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Nasir N, Molyneux S, Were F, Aderoba A, Fuller SS. Medical device regulation and oversight in African countries: a scoping review of literature and development of a conceptual framework. BMJ Glob Health 2023; 8:e012308. [PMID: 37558270 PMCID: PMC10414093 DOI: 10.1136/bmjgh-2023-012308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Accepted: 07/13/2023] [Indexed: 08/11/2023] Open
Abstract
Regulatory and other governance arrangements influence the introduction of medical devices into health systems and are essential for ensuring their effective and safe use. Challenges with medical device safety, quality and use are documented globally, with evidence suggesting these are linked to poor governance. Yet, medical device regulation and oversight remain inadequately defined and described, particularly in low-income and middle-income settings. Through this review, we sought to examine the literature available on regulatory and oversight processes for medical devices in African countries.Following a systematic approach, we searched academic databases including PubMed, Embase (Ovid) and MEDLINE (Ovid), supplemented by search for grey literature and relevant organisational websites, for documents describing medical device regulation and oversight in African countries. We summarised the data to present key actors, areas for regulation and oversight and challenges.A total of 39 documents reporting regulation and oversight of medical devices were included for analysis. Regulatory and oversight guidelines and processes were reported as inadequate, including limited pre-market testing, reliance on international certifications and limited processes for post-market monitoring and reporting of adverse events. Challenges for regulation and oversight reported included inadequate funding, personnel and technical expertise to perform regulatory functions. The literature highlighted gaps in guidelines for donated medical devices and in information on governance processes at the national level.The current literature provides a general overview of medical device regulatory guidelines and limited evidence on the implementation of regulatory/oversight processes at national and especially subnational levels. We recommend further research to elucidate existing governance arrangements for medical devices within African countries and propose a conceptual framework to inform future studies. The framework provides entry points for careful examination of governance and oversight in policy and practice, the exploration of governance realities across the health system and the influence of wider system dynamics.
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Affiliation(s)
- Naima Nasir
- Health Systems Collaborative, Center for Global Health Research, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Sassy Molyneux
- Health Systems Collaborative, Center for Global Health Research, Nuffield Department of Medicine, University of Oxford, Oxford, UK
- Health Systems and Research Ethics, KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
| | - Fred Were
- Department of Paediatrics and Child Health, University of Nairobi, Nairobi, Kenya
- Kenya Paediatric Research Consortium, Nairobi, Kenya
| | - Adeniyi Aderoba
- Reproductive, Maternal Health, and Healthy Ageing Unit, Universal Health Coverage-Life Course Cluster, World Health Organization Regional Office for Africa, Brazzaville, Democratic Republic of Congo
- Center for Global Health Research, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Sebastian S Fuller
- Health Systems Collaborative, Center for Global Health Research, Nuffield Department of Medicine, University of Oxford, Oxford, UK
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Mpaata CN, Matovu B, Takuwa M, Kiwanuka N, Lewis S, Norrie J, Ononge S, Tuck S, Wolters M, Demulliez M, Ssekitoleko RT. Systems and processes for regulation of investigational medical devices in Uganda. FRONTIERS IN MEDICAL TECHNOLOGY 2023; 4:1054120. [PMID: 36756148 PMCID: PMC9899893 DOI: 10.3389/fmedt.2022.1054120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Accepted: 12/19/2022] [Indexed: 01/24/2023] Open
Abstract
Background In many parts of the world, medical devices and the processes of their development are tightly regulated. However, the current regulatory landscape in Uganda like other developing countries is weak and poorly defined, which creates significant barriers to innovation, clinical evaluation, and translation of medical devices. Aim To evaluate current knowledge, systems and infrastructure for medical devices regulation and innovation in Uganda. Methods A mixed methods study design using the methods triangulation strategy was employed in this study. Data of equal weight were collected sequentially. First, a digital structured questionnaire was sent out to innovators to establish individual knowledge and experience with medical device innovation and regulation. Then, a single focus group discussion involving both medical device innovators and regulators to collect data about the current regulatory practices for medical devices in Uganda. Univariate and bivariate analysis was done for the quantitative data to summarize results in graphs and tables. Qualitative data was analyzed using thematic analysis. Ethical review and approval were obtained from the Makerere University School of Biomedical Sciences, Research and Ethics Committee, and the Uganda National Council for Science and Technology. Results A total of 47 innovators responded to the questionnaire. 14 respondents were excluded since they were not medical device innovators. Majority (76%) of individuals had been innovators for more than a year, held a bachelor's degree with a background in Engineering and applied sciences, and worked in an academic research institute. 22 of the 33 medical device innovators had stopped working on their innovations and had stalled at the proof-of-concept stage. Insufficient funding, inadequate technical expertise and confusing regulatory landscape were major challenges to innovation. The two themes that emerged from the discussion were "developing standards for medical devices regulation" and "implementation of regulations in practical processes". Legal limitations, lengthy processes, and low demand were identified as challenges to developing medical device regulations. Conclusions Efforts have been taken by government to create a pathway for medical device innovations to be translated to the market. More work needs to be done to coordinate efforts among stakeholders to build effective medical device regulations in Uganda.
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Affiliation(s)
- Charles Norman Mpaata
- Biomedical Engineering Unit, Department of Physiology, School of Biomedical Sciences College of Health Sciences, Makerere University, Kampala, Uganda
| | - Brian Matovu
- Biomedical Engineering Unit, Department of Physiology, School of Biomedical Sciences College of Health Sciences, Makerere University, Kampala, Uganda
| | - Mercy Takuwa
- Biomedical Engineering Unit, Department of Physiology, School of Biomedical Sciences College of Health Sciences, Makerere University, Kampala, Uganda
| | - Noah Kiwanuka
- Clinical Trials Unit, School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Steff Lewis
- Usher Institute, Edinburgh Medical School, University of Edinburgh, Edinburgh, United Kingdom
| | - John Norrie
- Usher Institute, Edinburgh Medical School, University of Edinburgh, Edinburgh, United Kingdom
| | - Sam Ononge
- Department of Obstetrics and Gynecology, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Sharon Tuck
- Usher Institute, Edinburgh Medical School, University of Edinburgh, Edinburgh, United Kingdom
| | - Maria Wolters
- Informatics Forum, School of Informatics, College of Science and Engineering, University of Edinburgh, Edinburgh, United Kingdom
| | - Marc Demulliez
- School of Engineering & Physical Sciences, Heriot-Watt University, Edinburgh, United Kingdom
| | - Robert T. Ssekitoleko
- Biomedical Engineering Unit, Department of Physiology, School of Biomedical Sciences College of Health Sciences, Makerere University, Kampala, Uganda,Correspondence: Robert T. Ssekitoleko
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Costa SP, Carvalho CM. Burden of bacterial bloodstream infections and recent advances for diagnosis. Pathog Dis 2022; 80:6631550. [PMID: 35790126 DOI: 10.1093/femspd/ftac027] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Revised: 06/07/2022] [Accepted: 07/01/2022] [Indexed: 11/13/2022] Open
Abstract
Bloodstream infections (BSIs) and subsequent organ dysfunction (sepsis and septic shock) are conditions that rank among the top reasons for human mortality and have a great impact on healthcare systems. Their treatment mainly relies on the administration of broad-spectrum antimicrobials since the standard blood culture-based diagnostic methods remain time-consuming for the pathogen's identification. Consequently, the routine use of these antibiotics may lead to downstream antimicrobial resistance and failure in treatment outcomes. Recently, significant advances have been made in improving several methodologies for the identification of pathogens directly in whole blood especially regarding specificity and time to detection. Nevertheless, for the widespread implementation of these novel methods in healthcare facilities, further improvements are still needed concerning the sensitivity and cost-effectiveness to allow a faster and more appropriate antimicrobial therapy. This review is focused on the problem of BSIs and sepsis addressing several aspects like their origin, challenges, and causative agents. Also, it highlights current and emerging diagnostics technologies, discussing their strengths and weaknesses.
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Affiliation(s)
- Susana P Costa
- Centre of Biological Engineering, University of Minho, Campus de Gualtar, 4710-057, Braga, Portugal.,LABBELS - Associate Laboratory, Braga/Guimarães, Portugal.,International Iberian Nanotechnology Laboratory, Av. Mestre José Veiga s/n, 4715-330, Braga, Portugal.,Instituto de Engenharia de Sistemas e Computadores - Microsistemas e Nanotecnologias (INESC MN) and IN - Institute of Nanoscience and Nanotechnology, Rua Alves Redol, 9 1000-029 Lisbon, Portugal
| | - Carla M Carvalho
- International Iberian Nanotechnology Laboratory, Av. Mestre José Veiga s/n, 4715-330, Braga, Portugal
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Chênes C, Albert H, Kao K, Ray N. Use of Physical Accessibility Modelling in Diagnostic Network Optimization: A Review. Diagnostics (Basel) 2022; 12:diagnostics12010103. [PMID: 35054270 PMCID: PMC8774366 DOI: 10.3390/diagnostics12010103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2021] [Revised: 12/29/2021] [Accepted: 01/03/2022] [Indexed: 11/16/2022] Open
Abstract
Diagnostic networks are complex systems that include both laboratory-tested and community-based diagnostics, as well as a specimen referral system that links health tiers. Since diagnostics are the first step before accessing appropriate care, diagnostic network optimization (DNO) is crucial to improving the overall healthcare system. The aim of our review was to understand whether the field of DNO, and especially route optimization, has benefited from the recent advances in geospatial modeling, and notably physical accessibility modeling, that have been used in numerous health systems assessment and strengthening studies. All publications published in English between the journal’s inception and 12 August 2021 that dealt with DNO, geographical accessibility and optimization, were systematically searched for in Web of Science and PubMed, this search was complemented by a snowball search. Studies from any country were considered. Seven relevant publications were selected and charted, with a variety of geospatial approaches used for optimization. This paucity of publications calls for exploring the linkage of DNO procedures with realistic accessibility modeling framework. The potential benefits could be notably better-informed travel times of either the specimens or population, better estimates of the demand for diagnostics through realistic population catchments, and innovative ways of considering disease epidemiology to inform DNO.
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Affiliation(s)
- Camille Chênes
- Institute for Environmental Sciences, University of Geneva, 1205 Geneva, Switzerland;
| | | | | | - Nicolas Ray
- Institute for Environmental Sciences, University of Geneva, 1205 Geneva, Switzerland;
- GeoHealth Group, Institute of Global Health, University of Geneva, 1202 Geneva, Switzerland
- Correspondence: ; Tel.: +41-22-379-07-84
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Frempong SN, King N, Sagoo GS. The cost-effectiveness of using rapid diagnostic tests for the diagnosis of typhoid fever in patients with suspected typhoid fever: a systematic review. Expert Rev Pharmacoecon Outcomes Res 2021; 22:391-397. [PMID: 34842022 DOI: 10.1080/14737167.2022.2012453] [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: 10/19/2022]
Abstract
INTRODUCTION Despite the availability of several commercial rapid diagnostic tests (RDTs) developed to detect typhoid fever, the cost-effectiveness in resource-limited settings is unclear. This review aimed to explore the literature on typhoid economic evaluations in order to assess the cost-effectiveness of using typhoid RDTs in resource-limited settings. AREAS COVERED A systematic review was conducted focusing on the identification of economic evaluations of typhoid RDTs to diagnose patients with suspected typhoid fever. Two studies were identified and included for narrative synthesis. Whilst highlighting a gap in the published literature, this review shows the use of typhoid RDTs to potentially be cost-effective in resource-limited settings. Factors that appeared as significant in determining cost-effectiveness related to test characteristics (such as sensitivity, specificity, and cost) and the prevalence of typhoid fever and should factor into any future evaluations. EXPERT OPINION Concerted effort is needed in resource-limited settings with regard to medical device regulation to ensure that clinically effective and cost-effective typhoid RDTs are widely available and introduced into clinical practice. Typhoid modeling (with respect to typhoid testing and treatment strategies) represents an understudied area and further work is needed.
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Affiliation(s)
- Samuel N Frempong
- Academic Unit of Health Economics, Leeds Institute of Health Sciences, University of Leeds, United Kingdom (UK).,National Institute for Health Research (NIHR) Leeds in Vitro Diagnostics Co-operative, Leeds, United Kingdom (UK)
| | - Natalie King
- Academic Unit of Health Economics, Leeds Institute of Health Sciences, University of Leeds, United Kingdom (UK)
| | - Gurdeep S Sagoo
- Academic Unit of Health Economics, Leeds Institute of Health Sciences, University of Leeds, United Kingdom (UK).,National Institute for Health Research (NIHR) Leeds in Vitro Diagnostics Co-operative, Leeds, United Kingdom (UK)
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Fleming KA, Horton S, Wilson ML, Atun R, DeStigter K, Flanigan J, Sayed S, Adam P, Aguilar B, Andronikou S, Boehme C, Cherniak W, Cheung AN, Dahn B, Donoso-Bach L, Douglas T, Garcia P, Hussain S, Iyer HS, Kohli M, Labrique AB, Looi LM, Meara JG, Nkengasong J, Pai M, Pool KL, Ramaiya K, Schroeder L, Shah D, Sullivan R, Tan BS, Walia K. The Lancet Commission on diagnostics: transforming access to diagnostics. Lancet 2021; 398:1997-2050. [PMID: 34626542 PMCID: PMC8494468 DOI: 10.1016/s0140-6736(21)00673-5] [Citation(s) in RCA: 144] [Impact Index Per Article: 48.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Revised: 02/26/2021] [Accepted: 03/12/2021] [Indexed: 12/30/2022]
Affiliation(s)
| | - Susan Horton
- School of Public Health and Health Systems, University of Waterloo, Waterloo, ON, Canada.
| | | | - Rifat Atun
- Harvard T H Chan School of Public Health, Harvard University, Boston, MA, USA
| | | | | | | | | | - Bertha Aguilar
- Médicos e Investigadores de la Lucha Contra el Cáncer de Mama, Mexico City, Mexico
| | - Savvas Andronikou
- Perelman School of Medicine, University of Pennsylvania Philadelphia, Philadelphia, PA, USA
| | | | - William Cherniak
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
| | - Annie Ny Cheung
- The University of Hong Kong, Hong Kong Special Administrative Region, China
| | | | - Lluis Donoso-Bach
- Department of Medical Imaging, Hospital Clínic of Barcelona, University of Barcelona, Barcelona, Spain
| | | | | | - Sarwat Hussain
- University of Massachusetts Medical School, Worcester, MA, USA
| | - Hari S Iyer
- Dana Farber Cancer Institute, Boston, MA, USA
| | - Mikashmi Kohli
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, QC, Canada
| | - Alain B Labrique
- Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | | | - John G Meara
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, MA, USA
| | - John Nkengasong
- Africa Centres for Disease Control and Prevention, Addis Ababa, Ethiopia
| | - Madhukar Pai
- School of Population and Global Health, McGill University, Montreal, QC, Canada
| | | | | | - Lee Schroeder
- University of Michigan Medical School, Ann Arbor, MI, USA
| | - Devanshi Shah
- School of Public Health and Health Systems, University of Waterloo, Waterloo, ON, Canada
| | | | | | - Kamini Walia
- Indian Council of Medical Research, Delhi, India
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7
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Ondoa P, Ndlovu N, Keita MS, Massinga-Loembe M, Kebede Y, Odhiambo C, Mekonen T, Ashenafi A, Kebede A, Nkengasong J. Preparing national tiered laboratory systems and networks to advance diagnostics in Africa and meet the continent's health agenda: Insights into priority areas for improvement. Afr J Lab Med 2020; 9:1103. [PMID: 33102173 PMCID: PMC7565058 DOI: 10.4102/ajlm.v9i2.1103] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Accepted: 05/29/2020] [Indexed: 12/21/2022] Open
Affiliation(s)
- Pascale Ondoa
- African Society for Laboratory Medicine, Addis Ababa, Ethiopia.,Amsterdam Institute for Global Health and Development, Academic Medical Centre, Department of Global Health, University of Amsterdam, Amsterdam, Netherlands
| | - Nqobile Ndlovu
- African Society for Laboratory Medicine, Addis Ababa, Ethiopia
| | - Mah-Sere Keita
- African Society for Laboratory Medicine, Addis Ababa, Ethiopia
| | | | - Yenew Kebede
- Africa Centres for Disease, Control and Prevention, Addis Ababa, Ethiopia
| | | | - Teferi Mekonen
- African Society for Laboratory Medicine, Addis Ababa, Ethiopia
| | - Aytenew Ashenafi
- Africa Centres for Disease, Control and Prevention, Addis Ababa, Ethiopia
| | - Amha Kebede
- African Society for Laboratory Medicine, Addis Ababa, Ethiopia
| | - John Nkengasong
- Africa Centres for Disease, Control and Prevention, Addis Ababa, Ethiopia
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8
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Incardona S, Bell D, Campillo A, Cunningham J, Ariey F, Fandeur T, Luchavez J, Luna CA, Ménard D, Nhem S, Sornillo JB, Witkowski B, Katz Z, Dittrich S, Ding XC. Keep the quality high: the benefits of lot testing for the quality control of malaria rapid diagnostic tests. Malar J 2020; 19:247. [PMID: 32660630 PMCID: PMC7359453 DOI: 10.1186/s12936-020-03324-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Accepted: 07/07/2020] [Indexed: 11/30/2022] Open
Abstract
Background The production and use of malaria rapid diagnostic tests (RDTs) has risen dramatically over the past 20 years. In view of weak or non-existing in vitro diagnostics (IVD) regulations and post-marketing surveillance (PMS) systems in malaria endemic countries, the World Health Organization, later joined by the Foundation for Innovative New Diagnostics, established an independent, centralized performance evaluation and Lot Testing (LT) programme to safeguard against poor quality of RDTs being distributed through the public health sector of malaria endemic countries. RDT performances and manufacturer quality management systems have evolved over the past decade raising questions about the future need for a centralized LT programme. Results Between 2007 and 2017, 6056 lots have been evaluated, representing approximately 1.6 Billion RDTs. A total of 69 lots (1.1%) failed the quality control. Of these failures, 26 were detected at receipt of the RDT lot in the LT laboratory, representing an estimated 7.9 million poor quality RDTs, and LT requesters were advised that RDTs were not of sufficient quality for use in patient management. Forty-three were detected after long-term storage in the laboratory, of which 24 (56%) were found to be due to a major issue with insufficient buffer volume in single use buffer vials, others predominantly showing loss of sensitivity. The annual cost of running the programme, based on expenses recorded in years 2014–2016, an estimated volume of 700 lots per year and including replenishment of quality control samples, was estimated at US$ 178,500 ($US 255 per lot tested). Conclusions Despite the clear benefits of the centralized LT programme and its low cost compared with the potential costs of each country establishing its own PMS system for RDTs, funding concerns have made its future beyond 2020 uncertain. In order to manage the risks of misdiagnosis due to low quality RDTs, and to ensure the continued safety and reliability of malaria case management, there is a need to ensure that an effective and implementable approach to RDT quality control continues to be available to programmes in endemic countries.
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Affiliation(s)
| | - David Bell
- Independent consultant, Issaquah, WA, USA
| | | | - Jane Cunningham
- World Health Organization/Global Malaria Programme (WHO/GMP), Geneva, Switzerland
| | - Frederic Ariey
- Hôpital Cochin, Laboratoire de Parasitologie-Mycologie, INSERM U1016 (Institut Cochin), Université de Paris, Paris, France
| | - Thierry Fandeur
- Direction Internationale, Institut Pasteur de Paris, Paris, France
| | - Jennifer Luchavez
- Parasitology Department, Research Institute for Tropical Medicine, Muntinlupa, Philippines
| | - Christian Anthony Luna
- Parasitology Department, Research Institute for Tropical Medicine, Muntinlupa, Philippines
| | - Didier Ménard
- Malaria Genetics and Resistance Unit, Parasites and Insect Vectors Department, Institut Pasteur, Paris, France
| | - Sina Nhem
- National Center for Entomology, Parasitology and Malaria Control, Phnom Penh, Cambodia
| | - Johanna Beulah Sornillo
- Epidemiology and Biostatistics Department, Research Institute for Tropical Medicine, Muntinlupa, Philippines
| | - Benoit Witkowski
- Laboratoire d'Epidémiologie Moléculaire du Paludisme, Institut Pasteur du Cambodge, Phnom Penh, Cambodia
| | | | - Sabine Dittrich
- FIND, Geneva, Switzerland.,Nuffield School of Medicine, University of Oxford, Oxford, UK
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Huang CY, Tung IL. Strategies for Heterogeneous R&D Alliances of In Vitro Diagnostics Firms in Rapidly Catching-Up Economies. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17103688. [PMID: 32456247 PMCID: PMC7277300 DOI: 10.3390/ijerph17103688] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 05/03/2020] [Accepted: 05/09/2020] [Indexed: 11/16/2022]
Abstract
Most developed countries already have high-quality in vitro diagnostic (IVD) techniques for diseases, but developing countries often do not have access to these technologies and cannot afford them. Enabling firms to leverage external resources to optimize their research and development (R&D) performance has become one of the most critical issues for small and medium-sized late-coming IVD firms. R&D alliances, especially heterogeneous alliances, are necessary for releasing the resource limitations of late-coming small and medium-sized enterprises (SMEs) and reaching the metaoptimum of the R&D performances. However, to the authors’ knowledge, a few, if any, previous studies have investigated the key success factors and strategies of heterogeneous alliances in the IVD industry. Therefore, the authors aim to define the critical factors for evaluating and selecting strategies for heterogeneous alliances in the IVD industry. A Decision-Making Trial and Evaluation Laboratory (DEMATEL)-based analytic network process (DANP) was proposed to prioritize the weights associated with the evaluation criteria. Then, a heterogeneous R&D alliance strategy was derived from the compromise ranking based on the modified VlseKriterijumska Optimizacija I Kompromisno Resenje (VIKOR) method. An empirical study of major Taiwanese IVD firms’ evaluation and selection of heterogeneous R&D alliance strategies will be used to reveal the practicability of the analytic framework. Based on the analytic results, the joint venture strategy is the most suitable heterogeneous R&D alliance strategy for IVD firms in rapidly catching-up economies. These results can serve as the basis for heterogeneous R&D alliance strategy definitions in the IVD industry in the future.
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Dacombe RJ, Watson V, Nyirenda L, Madanhire C, Simwinga M, Chepuka L, Johnson CC, Corbett EL, Hatzold K, Taegtmeyer M. Regulation of HIV self-testing in Malawi, Zambia and Zimbabwe: a qualitative study with key stakeholders. J Int AIDS Soc 2019; 22 Suppl 1:e25229. [PMID: 30907513 PMCID: PMC6432109 DOI: 10.1002/jia2.25229] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Accepted: 12/19/2018] [Indexed: 11/07/2022] Open
Abstract
INTRODUCTION HIV self-testing (HIVST) is being introduced as a new way for more undiagnosed people to know their HIV status. As countries start to implement HIVST, assuring the quality and regulating in vitro diagnostics, including HIVST, are essential. We aimed to document the emerging regulatory landscape and perceptions of key stakeholders involved in HIVST policy and regulation prior to implementation in three low- and middle-income countries. METHODS Between April and August 2016, we conducted semi-structured interviews in Malawi, Zambia and Zimbabwe to understand the relationships between different stakeholders on their perceptions of current and future HIVST regulation and the potential impact on implementation. We purposively sampled and interviewed 66 national-level key stakeholders from the Ministry of Health and the regulatory, laboratory, logistical, donor and non-governmental sectors. We used a thematic approach to analysis with an inductively developed common coding framework to allow inter-country comparison of emerging themes. RESULTS In all countries, the national reference laboratory was monitoring the quality of HIVST kits entering the public sector. In Malawi, there was no legal mandate to regulate medical devices, in Zambia one regulatory body with a clear mandate had started developing regulations and in Zimbabwe the mandate to regulate was overlapping between two bodies. Stakeholders indicated that they had a poor understanding of the process and requirements for HIVST regulation, as well as lack of clarity and coordination between organizational roles. The need for good collaboration between sectors, a strong post-market surveillance model for HIVST and technical assistance to develop regulators capacity was noted as priorities. Key informants identified technical working groups as a potential way collaboration could be improved upon to accelerate the regulation of HIVST. CONCLUSION Regulation of in vitro diagnostic devices, including HIVST, is now being recognized as important by regulators after a regional focus on pharmaceuticals. HIVST is providing an opportunity for each country to develop similar regulations to others in the region leading to a more coherent regulatory environment for the introduction of new devices.
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Affiliation(s)
- Russell J Dacombe
- Community Health Systems GroupDepartment of International Public HealthLiverpool School of Tropical MedicineLiverpoolUK
| | - Victoria Watson
- Community Health Systems GroupDepartment of International Public HealthLiverpool School of Tropical MedicineLiverpoolUK
| | - Lot Nyirenda
- Community Health Systems GroupDepartment of International Public HealthLiverpool School of Tropical MedicineLiverpoolUK
| | | | | | - Lignet Chepuka
- Medical and Surgical Nursing DepartmentKamuzu College of NursingBlantyreMalawi
| | | | | | | | - Miriam Taegtmeyer
- Community Health Systems GroupDepartment of International Public HealthLiverpool School of Tropical MedicineLiverpoolUK
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11
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Applegate TL, Fajardo E, Sacks JA. Hepatitis C Virus Diagnosis and the Holy Grail. Infect Dis Clin North Am 2018; 32:425-445. [DOI: 10.1016/j.idc.2018.02.010] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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12
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Rasti R, Nanjebe D, Karlström J, Muchunguzi C, Mwanga-Amumpaire J, Gantelius J, Mårtensson A, Rivas L, Galban F, Reuterswärd P, Andersson Svahn H, Alvesson HM, Boum Y, Alfvén T. Health care workers' perceptions of point-of-care testing in a low-income country-A qualitative study in Southwestern Uganda. PLoS One 2017; 12:e0182005. [PMID: 28750083 PMCID: PMC5547696 DOI: 10.1371/journal.pone.0182005] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2017] [Accepted: 07/11/2017] [Indexed: 12/02/2022] Open
Abstract
Background Point-of-care (POC) tests have become increasingly available and more widely used in recent years. They have been of particular importance to low-income settings, enabling them with clinical capacities that had previously been limited. POC testing programs hold a great potential for significant improvement in low-income health systems. However, as most POC tests are developed in high-income countries, disengagement between developers and end-users inhibit their full potential. This study explores perceptions of POC test end-users in a low-income setting, aiming to support the development of novel POC tests for low-income countries. Methods A qualitative study was conducted in Mbarara District, Southwestern Uganda, in October 2014. Fifty health care workers were included in seven focus groups, comprising midwives, laboratory technicians, clinical and medical officers, junior and senior nurses, and medical doctors. Discussions were audio-recorded and transcribed verbatim. Transcripts were coded through a data-driven approach for qualitative content analysis. Results Nineteen different POC tests were identified as currently being in use. While participants displayed being widely accustomed to and appreciative of the use of POC tests, they also assessed the use and characteristics of current tests as imperfect. An ideal POC test was characterized as being adapted to local conditions, thoughtfully implemented in the specific health system, and capable of improving the care of patients. Tests for specific medical conditions were requested. Opinions differed with regard to the ideal distribution of POC tests in the local health system. Conclusion POC tests are commonly used and greatly appreciated in this study setting. However, there are dissatisfactions with current POC tests and their use. To maximize benefit, stakeholders need to include end-user perspectives in the development and implementation of POC tests. Insights from this study will influence our ongoing efforts to develop POC tests that will be particularly usable in low-income settings.
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Affiliation(s)
- Reza Rasti
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden.,Sachs' Children and Youth Hospital, South General Hospital, Stockholm, Sweden
| | | | | | | | - Juliet Mwanga-Amumpaire
- Epicentre Mbarara Research Center, Mbarara, Uganda.,Mbarara University of Science and Technology, Mbarara, Uganda
| | - Jesper Gantelius
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden.,Division of Proteomics and Nanobiotechnology, KTH Royal Institute of Technology, Science for Life Laboratory, Stockholm, Sweden
| | - Andreas Mårtensson
- Department of Women's and Children's Health, International Maternal and Child Health (IMCH), Uppsala University, Uppsala, Sweden
| | - Lourdes Rivas
- Division of Proteomics and Nanobiotechnology, KTH Royal Institute of Technology, Science for Life Laboratory, Stockholm, Sweden
| | - Francesc Galban
- Division of Proteomics and Nanobiotechnology, KTH Royal Institute of Technology, Science for Life Laboratory, Stockholm, Sweden
| | - Philippa Reuterswärd
- Division of Proteomics and Nanobiotechnology, KTH Royal Institute of Technology, Science for Life Laboratory, Stockholm, Sweden
| | - Helene Andersson Svahn
- Division of Proteomics and Nanobiotechnology, KTH Royal Institute of Technology, Science for Life Laboratory, Stockholm, Sweden
| | - Helle M Alvesson
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
| | - Yap Boum
- Epicentre Mbarara Research Center, Mbarara, Uganda.,Mbarara University of Science and Technology, Mbarara, Uganda
| | - Tobias Alfvén
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden.,Sachs' Children and Youth Hospital, South General Hospital, Stockholm, Sweden
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13
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McNerney R, Peeling RW. Regulatory In Vitro Diagnostics Landscape in Africa: Update on Regional Activities. Clin Infect Dis 2016; 61Suppl 3:S135-40. [PMID: 26409274 DOI: 10.1093/cid/civ553] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Improved diagnostic tests for tuberculosis case detection are urgently needed that are affordable, robust, and easy to use so that they can be implemented widely. The mandate of national regulatory authorities is to ensure the safety and effectiveness of diagnostics, protecting the population against unsafe products while expediting access to beneficial new devices. However, regulatory approval processes in the developing world are often complex, lengthy, and not transparent. Recent progress in building regulatory capacity using harmonized approaches will reduce duplication in clinical performance studies and manufacturing audits, facilitate information sharing through trust and mutual confidence building, and ultimately improve efficiency. These savings can be passed onto the consumers in the form of more affordable pricing and allowing new high-quality tests for tuberculosis to be introduced more quickly and without delay.
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Affiliation(s)
- Ruth McNerney
- Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, United Kingdom
| | - Rosanna W Peeling
- Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, United Kingdom
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14
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Fonjungo PN, Boeras DI, Zeh C, Alexander H, Parekh BS, Nkengasong JN. Access and Quality of HIV-Related Point-of-Care Diagnostic Testing in Global Health Programs. Clin Infect Dis 2015; 62:369-374. [PMID: 26423384 DOI: 10.1093/cid/civ866] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2015] [Accepted: 09/17/2015] [Indexed: 11/12/2022] Open
Abstract
Access to point-of-care testing (POCT) improves patient care, especially in resource-limited settings where laboratory infrastructure is poor and the bulk of the population lives in rural settings. However, because of challenges in rolling out the technology and weak quality assurance measures, the promise of human immunodeficiency virus (HIV)-related POCT in resource-limited settings has not been fully exploited to improve patient care and impact public health. Because of these challenges, the Joint United Nations Programme on HIV/AIDS (UNAIDS), in partnership with other organizations, recently launched the Diagnostics Access Initiative. Expanding HIV programs, including the "test and treat" strategies and the newly established UNAIDS 90-90-90 targets, will require increased access to reliable and accurate POCT results. In this review, we examine various components that could improve access and uptake of quality-assured POC tests to ensure coverage and public health impact. These components include evaluation, policy, regulation, and innovative approaches to strengthen the quality of POCT.
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Affiliation(s)
- Peter N Fonjungo
- International Laboratory Branch, Division of Global HIV/AIDS, Center for Global Health, US Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Debrah I Boeras
- International Laboratory Branch, Division of Global HIV/AIDS, Center for Global Health, US Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Clement Zeh
- HIV Research Branch, US Centers for Disease Control and Prevention, Kisumu, Kenya
| | - Heather Alexander
- International Laboratory Branch, Division of Global HIV/AIDS, Center for Global Health, US Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Bharat S Parekh
- International Laboratory Branch, Division of Global HIV/AIDS, Center for Global Health, US Centers for Disease Control and Prevention, Atlanta, Georgia
| | - John N Nkengasong
- International Laboratory Branch, Division of Global HIV/AIDS, Center for Global Health, US Centers for Disease Control and Prevention, Atlanta, Georgia
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15
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Visser T, Daily J, Hotte N, Dolkart C, Cunningham J, Yadav P. Rapid diagnostic tests for malaria. Bull World Health Organ 2015; 93:862-6. [PMID: 26668438 PMCID: PMC4669726 DOI: 10.2471/blt.14.151167] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2014] [Revised: 08/20/2015] [Accepted: 08/25/2015] [Indexed: 11/27/2022] Open
Abstract
Maintaining quality, competitiveness and innovation in global health technology is a constant challenge for manufacturers, while affordability, access and equity are challenges for governments and international agencies. In this paper we discuss these issues with reference to rapid diagnostic tests for malaria. Strategies to control and eliminate malaria depend on early and accurate diagnosis. Rapid diagnostic tests for malaria require little training and equipment and can be performed by non-specialists in remote settings. Use of these tests has expanded significantly over the last few years, following recommendations to test all suspected malaria cases before treatment and the implementation of an evaluation programme to assess the performance of the malaria rapid diagnostic tests. Despite these gains, challenges exist that, if not addressed, could jeopardize the progress made to date. We discuss recent developments in rapid diagnostic tests for malaria, highlight some of the challenges and provide suggestions to address them.
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Affiliation(s)
- Theodoor Visser
- Clinton Health Access Initiative, Inc., 383 Dorchester Avenue, Suite 400, Boston, MA 02127, United States of America (USA)
| | | | - Nora Hotte
- William Davidson Institute, University of Michigan, Ann Arbor, USA
| | - Caitlin Dolkart
- Clinton Health Access Initiative, Inc., 383 Dorchester Avenue, Suite 400, Boston, MA 02127, United States of America (USA)
| | - Jane Cunningham
- Global Malaria Programme, World Health Organization, Geneva, Switzerland
| | - Prashant Yadav
- William Davidson Institute, University of Michigan, Ann Arbor, USA
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16
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McNerney R. Diagnostics for Developing Countries. Diagnostics (Basel) 2015; 5:200-9. [PMID: 26854149 PMCID: PMC4665590 DOI: 10.3390/diagnostics5020200] [Citation(s) in RCA: 57] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2015] [Revised: 05/07/2015] [Accepted: 05/12/2015] [Indexed: 12/14/2022] Open
Abstract
Improving the availability of high quality diagnostic tests for infectious diseases is a global priority. Lack of access by people living in low income countries may deprive them of life saving treatment and reduces opportunities to prevent onward transmission and spread of the disease. Diagnostic laboratories are often poorly resourced in developing countries, and sparsely distributed. Improved access may be achieved by using tests that do not require laboratory support, including rapid tests for use at the point-of-care. Despite increased interest, few new in vitro diagnostic (IVD) products reach the majority populations in low income countries. Barriers to uptake include cost and lack of robustness, with reduced test performances due to environmental pressures such as high ambient temperatures or dust. In addition to environmental factors test developers must consider the local epidemiology. Confounding conditions such as immunosuppression or variations in antigen presentation or genotype can affect test performance. Barriers to product development include access to finance to establish manufacturing capacity and cover the costs of market entry for new devices. Costs and delays may be inflated by current regulatory preregistration processes to ensure product safety and quality, and more harmonized approaches are needed.
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Affiliation(s)
- Ruth McNerney
- TB Alert, Community Base, 113 Queens Road, Brighton, BN1 3XG, UK.
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17
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Rugera SP, McNerney R, Poon AK, Akimana G, Mariki RF, Kajumbula H, Kamau E, Mpawenimana S, Said SY, Toroitich A, Ronoh W, Sollis KA, Sonoiya S, Peeling RW. Regulation of medical diagnostics and medical devices in the East African community partner states. BMC Health Serv Res 2014; 14:524. [PMID: 25366990 PMCID: PMC4221680 DOI: 10.1186/s12913-014-0524-2] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2013] [Accepted: 10/13/2014] [Indexed: 11/23/2022] Open
Abstract
Background Medical devices and in vitro diagnostic tests (IVD) are vital components of health delivery systems but access to these important tools is often limited in Africa. The regulation of health commodities by National Regulatory Authorities is intended to ensure their safety and quality whilst ensuring timely access to beneficial new products. Streamlining and harmonizing regulatory processes may reduce delays and unnecessary expense and improve access to new products. Whereas pharmaceutical products are widely regulated less attention has been placed on the regulation of other health products. A study was undertaken to assess regulation of medical diagnostics and medical devices across Partner States of the East African Community (EAC). Methods Data was collected during October 2012 through desk based review of documents and field research, including face to face interviews with the assistance of a structured questionnaire with closed and open ended questions. Key areas addressed were (i) existence and role of National Regulatory Authorities; (ii) policy and legal framework for regulation; (iii) premarket control; (iv) marketing controls; (v) post-marketing control and vigilance; (vi) country capacity for regulation; (vii) country capacity for evaluation studies for IVD and (viii) priorities and capacity building for harmonization in EAC Partner States. Results Control of medical devices and IVDs in EAC Partner States is largely confined to national disease programmes such as tuberculosis, HIV and malaria. National Regulatory Authorities for pharmaceutical products do not have the capacity to regulate medical devices and in some countries laboratory based organisations are mandated to ensure quality of products used. Some activities to evaluate IVDs are performed in research laboratories but post market surveillance is rare. Training in key areas is considered essential to strengthening regulatory capacity for IVDs and other medical devices. Conclusions Regulation of medical devices and in vitro diagnostics has been neglected in EAC Partner States. Regulation is weak across the region, and although the majority of States have a legal mandate to regulate medical devices there is limited capacity to do so. Streamlining regulation in the EAC is seen as a positive aspiration with diagnostic tests considered a priority area for harmonisation. Electronic supplementary material The online version of this article (doi:10.1186/s12913-014-0524-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Simon Peter Rugera
- Department of Medical Laboratory Sciences, Mbarara University of Science and Technology, Mbarara, Uganda.
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