Diagnostics and monitoring tools for noncommunicable diseases: a missing component in the global response

Abstract

A key component of any health system is the capacity to accurately diagnose individuals. One of the six building blocks of a health system as defined by the World Health Organization (WHO) includes diagnostic tools. The WHO’s Noncommunicable Disease Global Action Plan includes addressing the lack of diagnostics for noncommunicable diseases, through multi-stakeholder collaborations to develop new technologies that are affordable, safe, effective and quality controlled, and improving laboratory and diagnostic capacity and human resources. Many challenges exist beyond price and availability for the current tools included in the Package of Essential Noncommunicable Disease Interventions (PEN) for cardiovascular disease, diabetes and chronic respiratory diseases. These include temperature stability, adaptability to various settings (e.g. at high altitude), need for training in order to perform and interpret the test, the need for maintenance and calibration, and for Blood Glucose Meters non-compatible meters and test strips. To date the issues surrounding access to diagnostic and monitoring tools for noncommunicable diseases have not been addressed in much detail. The aim of this Commentary is to present the current landscape and challenges with regards to guidance from the WHO on diagnostic tools using the WHO REASSURED criteria, which define a set of key characteristics for diagnostic tests and tools. These criteria have been used for communicable diseases, but so far have not been used for noncommunicable diseases. Diagnostic tools have played an important role in addressing many communicable diseases, such as HIV, TB and neglected tropical diseases. Clearly more attention with regards to diagnostics for noncommunicable diseases as a key component of the health system is needed.

Wearable electrochemical biosensors to measure biomarkers with complex blood-to-sweat partition such as proteins and hormones

“…World Health Organization (WHO) had proposed nine principles to design wearable health monitoring devices, called REASSURED [ 144 ]. Real-time connectivity (i.e., once generated, users immediately obtain results), ii) ease of specimen collection (i.e., noninvasive), iii) affordable, iv) sensitive (i.e., no-false negatives), v) specific (i.e., no-false positives), vi) user-friendly (i.e., straightforward measurement), vii) rapid and robust (i.e., high device stability and short time of response, 15 min to 2 h), viii) equipment-free and environmentally friendly (i.e., autonomous power supply and easy disposable), ix) deliverable to end-users (i.e., cheap).…”

Point-of-care biochemical assays using electrochemical technologies: approaches, applications, and opportunities

“…Although these sensors offer promise for use in lab applications, there is a long way to go before their large-scale rapid screening. The World Health Organization has imposed requirements on the performance-related aspects of wearable devices in terms of stability, immunity to interference, and real-time connectivity [71]. Although research on electrochemical biosensors has widened their linear range, lowered their limit of detection, and improved their sensitivity, there is considerable room for improvement before they can be applied to clinical testing.…”

Bringing the lab bench to the field: Point‐of‐care testing for enhancing health research and stakeholder engagement in rural/remote, indigenous, and resource‐limited contexts

“…While studies have demonstrated the efficacy of POCT for monitoring NCDs among individuals and within communities, such tools are more widely available in high‐income countries; again, this differential access represents one intervention point through which POCT can help curtail inequities in disease states within RIR settings. However, availability, usability, affordability, and sustainability of POCT, as well as a relatively recent emergence of NCDs in many RIR settings (and subsequent lack of infrastructure in place to address these conditions), are among some of the key barriers that limit access to and justification for POCT use in these contexts and consequently, contribute to global health inequities (Bernabé‐Ortiz et al, 2021).…”