Study of implementation and direct cost estimates for diagnostic tests for human visceral leishmaniasis in an urban area in Brazil

Abstract

This work reports the process and costs of comprehensively implementing two tests to decentralize the diagnosis of visceral leishmaniasis (VL) in an endemic city in Brazil: a rapid test (IT LEISH) and a direct agglutination test (DAT-LPC). The implementation began by training health professionals to perform the tests. Estimation of the training costs considered the proportional remuneration of all professionals involved and the direct costs of the tests used for training. The study was conducted between November 2011 and November 2013. During that time, 17 training sessions were held, and 175 professionals were trained. The training cost for each professional was US$ 7.13 for the IT LEISH and US$ 9.93 for the DAT-LPC. The direct costs of the IT LEISH and DAT-LPC were estimated to be US$ 6.62 and US$ 5.44, respectively. This first evaluation of the implementation of these diagnostic tests indicates the feasibility of decentralizing both methods to extend access to VL diagnosis in Brazil.

A scoping review on the field validation and implementation of rapid diagnostic tests for vector-borne and other infectious diseases of poverty in urban areas

“…The sensitivity of the rK39 rapid test was 100% (95% CI: 94.95–100%) and specificity was 86.33% (95% CI: 79.23–91.36%) [167] and sensitivity of KAtex® was 77.77% and specificity was 98.24% [168]. In an endemic area in Brazil, the direct cost of IT-LEISH® was estimated to be USD 6.62 compared to USD 6.72 for the Kala-Azar Detect® rapid test [169]. The IT LEISH was found to be more appropriate to implement in the same endemic area due to its use of capillary blood, the positive reaction of 96% of patients to the finger prick blood collection, and its acceptability among healthcare professionals [170].…”

Cost-effectiveness of serological tests for human visceral leishmaniasis in the Brazilian scenario

“…The use of blood as a biological sample represents a great advance in VL diagnosis, especially in remote areas with poor lab infrastructure. In Brazil, despite the availability of RDTs for use with blood/serum and the feasibility of RDT decentralization to municipal laboratories [26], they are still centralized in reference labs to be performed using serum. Therefore, even in referral labs, where several resources are available to carry out other methodologies, RDTs are also used due to their high performance and availability, confirming the usefulness of a global comparison among tests.…”

“…RDTs are simple to perform and to interpret, do not require laboratory infrastructure or specialized professionals and can be performed at the patient’s bedside. Thus, they are ideal tools as point-of-care testing at primary health centers, after an implementation process [ 26 ]. However, caution is required for VL screening in subgroups of patients with expected low performance of RDTs: immunosuppressed patients and children under 2 years old [ 27 , 28 ].…”

Análise epidemiológica da Leishmaniose Visceral no Estado do Tocantins no período de 2007 a 2017.

“…Entre 2007 e 2012, 53% dos casos de LV no Brasil foram confirmados por IFI, e no estudo em Aracaju, entre 1999 e 2008, 71,4% dos casos foram confirmados por essa técnica. 8,20,23 Em um estudo realizado no Rio Grande do Norte, em 18,14% dos indivíduos não foi realizado nenhum método laboratorial de diagnóstico. Em 13% dos casos foi realizada a IFI associada ao exame parasitológico (mielograma).…”