Improving the Accessibility and Efficiency of Point-of-Care Diagnostics Services in Low- and Middle-Income Countries: Lean and Agile Supply Chain Management

Kuupiel, Desmond; Bawontuo, Vitalis; Mashamba-Thompson, Tivani P.

doi:10.3390/diagnostics7040058

Cited by 55 publications

(100 citation statements)

References 73 publications

(257 reference statements)

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“…Self‐testing and sampling have increased screening uptake, but innovative treatment services to avoid ineffective and inappropriate treatment should be explored . POCT implementation should consider integration within the STI management pathways, including patient flow, immediate treatment, partner management and retesting , and the existing health systems .…”

Section: Discussionmentioning

confidence: 99%

Diagnosing sexually transmitted infections in resource‐constrained settings: challenges and ways forward

Ndowa²,

et al. 2019

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Introduction Sexually transmitted infections (STIs) remain prevalent and are increasing in several populations. Appropriate STI diagnosis is crucial to prevent the transmission and sequelae of untreated infection. We reviewed the diagnostic accuracy of syndromic case management and existing point‐of‐care tests (POCTs), including those in the pipeline, to diagnose STIs in resource‐constrained settings. Methods We prioritized updating the systematic review and meta‐analysis of the diagnostic accuracy of vaginal discharge from 2001 to 2015 to include studies until 2018. We calculated the absolute effects of different vaginal flowcharts and the diagnostic performance of POCTs on important outcomes. We searched the peer‐reviewed literature for previously conducted systematic reviews and articles from 1990 to 2018 on the diagnostic accuracy of syndromic management of vaginal and urethral discharge, genital ulcer and anorectal infections. We conducted literature reviews from 2000 to 2018 on the existing POCTs and those in the pipeline. Results and discussions The diagnostic accuracy of urethral discharge and genital ulcer disease syndromes is relatively adequate. Asymptomatic Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) infections limit the use of vaginal discharge and anorectal syndromes. The pooled diagnostic accuracy of vaginal syndromic case management for CT/NG is low, resulting in high numbers of overtreatment and missed treatment. The absolute effect of POCTs was reduced overtreatment and missed treatment. Findings of the reviews on syndromic case management underscored the need for low‐cost and accurate POCTs for the identification, first, of CT/NG, and, second, of Mycoplasma genitalium (MG) and Trichomonas vaginalis (TV) and NG and MG resistance/susceptibility testing. Near‐patient POCT molecular assays for CT/NG/TV are commercially available. The prices of these POCTs remain the barrier for uptake in resource‐constrained settings. This is driving the development of lower cost solutions. Conclusions The WHO syndromic case management guidelines should be updated to raise the quality of STI management through the integration of laboratory tests. STI screening strategies are needed to address asymptomatic STIs. POCTs that are accurate, rapid, simple and affordable are urgently needed in resource‐constrained settings to support the uptake of aetiological diagnosis and treatment.

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Section: Discussionmentioning

confidence: 99%

Diagnosing sexually transmitted infections in resource‐constrained settings: challenges and ways forward

Ndowa²,

et al. 2019

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“…Point‐of‐care (POC) technology is a potential solution to this challenge and POC tests for CD4, serum creatinine, ALT and haemoglobin have been used effectively in studies examining rapid and same‐day ART initiation. However, there are barriers to the adoption and wide‐scale implementation of POC testing platforms; including policy, infrastructure, cost, quality assurance and supply chain . An additional challenge for targeted pre‐ART laboratory screening is the recent deprioritisation of pre‐ART CD4 testing by large donor organisations.…”

Section: Discussionmentioning

confidence: 99%

Use of pre‐ART laboratory screening to identify renal, hepatic and haematological abnormalities in Côte d'Ivoire

Minchella

Adjé-Touré

Zhang

et al. 2020

Tropical Med Int Health

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background High demand for HIV-services and extensive clinical guidelines force health systems in low-resource settings to dedicate resources to service delivery at the expense of other priorities. Simplifying services may reduce the burden on health systems and pre-antiretroviral therapy (ART) laboratory screening is among the services under consideration for simplification.methods We assessed the frequencies of conditions linked to ART toxicities among 34,994 adult, ART-na€ ıve patients with specimens referred to the RETRO-CI laboratory in Abidjan, Côte d'Ivoire between 1998 and 2017. Screening included tests for serum creatinine, alanine aminotransferase (ALT) and haemoglobin (Hb) to identify renal dysfunction (estimated glomerular filtration rate < 50 mL/min), hepatic abnormalities (ALT > 59 upper limit of normal) and severe anaemia (Hb < 6.5 g/dL), respectively. We considered screening results across four eras and identified factors associated with the conditions in question.results The prevalence of renal dysfunction, hepatic abnormalities and severe anaemia were largely unchanged over time and just 8.4% of patients had any of the three conditions. Key factors associated with renal dysfunction and severe anaemia were age > 50 years (adjusted odds ratio (aOR): 2.53; 95% confidence interval (CI): 2.19-2.92; P < 0.001) and CD4 < 100 cells/µl (aOR: 2.57; 95% CI: 2.30-2.88; P < 0.001).conclusion The relative infrequency of conditions linked to toxicity in Côte d'Ivoire supports the notion that simplification of pre-ART laboratory screening may be undertaken with limited negative impact on identification of adverse events. Targeted screening may be a feasible strategy to balance detection of conditions associated with ART toxicities with simplification of services.

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“…For this type of testing to be efficient in any health care institution, it needs to go through the following procedures: i) sample collection, ii) sample processing, iii) testing and/or instrumentation, iv) analysis of results and reporting, v) interpretation and vi) waste disposal. These multiple testing procedures, pose great technical challenges for POC testing in resource limited settings, because of limited laboratory testing capability and lack of skilled operators (Kuupiel, Bawontuo, & Mashamba-Thompson, 2017;Wang et al, 2016). resource-limited settings as they eliminate the need for laboratory infrastructure, allowing for non-laboratory users to perform diagnostic tests (N. .…”

Section: The Need For Use Of Experiential Learning For Quality Improvmentioning

confidence: 99%

Experiential Learning Curriculum Delivery Approach for Quality Improvement in Resource Limited Settings: Mobile Learning for Point-of-Care Technologies

Chamane¹,

Mashamba-Thompson²

2019

GJHS

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Background: Despite impressive progress that has been made in the provision of health care services to all, the issue of quality service delivery still remains a challenge particularly for point-of-care (POC) diagnostics in resource-limited-settings. Poor competency of primary health care workers in these settings has been shown to be amongst the main contributors to poor quality service delivery.Findings: Participatory-based continuous professional development (CPD) strategies to support technology advancements in health care are recommended. Experiential learning approaches have been shown to be efficient in supplementing traditional teaching methods for both health care students and professionals. These approaches have been shown to further contribute towards continuous skills development and lifelong learning. Conclusion:This review therefore provided an overview of literature on experiential learning as one of CPD approaches in relation to health care service improvement in resource-limited setting. In addition, this review has recommended a mobile-based experiential learning approach to help deliver a quality POC technology curriculum to Primary health care-based workers in resource-limited settings.Keywords: primary health care, quality improvement, experiential learning, onsite training, participatory-based learning and mobile learningThe purpose of this review is to provide an overview of literature on experiential learning as one of CPD

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Improving the Accessibility and Efficiency of Point-of-Care Diagnostics Services in Low- and Middle-Income Countries: Lean and Agile Supply Chain Management

Cited by 55 publications

References 73 publications

Diagnosing sexually transmitted infections in resource‐constrained settings: challenges and ways forward

Diagnosing sexually transmitted infections in resource‐constrained settings: challenges and ways forward

Use of pre‐ART laboratory screening to identify renal, hepatic and haematological abnormalities in Côte d'Ivoire

Experiential Learning Curriculum Delivery Approach for Quality Improvement in Resource Limited Settings: Mobile Learning for Point-of-Care Technologies

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