Innovative technologies for point‐of‐care testing of viral hepatitis in low‐resource and decentralized settings

Abstract

According to the Global Burden of Diseases, chronic viral hepatitis B and C are one of the most challenging global health conditions that rank among the first causes of morbidity and mortality worldwide. Low- and middle-income countries are particularly affected by the health burden associated with HBV or HCV infection. One major gap in efficiently addressing the issue of viral hepatitis is universal screening. However, the costs and chronic lack of human resources for using traditional screening strategies based on serology and molecular biology preclude any scaling-up. Point-of-care tests have been deemed a powerful potential solution to fill the current diagnostics gap in low-resource and decentralized settings. Despite high interest resulting from their development in recent years, very few point-of-care devices have reached the market. Scaling down and automating all testing steps in 1 single device (eg, sample preparation, detection and readout) is indeed challenging. But innovations in multiple disciplines such as nanotechnologies, microfluidics, biosensors and synthetic biology have led to the creation of chip-sized laboratory systems called "lab-on-a-chip" devices. This review aims to explain how these innovations can overcome technological barriers that usually arise for each testing step while developing integrated point-of-care tests. Point-of-care test prototypes rarely meet the requirements for mass production, which also hinders their large-scale production. In addition to logistical hurdles, legal and economic constraints specific to the commercialization of in vitro diagnostics, which have also participated in the low transfer of innovative point-of-care tests to the field, are discussed.

Screening, diagnosis and care cascade for viral hepatitis B and C in Yaoundé, Cameroon: a qualitative study of patients and health providers coping with uncertainty and unbearable costs

“…More specifically, our results highlight the urgent need for a comprehensive national programme in Cameroon for the screening, care and treatment of HBV and HCV. Screening uptake and access to a subsidised pretherapeutic package could be enhanced through technological innovations and point-of-care devices which may improve both geographical and financial accessibility, especially thanks to reduced costs related to transport 23 24. To reach this goal, national health authorities may rely on WHO guidelines on hepatitis B and C testing which propose simplified algorithms which are easy to implement,8 as well on recent WHO recommendations for the screening, care and treatment of chronic hepatitis B and C infections 25 26…”

Serological and molecular rapid diagnostic tests for Toxoplasma infection in humans and animals

“…The unique electrical, magnetic, luminescent, and catalytic properties of nanomaterials allow rapid, sensitive, and inexpensive diagnosis of microbial infections, and confer the potential for real-time detection of target biomarkers in a small volume of patient sample [128]. Also, advances in nanotechnology, microfluidics, biosensors, and synthetic biology have given rise to the generation of miniature-sized laboratory systems known as "lab-on-chip" devices [129]. It can also address the demand of nucleic acid testing at the POC level that integrates all the steps from sample preparation to nucleic acid amplification and detection in a single device [130].…”

Sensing with photoluminescent semiconductor quantum dots

“…POCs devices are meant for diagnostic screening at or near the patient site of care. To be effective, they must be affordable, reliable, and user friendly [56].…”