Point of care biomarkers to guide antibiotic prescription for acute febrile illness in sub-Saharan Africa: promises and caveats

Background: Rural hospitals in sub-Saharan Africa suffer from numerous disparities in resources and practices, and subsequently patient care is affected.Methods: In order to assess current practices and opportunities for improvement in pulse oximetry use and patient-care handoffs, a cross-sectional survey was administered to clinicians at a referral level hospital serving a large rural area in Shinyanga, Tanzania.Results: Respondents (n=46) included nurses (50%), medical doctors (48%), and clinical officers (2%). A response rate of 92% was achieved, and 81% of clinicians acknowledged routine difficulties in the use of current devices when obtaining pulse oximetry. Although 83% of respondents reported using a written handoff at shift change, information reporting was inconsistent and rarely included specific management guidance.Conclusions: Further research is needed to elucidate handoff practices in developing settings, but there is a large opportunity for novel point-of-care devices and tools to improve both pulse oximetry use and patient care handoffs in rural Africa.

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Faculty Opinions recommendation of Evaluation of near point-of-care viral load implementation in public health facilities across seven countries in sub-Saharan Africa.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.739384564.793581963 ◽

2021 ◽

Author(s):

Lynne Mofenson

Keyword(s):

Public Health ◽

Viral Load ◽

Point Of Care ◽

Health Facilities ◽

Sub Saharan Africa ◽

Public Health Facilities ◽

Sub Saharan

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Febrile Illness Evaluation in a Broad Range of Endemicities (FIEBRE): protocol for a multisite prospective observational study of the causes of fever in Africa and Asia

BMJ Open ◽

10.1136/bmjopen-2019-035632 ◽

2020 ◽

Vol 10 (7) ◽

pp. e035632 ◽

Cited By ~ 1

Author(s):

Heidi Hopkins ◽

Quique Bassat ◽

Clare IR Chandler ◽

John A Crump ◽

Nicholas A Feasey ◽

...

Keyword(s):

Social Science ◽

Blood Sample ◽

Venous Blood ◽

Febrile Illness ◽

Clinical Diagnostics ◽

Control Measures ◽

Sub Saharan Africa ◽

Venous Blood Sample ◽

Open Access Journals ◽

Sub Saharan

IntroductionFever commonly leads to healthcare seeking and hospital admission in sub-Saharan Africa and Asia. There is only limited guidance for clinicians managing non-malarial fevers, which often results in inappropriate treatment for patients. Furthermore, there is little evidence for estimates of disease burden, or to guide empirical therapy, control measures, resource allocation, prioritisation of clinical diagnostics or antimicrobial stewardship. The Febrile Illness Evaluation in a Broad Range of Endemicities (FIEBRE) study seeks to address these information gaps.Methods and analysisFIEBRE investigates febrile illness in paediatric and adult outpatients and inpatients using standardised clinical, laboratory and social science protocols over a minimum 12-month period at five sites in sub-Saharan Africa and Southeastern and Southern Asia. Patients presenting with fever are enrolled and provide clinical data, pharyngeal swabs and a venous blood sample; selected participants also provide a urine sample. Laboratory assessments target infections that are treatable and/or preventable. Selected point-of-care tests, as well as blood and urine cultures and antimicrobial susceptibility testing, are performed on site. On day 28, patients provide a second venous blood sample for serology and information on clinical outcome. Further diagnostic assays are performed at international reference laboratories. Blood and pharyngeal samples from matched community controls enable calculation of AFs, and surveys of treatment seeking allow estimation of the incidence of common infections. Additional assays detect markers that may differentiate bacterial from non-bacterial causes of illness and/or prognosticate illness severity. Social science research on antimicrobial use will inform future recommendations for fever case management. Residual samples from participants are stored for future use.Ethics and disseminationEthics approval was obtained from all relevant institutional and national committees; written informed consent is obtained from all participants or parents/guardians. Final results will be shared with participating communities, and in open-access journals and other scientific fora. Study documents are available online (https://doi.org/10.17037/PUBS.04652739).

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Cost-Effectiveness of Rapid Point-of-Care Prenatal Syphilis Screening in Sub-Saharan Africa

Sexually Transmitted Diseases ◽

10.1097/olq.0b013e318176196d ◽

2008 ◽

Vol 35 (9) ◽

pp. 775-784 ◽

Cited By ~ 46

Author(s):

Chara E. Rydzak ◽

Sue J. Goldie

Keyword(s):

Cost Effectiveness ◽

Point Of Care ◽

Sub Saharan Africa ◽

Syphilis Screening ◽

Sub Saharan

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Initial Experience with Cancer Guidelines Navigator, a tool to standardize and improve the quality of cancer care in Sub-Saharan Africa, at Ocean Road Cancer Institute in Tanzania.

Journal of Clinical Oncology ◽

10.1200/jco.2020.38.15_suppl.e14106 ◽

2020 ◽

Vol 38 (15_suppl) ◽

pp. e14106-e14106

Author(s):

Fernando Jose Suarez Saiz ◽

Leemor Yuravlivker ◽

Jerry Ndumbalo ◽

Julius Mwaiselage ◽

Sadiq Maalim Siu ◽

...

Keyword(s):

Cancer Treatment ◽

Treatment Planning ◽

Reference System ◽

Point Of Care ◽

Lessons Learned ◽

Ease Of Use ◽

Sub Saharan Africa ◽

Digital Reference ◽

Sub Saharan ◽

Cancer Guidelines

e14106 Background: The IBM Cancer Guidelines Navigator (CGN) is a digital reference system to support treatment planning that allows clinicians to enter a cancer patient’s clinical characteristics and presents the corresponding treatment options in the NCCN Harmonized Guidelines (TM) for Sub-Saharan Africa. In October 2019, Ocean Road Cancer Institute (ORCI) in Tanzania became the first site in Africa to initiate a hospital-wide implementation of the tool to help clinicians reduce cancer treatment variability by increasing adherence to standard evidence-based care. We describe training and lessons learned from system introduction. Methods: Training for clinical staff at ORCI occurred over one week and included daily one-hour lectures, followed by personalized hands-on training. A survey was administered to assess usability and use cases of the tool. Results: Thirty-one ORCI clinical and IT staff members participated in training, and 12 completed the survey. Responses indicated that the most beneficial uses for CGN were at point of care and for self-learning. Participants indicated that the top benefits of the tool were quick access to guidelines and evidence (75%) and ease of use (58%). Expanding cancer coverage (42%), offline access and better integration into the workflow (25%) were identified as areas for improvement. Post-training, ORCI implemented easier access to CGN on each computer and tablet used for consultation and care management. Conclusions: CGN is a digital reference system that is designed to support easy and efficient access to regionalized cancer-treatment guidelines for point-of-care treatment planning and education. Expansion of this program has been planned for other hospitals in Tanzania. Future studies will examine whether CGN usage affects guideline adherence.

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Serological Diagnostic Assays for HIV-Associated Tuberculosis in Sub-Saharan Africa?

Clinical and Vaccine Immunology ◽

10.1128/cvi.00201-14 ◽

2014 ◽

Vol 21 (6) ◽

pp. 787-790 ◽

Cited By ~ 2

Author(s):

Stephen D. Lawn

Keyword(s):

Potential Role ◽

Point Of Care ◽

Antibody Responses ◽

Sub Saharan Africa ◽

Simple Point ◽

Content Type ◽

Diagnostic Assays ◽

Hiv Coinfection ◽

Sub Saharan

ABSTRACTIn this issue ofClinical and Vaccine Immunology, Siev and colleagues present an evaluation of antibody responses to four immunodominant proteins ofMycobacterium tuberculosisin patients with HIV-associated pulmonary tuberculosis (TB) in South Africa (M. Siev, D. Wilson, S. Kainth, V. O. Kasprowicz, C. M. Feintuch, E. Jenny-Avital, and J. J. Achkar, 21:791–798, 2014, doi:http://dx.doi.org/10.1128/CVI.00805-13). This commentary discusses the enormous need for simple point-of-care assays for tuberculosis (TB) diagnosis in patients with and without HIV coinfection in high-burden settings and considers the potential role of serological assays and the huge challenges inherent in developing and validating such assays.

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Redefining typhoid diagnosis: what would an improved test need to look like?

10.1101/19001958 ◽

2019 ◽

Author(s):

Richard Mather ◽

Heidi Hopkins ◽

Christopher M. Parry ◽

Sabine Dittrich

Keyword(s):

Typhoid Fever ◽

Diagnostic Test ◽

Clinical Medicine ◽

Point Of Care ◽

Treatment Algorithm ◽

Febrile Illness ◽

Diagnosis And Treatment ◽

Acute Febrile Illness ◽

Next Generation ◽

Antibiotic Overuse

IntroductionTyphoid fever is one of the most common bacterial causes of acute febrile illness in the developing world, with an estimated 10.9 million new cases and 116.8 thousand deaths in 2017. Typhoid point-of-care (POC) diagnostic tests are widely used but have poor sensitivity and specificity, resulting in antibiotic overuse that has led to the emergence and spread of multidrug resistant strains. With recent advances in typhoid surveillance and detection, this is the ideal time to produce a target product profile (TPP) that guides product development and ensure that a next-generation test meets the needs of users in the resource-limited settings where typhoid is endemic.MethodsA structured literature review was conducted to develop a draft TPP for a next-generation typhoid diagnostic test with minimal and optimal desired characteristics for 36 test parameters. The TPP was refined using feedback collected from a Delphi survey of key stakeholders in clinical medicine, microbiology, diagnostics and public and global health.ResultsA next-generation typhoid diagnostic test should improve patient management through the diagnosis and treatment of infection with acute Salmonella enterica serovars Typhi or Paratyphi with a sensitivity ≥90% and specificity ≥95%. The test would ideally be used at the lowest level of the healthcare system in settings without a reliable power or water supply and provide results in less than 15 minutes at a cost of <$1.00 USD.ConclusionThis report outlines the first comprehensive TPP for typhoid fever and is intended to guide the development of a next-generation typhoid diagnostic test. An accurate POC test will reduce the morbidity and mortality of typhoid fever through rapid diagnosis and treatment and will have the greatest impact in reducing antimicrobial resistance if it is combined with diagnostics for other causes of acute febrile illness in a treatment algorithm.

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Evaluating kidney function using a point-of-care creatinine test in Ugandan children with severe malaria: a prospective cohort study

BMC Nephrology ◽

10.1186/s12882-021-02573-x ◽

2021 ◽

Vol 22 (1) ◽

Author(s):

Anthony Batte ◽

Kristin J. Murphy ◽

Ruth Namazzi ◽

Katrina Co ◽

Robert O. Opoka ◽

...

Keyword(s):

Severe Malaria ◽

Point Of Care ◽

Isotope Dilution Mass Spectrometry ◽

Kidney Injury ◽

Sub Saharan Africa ◽

Middle Income ◽

Middle Income Countries ◽

Point Of Care Test ◽

Care Assessment ◽

Sub Saharan

Abstract Background Acute kidney injury (AKI) disproportionately affects individuals in low-and middle-income countries (LMIC). However, LMIC—particularly countries in sub-Saharan Africa— are under-represented in global AKI research. A critical barrier in diagnosing AKI is access to reliable serum creatinine results. We evaluated the utility of a point-of-care test to measure creatinine and diagnose AKI in Ugandan children with malaria. Methods Paired admission creatinine was assessed in 539 Ugandan children 6 months to 4 years of age hospitalized with severe malaria based on blood smear or rapid diagnostic test. Creatinine levels were measured using isotope dilution mass spectrometry (IDMS)-traceable methods. The reference creatinine was measured using the modified Jaffe method by a certified laboratory and the point-of-care testing was conducted using an i-STAT blood analyzer (i-STAT1, with and without adjustment for the partial pressure of carbon dioxide). AKI was defined and staged using the Kidney Disease: Improving Global Outcomes criteria. Results The mean age of children was 2.1 years, and 21.6% of children were stunted. Mortality was 7.6% in-hospital. Over the entire range of measured creatinine values (<0.20mg/dL-8.4mg/dL), the correlation between the reference creatinine and adjusted and unadjusted point-of-care creatinine was high with R2 values of 0.95 and 0.93 respectively; however, the correlation was significantly lower in children with creatinine values <1mg/dL (R2 of 0.44 between the reference and adjusted and unadjusted i-STAT creatinine). The prevalence of AKI was 45.5% using the reference creatinine, and 27.1 and 32.3% using the unadjusted and adjusted point-of-care creatinine values, respectively. There was a step-wise increase in mortality across AKI stages, and all methods were strongly associated with mortality (p<0.0001 for all). AKI defined using the reference creatinine measure was the most sensitive to predict mortality with a sensitivity of 85.4% compared to 70.7 and 63.4% with the adjusted and unadjusted point-of-care creatinine values, respectively. Conclusions Point-of-care assessment of creatinine in lean Ugandan children <4 years of age underestimated creatinine and AKI compared to the clinical reference. Additional studies are needed to evaluate other biomarkers of AKI in LMIC to ensure equitable access to AKI diagnostics globally.

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