Developing and interpreting models to improve diagnostics in developing countries

Girosi, Federico; Olmsted, Stuart S.; Keeler, Emmett B.; Burgess, Deborah C. Hay; Lim, Yee-Wei; Aledort, Julia E.; Rafael, Maria E.; Ricci, Karen A.; Boer, R. de; Hilborne, Lee H.; Derose, Kathryn Pitkin; Shea, Molly; Beighley, Christopher; Dahl, Carol; Wasserman, Jeffrey

doi:10.1038/nature05441

Cited by 68 publications

(47 citation statements)

References 2 publications

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“…Clinical diagnostic testing is severely lacking, especially at low or no infrastructure sites (Girosi et al, 2006;Urdea et al, 2006). Low cost PCR systems capable of delivering ultrafast sampleto-answer results (Maltezos et al, 2010) would play a significant role in making high quality diagnostics accessible to global health practitioners.…”

Section: Introductionmentioning

confidence: 99%

“…Low cost PCR systems capable of delivering ultrafast sampleto-answer results (Maltezos et al, 2010) would play a significant role in making high quality diagnostics accessible to global health practitioners. In particular, real-time PCR-based assays -the most popular molecular diagnostic tests -are highly limited by several factors, including unreliable electricity and the consequent lack of cold storage (Girosi et al, 2006;Urdea et al, 2006). Available commercial PCR master mixes are generally recommended for storage at very low temperatures (−20°C for 1 year or 2-8°C for 6 months), thus limiting their use and the development of devices in low-resource settings without reliable cold storage.…”

Section: Introductionmentioning

confidence: 99%

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Evaluating the thermostability of commercial fast real-time PCR master mixes

Tayoun

Ward

Maltezos

et al. 2012

Experimental and Molecular Pathology

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Evaluating the thermostability of commercial fast real-time PCR master mixes

Tayoun

Ward

Maltezos

et al. 2012

Experimental and Molecular Pathology

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“…However, it is not suited for evaluating POC devices, whose major benefit is to improve access to health care services by redesigning the health care delivery system. The second approach acknowledges programmatic constraints and espouses scaling up an new medical technology in a hierarchical manner from tertiary hospitals to primary health centers (Girosi et al 2006, Wagner et al 2010). But it does not usually quantify the impact of various approaches to scale-up on health outcomes.…”

mentioning

confidence: 99%

Optimal Decentralization of Early Infant Diagnosis of HIV in Resource-Limited Settings

Deo

Sohoni

2015

M&SOM

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Early infant diagnosis (EID) programs in many resource-limited settings are aimed at diagnosing infants born to HIV positive mothers. Due to the complexity of the diagnostic technology, EID programs are often highly centralized with few laboratories testing blood samples from a large network of health facilities. This leads to long diagnostic delays and consequent failure of patients to collect results in a timely manner. Several point-of-care (POC) devices that provide rapid diagnosis within the health facilities are being developed to mitigate these drawbacks of centralized EID networks. We study the decision of which facilities should receive the POC device (the placement plan) using the EID program in Mozambique as a case-study. We argue that the choice of an appropriate plan is critical to maximizing the public health impact of POC devices in the presence of tight budget constraints. To formalize this argument, we develop a detailed simulation model to evaluate the impact of a placement plan. It comprises two parts: an operational model that quantifies the impact of a POC placement plan on the diagnostic delay and a behavioral part that quantifies the impact of diagnostic delay on the likelihood of result collection by infants' caregivers. We also develop an approximate version of these operational and patient behavior dynamics and embed them in an optimization model to generate candidate POC placement plans. We find that the optimization based plan can result in up to 30% more patients collecting their results compared to rules of thumb that have practical appeal. Finally, we show that the effectiveness of POC devices is much higher than other operational improvements to the EID network such as increased laboratory capacity, reduced transportation delay, and more regularized transport.

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“…In contrast, lateral flow immunochromatographic tests, can be used at the point of care and in settings with minimal infrastructure (5,21). Lateral flow methods have been used for several decades for clinical and veterinary diagnosis (16).…”

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confidence: 99%

Development and Evaluation of a Magnetic Immunochromatographic Test To Detect Taenia solium , Which Causes Taeniasis and Neurocysticercosis in Humans

Handali

Klarman

Gaspard

et al. 2010

Clin Vaccine Immunol

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Taeniasis/cysticercosis caused by Taenia solium is a frequent parasitic infection of the human brain in most of the world. Rapid and simple screening tools to identify taeniasis and cysticercosis cases are needed for control programs, mostly to identify tapeworm carriers which are the source of infection and need to be treated, or as tools for point-of-care case detection or confirmation. These screening assays should be affordable, reliable, rapid, and easy to perform. Immunochromatographic tests meet these criteria. To demonstrate proof of principle, we developed and evaluated two magnetic immunochromatographic tests (MICTs) for detection of human Taenia solium taeniasis antibodies (ES33-MICT) and neurocysticercosis antibodies (T24-MICT). These assays detected stage-specific antibodies by using two recombinant proteins, rES33 for detection of taeniasis antibodies and rT24H for detection of cysticercosis antibodies. The sensitivity and specificity of the ES33-MICT to detect taeniasis infections were 94.5% and 96%, respectively, and those of the T24-MICT to detect cases of human cysticercosis with two or more viable brain cysts were 93.9% and 98.9%, respectively. These data provide proof of principle that the ES33-and T24-MICTs provide rapid and suitable methods to identify individuals with taeniasis and cysticercosis.

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Developing and interpreting models to improve diagnostics in developing countries

Cited by 68 publications

References 2 publications

Evaluating the thermostability of commercial fast real-time PCR master mixes

Evaluating the thermostability of commercial fast real-time PCR master mixes

Optimal Decentralization of Early Infant Diagnosis of HIV in Resource-Limited Settings

Development and Evaluation of a Magnetic Immunochromatographic Test To Detect Taenia solium , Which Causes Taeniasis and Neurocysticercosis in Humans

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