat de BarcelonaBarcelonaSpain
- Centro de Investigação em Saude de Manhiça (CISM)ManhiçaMozambique
- PhD Program in Methodology of Biomedical ResearchFaculty of MedicineUniversity of BarcelonaBarcelonaSpain
| | | | - Anna Febrer
- ISGlobal, Hospital Clínic‐Universitat de BarcelonaBarcelonaSpain
| | - Aina Casellas
- ISGlobal, Hospital Clínic‐Universitat de BarcelonaBarcelonaSpain
| | - Belén Saavedra
- ISGlobal, Hospital Clínic‐Universitat de BarcelonaBarcelonaSpain
- Centro de Investigação em Saude de Manhiça (CISM)ManhiçaMozambique
| | - Tom Chiller
- Mycotic Diseases BranchUnited States Centers for Disease Control and Prevention (CDC)AtlantaGAUSA
| | | | - Alberto Garcia‐Basteiro
- ISGlobal, Hospital Clínic‐Universitat de BarcelonaBarcelonaSpain
- Centro de Investigação em Saude de Manhiça (CISM)ManhiçaMozambique
| | - Emilio Letang
- ISGlobal, Hospital Clínic‐Universitat de BarcelonaBarcelonaSpain
- Department of Infectious Diseases Hospital del MarHospital del Mar Research Institute (IMIM)BarcelonaSpain
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15
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Jing M, Bond R, Robertson LJ, Moore J, Kowalczyk A, Price R, Burns W, Nesbit MA, McLaughlin J, Moore T. User experience analysis of AbC-19 Rapid Test via lateral flow immunoassays for self-administrated SARS-CoV-2 antibody testing. Sci Rep 2021; 11:14026. [PMID: 34234188 PMCID: PMC8263628 DOI: 10.1038/s41598-021-93262-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Accepted: 06/07/2021] [Indexed: 12/24/2022] Open
Abstract
Lateral flow immunoassays are low cost, rapid and highly efficacious point-of-care devices, which have been used for SARS-CoV-2 antibody testing by professionals. However, there is a lack of understanding about how self-administered tests are used by the general public for mass testing in different environmental settings. The purpose of this study was to assess the user experience (UX) (including usability) of a self-testing kit to identify COVID-19 antibodies used by a representative sample of the public in their cars, which included 1544 participants in Northern Ireland. The results based on 5-point Likert ratings from a post-test questionnaire achieved an average UX score of 96.03% [95% confidence interval (CI) 95.05–97.01%], suggesting a good degree of user experience. The results of the Wilcoxon rank sum tests suggest that UX scores were independent of the user’s age and education level although the confidence in this conclusion could be strengthened by including more participants aged younger than 18 and those with only primary or secondary education. The agreement between the test result as interpreted by the participant and the researcher was 95.85% [95% CI 94.85–96.85%], Kappa score 0.75 [95% CI 0.69–0.81] (indicating substantial agreement). Text analysis via the latent Dirichlet allocation model for the free text responses in the survey suggest that the user experience could be improved for blood-sample collection, by modifying the method of sample transfer to the test device and giving clearer instructions on how to interpret the test results. The overall findings provide an insight into the opportunities for improving the design of SARS-CoV-2 antibody testing kits to be used by the general public and therefore inform protocols for future user experience studies of point-of-care tests.
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Affiliation(s)
- Min Jing
- Faculty of Computing, Engineering and the Built Environment, Ulster University, Jordanstown , UK
| | - Raymond Bond
- Faculty of Computing, Engineering and the Built Environment, Ulster University, Jordanstown , UK
| | - Louise J Robertson
- Biomedical Sciences Research Institute, Ulster University, Coleraine, UK
| | - Julie Moore
- Biomedical Sciences Research Institute, Ulster University, Coleraine, UK
| | - Amanda Kowalczyk
- Biomedical Sciences Research Institute, Ulster University, Coleraine, UK
| | - Ruth Price
- Biomedical Sciences Research Institute, Ulster University, Coleraine, UK
| | - William Burns
- Faculty of Computing, Engineering and the Built Environment, Ulster University, Jordanstown , UK
| | - M Andrew Nesbit
- Biomedical Sciences Research Institute, Ulster University, Coleraine, UK
| | - James McLaughlin
- Faculty of Computing, Engineering and the Built Environment, Ulster University, Jordanstown , UK.
| | - Tara Moore
- Biomedical Sciences Research Institute, Ulster University, Coleraine, UK. .,Avellino USA, 1505 Adams Dr, Menlo Park, CA, 94025, USA.
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16
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Sachdeva S, Davis RW, Saha AK. Microfluidic Point-of-Care Testing: Commercial Landscape and Future Directions. Front Bioeng Biotechnol 2021; 8:602659. [PMID: 33520958 PMCID: PMC7843572 DOI: 10.3389/fbioe.2020.602659] [Citation(s) in RCA: 101] [Impact Index Per Article: 33.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Accepted: 12/15/2020] [Indexed: 12/23/2022] Open
Abstract
Point-of-care testing (POCT) allows physicians to detect and diagnose diseases at or near the patient site, faster than conventional lab-based testing. The importance of POCT is considerably amplified in the trying times of the COVID-19 pandemic. Numerous point-of-care tests and diagnostic devices are available in the market including, but not limited to, glucose monitoring, pregnancy and infertility testing, infectious disease testing, cholesterol testing and cardiac markers. Integrating microfluidics in POCT allows fluid manipulation and detection in a singular device with minimal sample requirements. This review presents an overview of two technologies - (a.) Lateral Flow Assay (LFA) and (b.) Nucleic Acid Amplification - upon which a large chunk of microfluidic POCT diagnostics is based, some of their applications, and commercially available products. Apart from this, we also delve into other microfluidic-based diagnostics that currently dominate the in-vitro diagnostic (IVD) market, current testing landscape for COVID-19 and prospects of microfluidics in next generation diagnostics.
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Affiliation(s)
| | | | - Amit K. Saha
- Genome Technology Center, School of Medicine, Stanford University, Palo Alto, CA, United States
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17
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Baluku JB, Mugabe P, Mwebaza S, Nakaweesi J, Senyimba C, Opio JP, Mukasa B. Cryptococcal Antigen Screening Among Antiretroviral Therapy-Experienced People With HIV With Viral Load Nonsuppression in Rural Uganda. Open Forum Infect Dis 2021; 8:ofab010. [PMID: 33604402 PMCID: PMC7880263 DOI: 10.1093/ofid/ofab010] [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: 11/17/2020] [Accepted: 01/05/2021] [Indexed: 11/12/2022] Open
Abstract
Background The World Health Organization recommends screening for the cryptococcal antigen (CrAg), a predictor of cryptococcal meningitis, among antiretroviral therapy (ART)-naïve people with HIV (PWH) with CD4 <100 cells/mm3. CrAg positivity among ART-experienced PWH with viral load (VL) nonsuppression is not well established, yet high VLs are associated with cryptococcal meningitis independent of CD4 count. We compared the frequency and positivity yield of CrAg screening among ART-experienced PWH with VL nonsuppression and ART-naïve PWH with CD4 <100 cells/mm3 attending rural public health facilities in Uganda. Methods We reviewed routinely generated programmatic reports on cryptococcal disease screening from 104 health facilities in 8 rural districts of Uganda from January 2018 to July 2019. A lateral flow assay (IMMY CrAg) was used to screen for cryptococcal disease. PWH were eligible for CrAg screening if they were ART-naïve with CD4 <100 cell/mm3 or ART-experienced with an HIV VL >1000 copies/mL after at least 6 months of ART. We used Pearson's chi-square test to compare the frequency and yield of CrAg screening. Results Of 71 860 ART-experienced PWH, 7210 (10.0%) were eligible for CrAg screening. Among 15 417 ART-naïve PWH, 5719 (37.1%) had a CD4 count measurement, of whom 937 (16.4%) were eligible for CrAg screening. The frequency of CrAg screening was 11.5% (830/7210) among eligible ART-experienced PWH compared with 95.1% (891/937) of eligible ART- naïve PWH (P < .001). The CrAg positivity yield was 10.5% among eligible ART-experienced PWH compared with 13.8% among eligible ART-naïve PWH (P = .035). Conclusions The low frequency and high positivity yield of CrAg screening among ART-experienced PWH with VL nonsuppression suggest a need for VL- directed CrAg screening in this population. Studies are needed to evaluate the cost-effectiveness and impact of CrAg screening and fluconazole prophylaxis on the outcomes of ART-experienced PWH with VL nonsuppression.
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Affiliation(s)
| | - Pallen Mugabe
- Directorate of Programs Mildmay Uganda, Kampala, Uganda
| | - Shem Mwebaza
- Directorate of Programs Mildmay Uganda, Kampala, Uganda
| | | | | | - Joel Peter Opio
- Division of Global HIV and TB, US centers for Disease Control and Prevention, Kampala, Uganda
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18
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Jing M, Mclaughlin D, Mcnamee SE, Raj S, Namee BM, Steele D, Finlay D, Mclaughlin J. A Novel Method for Quantitative Analysis of C-Reactive Protein Lateral Flow Immunoassays Images via CMOS Sensor and Recurrent Neural Networks. IEEE JOURNAL OF TRANSLATIONAL ENGINEERING IN HEALTH AND MEDICINE 2021; 9:1900415. [PMID: 34873497 PMCID: PMC8641912 DOI: 10.1109/jtehm.2021.3130494] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Revised: 11/04/2021] [Accepted: 11/16/2021] [Indexed: 12/28/2022]
Abstract
Objective: To design and implement an easy-to-use, Point-of-Care (PoC) lateral flow immunoassays (LFA) reader and data analysis system, which provides a more in-depth quantitative analysis for LFA images than conventional approaches thereby supporting efficient decision making for potential early risk assessment of cardiovascular disease (CVD). Methods and procedures: A novel end-to-end system was developed including a portable device with CMOS camera integrated with optimized illumination and optics to capture the LFA images produced using high-sensitivity C-Reactive Protein (hsCRP) (concentration level < 5 mg/L). The images were transmitted via WiFi to a back-end server system for image analysis and classification. Unlike common image classification approaches which are based on averaging image intensity from a region-of-interest (ROI), a novel approach was developed which considered the signal along the sample’s flow direction as a time series and, consequently, no need for ROI detection. Long Short-Term Memory (LSTM) networks were deployed for multilevel classification. The features based on Dynamic Time Warping (DTW) and histogram bin counts (HBC) were explored for classification. Results: For the classification of hsCRP, the LSTM outperformed the traditional machine learning classifiers with or without DTW and HBC features performed the best (with mean accuracy of 94%) compared to other features. Application of the proposed method to human plasma also suggests that HBC features from LFA time series performed better than the mean from ROI and raw LFA data. Conclusion: As a proof of concept, the results demonstrate the capability of the proposed framework for quantitative analysis of LFA images and suggest the potential for early risk assessment of CVD. Clinical impact: The hsCRP levels < 5 mg/L were aligned with clinically actionable categories for early risk assessment of CVD. The outcomes demonstrated the real-world applicability of the proposed system for quantitative analysis of LFA images, which is potentially useful for more LFA applications beyond presented in this study.
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Affiliation(s)
- Min Jing
- School of EngineeringUlster University Jordanstown BT37 0QB U.K
| | - Donal Mclaughlin
- Department of Physics and AstronomyUniversity College London London WC1E 6BT U.K
| | - Sara E Mcnamee
- School of EngineeringUlster University Jordanstown BT37 0QB U.K
| | - Shasidran Raj
- School of EngineeringUlster University Jordanstown BT37 0QB U.K
| | - Brian Mac Namee
- School of Computer ScienceUniversity College Dublin Dublin 4 D04 V1W8 Ireland
| | | | - Dewar Finlay
- School of EngineeringUlster University Jordanstown BT37 0QB U.K
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19
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Ndlovu Z, Burton R, Stewart R, Bygrave H, Roberts T, Fajardo E, Mataka A, Szumilin E, Kerschberger B, Van Cutsem G, Ellman T. Framework for the implementation of advanced HIV disease diagnostics in sub-Saharan Africa: programmatic perspectives. Lancet HIV 2020; 7:e514-e520. [PMID: 32473102 DOI: 10.1016/s2352-3018(20)30101-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Revised: 03/16/2020] [Accepted: 03/23/2020] [Indexed: 01/21/2023]
Abstract
Patients with advanced HIV disease have a high risk of mortality, mainly from tuberculosis and cryptococcal meningitis. The advanced HIV disease management package recommended by WHO, which includes diagnostics, therapeutics, and patient psychosocial support, is barely implemented in many different countries. Here, we present a framework for the implementation of advanced HIV disease diagnostics. Laboratory and point-of-care-based reflex testing, coupled with provider-initiated requested testing, for cryptococcal antigen and urinary Mycobacterium tuberculosis lipoarabinomannan antigen, should be done for all patients with CD4+ cell counts of 200 cells per μL or less. Implementation of the advanced HIV disease package should be encouraged within primary health-care facilities and task shifting of testing to lay cadres could facilitate access to rapid results. Implementation of differentiated antiretroviral therapy delivery models can allow clinicians enough time to focus on the management of patients with advanced HIV disease. Efficient up-referral and post-discharge systems, including the development of patient-centric advanced HIV disease literacy, are also crucial. Implementation of the advanced HIV disease package is feasible at all health-care levels, and it should be part of the core of the global response towards ending AIDS as a public health threat.
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Affiliation(s)
- Zibusiso Ndlovu
- Médecins Sans Frontières, Southern African Medical Unit, Cape Town, South Africa.
| | - Rosie Burton
- Médecins Sans Frontières, Southern African Medical Unit, Cape Town, South Africa
| | | | - Helen Bygrave
- Médecins Sans Frontières, Access Campaign, Geneva, Switzerland
| | - Teri Roberts
- Médecins Sans Frontières, Access Campaign, Geneva, Switzerland
| | | | - Anafi Mataka
- African Society for Laboratory Medicine, Addis Ababa, Ethiopia
| | | | | | - Gilles Van Cutsem
- Médecins Sans Frontières, Southern African Medical Unit, Cape Town, South Africa; Centre for Infectious Disease Epidemiology and Research, University of Cape Town, South Africa
| | - Tom Ellman
- Médecins Sans Frontières, Southern African Medical Unit, Cape Town, South Africa
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