scholarly journals Point of Care Diagnostics in Resource-Limited Settings: A Review of the Present and Future of PoC in Its Most Needed Environment

Biosensors ◽  
2020 ◽  
Vol 10 (10) ◽  
pp. 133
Author(s):  
Benjamin Heidt ◽  
Williane Siqueira ◽  
Kasper Eersels ◽  
Hanne Diliën ◽  
Bart van Grinsven ◽  
...  
Keyword(s):  
Low Income ◽  
Value Chain ◽  
Point Of Care ◽  
Healthcare Providers ◽  
Low Income Countries ◽  
Patient Treatment ◽  
Resource Limited Settings ◽  
Widespread Application ◽  
Resource Limited ◽  
Fundamental Research

Point of care (PoC) diagnostics are at the focus of government initiatives, NGOs and fundamental research alike. In high-income countries, the hope is to streamline the diagnostic procedure, minimize costs and make healthcare processes more efficient and faster, which, in some cases, can be more a matter of convenience than necessity. However, in resource-limited settings such as low-income countries, PoC-diagnostics might be the only viable route, when the next laboratory is hours away. Therefore, it is especially important to focus research into novel diagnostics for these countries in order to alleviate suffering due to infectious disease. In this review, the current research describing the use of PoC diagnostics in resource-limited settings and the potential bottlenecks along the value chain that prevent their widespread application is summarized. To this end, we will look at literature that investigates different parts of the value chain, such as fundamental research and market economics, as well as actual use at healthcare providers. We aim to create an integrated picture of potential PoC barriers, from the first start of research at universities to patient treatment in the field. Results from the literature will be discussed with the aim to bring all important steps and aspects together in order to illustrate how effectively PoC is being used in low-income countries. In addition, we discuss what is needed to improve the situation further, in order to use this technology to its fullest advantage and avoid “leaks in the pipeline”, when a promising device fails to take the next step of the valorization pathway and is abandoned.

scholarly journals Multiple sclerosis in resource-limited settings

Neurology ◽  
2019 ◽  
Vol 93 (4) ◽  
pp. 176-180 ◽  
Author(s):  
Farrah J. Mateen
Keyword(s):  
Multiple Sclerosis ◽  
Low Income ◽  
Care Delivery ◽  
Point Of Care ◽  
Models Of Care ◽  
Low Income Countries ◽  
Resource Limited Settings ◽  
Middle Income ◽  
Clinical Registries ◽  
Resource Limited

This position piece is meant to extend the humanitarian argument for assisting people with multiple sclerosis (MS) in resource-limited settings, in this case, through research. It is also meant to highlight areas of strength of some low- and middle-income countries (LMICs), and therefore emphasize how the field of MS could best be served globally by more research with and for resource-limited populations. Possible areas of particular strength include (1) ethnicity, genetic diversity, and migration studies; (2) analysis of possibly emerging environmental and lifestyle-related risk factors; (3) understanding the immune system when exposed to novel pathogens and various infectious agents; (4) reverse innovation to promote better point-of-care diagnostic tests; (5) high participation rates in clinical registries and research; (6) appreciation of MS in special populations including a higher focus on pediatrics and pregnancy; (7) culturally adept means of treatment and rehabilitating disability; (8) models of care delivery for chronic, complex neurologic diseases; and (9) use of off-label, generic, and less commonly implemented disease-modifying therapy sequences. Strategies for strengthening the MS research landscape include (1) creation of centers of research excellence in LMICs and twinning of institutions between high- and low-income countries; (2) standardization of research procedures and reduction of bureaucracies; (3) consensus meetings and network building; (4) opening additional avenues for publications and expanding the types of available publications; (5) identifying and establishing dedicated funding mechanisms; (6) focus on local relevance; and (7) setting expectations to include patients from LMICs in international clinical trials. These underutilized opportunities build an argument that global partnerships for research and knowledge coordination could better reach across populations, geographies, economies, and expertise.

3D Printing of Microfluidics for Point of Care Diagnosis

2017 ◽  
Author(s):  
John P. Sibbitt ◽  
Mei He
Keyword(s):  
3D Printing ◽  
Low Income ◽  
Point Of Care ◽  
Low Cost ◽  
High Sensitivity ◽  
Disease Diagnosis ◽  
Low Income Countries ◽  
3D Design ◽  
Resource Limited ◽  
Production Techniques

Microfluidic lab-on-a-chip (MLOC) technology is a promising approach for point-of-care (POC) diagnosis; low reagent consumption, high sensitivity and quick analysis time are the most prominent benefits. However, microfabrication of MLOCs utilizes specialized techniques and infrastructure, making conventional fabrication time consuming and difficult. While relatively inexpensive production techniques exist for POC diagnoses, such as replication of polymer-based (e.g., PDMS) microfluidic POC devices on lithographic molds, this approach has limitations including: further hydrophilic surface modifications of PDMS, inability to change lithographic mold Z dimensions, and slow prototyping. In contrast, stereo-lithographical (SLA) printing can integrate all of the necessary fabrication resources in one instrument, allowing highly versatile microfluidic devices to be made at low cost. In this paper, we report two microfabrication approaches of microfluidics utilizing (SLA) 3D printing technology: I) Direct SLA printing of channels and structures of a monolithic microfluidic POC device; II) Indirect fabrication, utilizing SLA 3D printed molds for PDMS based microfluidic device replication. Additionally, we discuss previous work providing a proof of concept of applications in POC diagnosis, using direct 3D printing fabrication (approach I). The robustness and simplicity of these protocols allow integrating 3D design and microfabrication with smartphone-based disease diagnosis as a stand-alone system, offering strong adaptability for establishing diagnostic capacity in resource-limited areas and low-income countries.

scholarly journals Demonstration of a Longitudinal Action Medical Mission (LAMM) Model to Teach Point-of-Care Ultrasound in Resource-Limited Settings

2020 ◽  
Author(s):  
Michael Steven Yao ◽  
Lauren Uhr ◽  
George Daghlian ◽  
Junedh M Amrute ◽  
Ramya Deshpande ◽  
...  
Keyword(s):  
Point Of Care ◽  
Healthcare Delivery ◽  
Healthcare Providers ◽  
The United States ◽  
Point Of Care Ultrasound ◽  
Post Intervention ◽  
Resource Limited Settings ◽  
Resource Limited ◽  
Medical Education And Training ◽  
Medical Volunteerism

BACKGROUND: Short-term medical missions prevail as the most common form of international medical volunteerism, but they are ill-suited for medical education and training local providers in resource-limited settings. OBJECTIVE: The purpose of this study is to evaluate the effectiveness of a longitudinal educational program in training clinicians how to perform point-of-care ultrasound (POCUS) in resource-limited clinics. DESIGN: A retrospective study of such a four-month POCUS training program was conducted with clinicians from a rural hospital in Haiti. The model included one-on-one, in-person POCUS teaching sessions by volunteer instructors from the United States and Europe. The Haitian trainees were assessed at the start of the program and at its conclusion by a direct objective structured clinical examination (OSCE), administered by the visiting instructors, with similar pre- and post- program ultrasound competency assessments. RESULTS: Post-intervention, a significant improvement was observed (p < 0.0001), and each trainee showed significant overall improvement in POCUS competency independent of the initial competency pre-training (p < 0.005). There was a statistically significant improvement in POCUS application for five of the six medically relevant assessment categories tested. CONCLUSION: Our results provide a proof-of-concept for the longitudinal education-centered healthcare delivery framework in a resource-limited setting. Our longitudinal model provides local healthcare providers the skills to detect and diagnose significant pathologies, thereby reducing avoidable morbidity and mortality at little or no addition cost or risk to the patient. Furthermore, training local physicians obviates the need for frequent volunteering trips, saving costs in healthcare training and delivery.

scholarly journals 590Online + In-person: A Model for the Instruction of Contemporary Epidemiologic Methods in Resource-Limited Settings

2021 ◽  
Vol 50 (Supplement_1) ◽  
Author(s):  
Vivian Avelino-silva ◽  
Aggrey Semeere ◽  
Miriam Laker-Oketta ◽  
Helen Byakwaga ◽  
Mark Pletcher ◽  
...  
Keyword(s):  
Small Group ◽  
Low Income ◽  
Epidemiologic Methods ◽  
Low Cost ◽  
Group Discussion ◽  
Low Income Countries ◽  
Resource Limited Settings ◽  
Resource Limited ◽  
High Level ◽  
The U.S

Abstract Focus of Presentation Many low-income countries cannot support faculty to develop contemporary graduate-level courses in epidemiology and biostatistics. There are also insufficient resources to support all students who are interested in traveling abroad to study in resource-rich settings. To address this, we describe our experience with training a few students from resource-limited countries in the U.S. who have subsequently returned to their home countries and became instructors in a novel online plus in-person teaching model. Findings Most courses at our major U.S. training program in epidemiology videotape lectures for viewing on one’s own and post all other materials (e.g., homework) on the course’s website. The weekly learning cycle culminates with an in-person high-level small group discussion, led by a faculty member who facilitates 10-15 students. For the past 5 years, non-U.S. scholars from Africa and South America who have taken our courses in the U.S. have travelled back to their countries and become small group leaders for our courses. Identical to U.S. students, the students in these international venues view videotaped lectures, access other materials online, and have weekly in-person small group discussions. These international students represent another concurrent small group for the U.S-based course; they have identical access and evaluation. Conclusions By pairing online resources from a resource-rich setting with local in-person instruction, we provide students in resource-limited settings access to contemporary instruction in epidemiology at very low cost. Key messages Online plus local in-person teaching is a feasible model for providing instruction regarding epidemiologic methods in resource-limited settings.

scholarly journals Towards AI-Enabled Multimodal Diagnostics and Management of COVID-19 and Comorbidities in Resource-Limited Settings

Informatics ◽  
2021 ◽  
Vol 8 (4) ◽  
pp. 63
Author(s):  
Olawande Daramola ◽  
Peter Nyasulu ◽  
Tivani Mashamba-Thompson ◽  
Thomas Moser ◽  
Sean Broomhead ◽  
...  
Keyword(s):  
Point Of Care ◽  
Low Cost ◽  
Personal Data ◽  
Disease Diagnosis ◽  
Careful Consideration ◽  
Diagnostic Methods ◽  
Contact Tracing ◽  
Patient Treatment ◽  
Resource Limited Settings ◽  
Resource Limited

A conceptual artificial intelligence (AI)-enabled framework is presented in this study involving triangulation of various diagnostic methods for management of coronavirus disease 2019 (COVID-19) and its associated comorbidities in resource-limited settings (RLS). The proposed AI-enabled framework will afford capabilities to harness low-cost polymerase chain reaction (PCR)-based molecular diagnostics, radiological image-based assessments, and end-user provided information for the detection of COVID-19 cases and management of symptomatic patients. It will support self-data capture, clinical risk stratification, explanation-based intelligent recommendations for patient triage, disease diagnosis, patient treatment, contact tracing, and case management. This will enable communication with end-users in local languages through cheap and accessible means, such as WhatsApp/Telegram, social media, and SMS, with careful consideration of the need for personal data protection. The objective of the AI-enabled framework is to leverage multimodal diagnostics of COVID-19 and associated comorbidities in RLS for the diagnosis and management of COVID-19 cases and general support for pandemic recovery. We intend to test the feasibility of implementing the proposed framework through community engagement in sub-Saharan African (SSA) countries where many people are living with pre-existing comorbidities. A multimodal approach to disease diagnostics enabling access to point-of-care testing is required to reduce fragmentation of essential services across the continuum of COVID-19 care.

scholarly journals Validation of a point-of-care rapid diagnostic test for hepatitis C for use in resource-limited settings

2019 ◽  
Vol 11 (4) ◽  
pp. 314-315
Author(s):  
James S Leathers ◽  
Maria Belen Pisano ◽  
Viviana Re ◽  
Gertine van Oord ◽  
Amir Sultan ◽  
...  
Keyword(s):  
Point Of Care ◽  
Low Cost ◽  
Rapid Diagnosis ◽  
Direct Acting Antivirals ◽  
Resource Limited Settings ◽  
Rapid Diagnosis Test ◽  
Resource Limited ◽  
Specificity And Sensitivity ◽  
Hcv Screening ◽  
Direct Acting

Abstract Background Treatment of HCV with direct-acting antivirals has enabled the discussion of HCV eradication worldwide. Envisioning this aim requires implementation of mass screening in resource-limited areas, usually constrained by testing costs. Methods We validated a low-cost, rapid diagnosis test (RDT) for HCV in three different continents in 141 individuals. Results The HCV RDT showed 100% specificity and sensitivity across different samples regardless of genotype or viral load (in samples with such information, 90%). Conclusions The HCV test validated in this study can allow for HCV screening in areas of need when properly used.

scholarly journals Aptamer-Based Diagnostic Systems for the Rapid Screening of TB at the Point-of-Care

Diagnostics ◽  
2021 ◽  
Vol 11 (8) ◽  
pp. 1352
Author(s):  
Darius Riziki Martin ◽  
Nicole Remaliah Sibuyi ◽  
Phumuzile Dube ◽  
Adewale Oluwaseun Fadaka ◽  
Ruben Cloete ◽  
...  
Keyword(s):  
Low Income ◽  
Point Of Care ◽  
Health Care Systems ◽  
Cost Effective ◽  
Rapid Screening ◽  
Low Income Countries ◽  
Sputum Smear ◽  
Diagnostic Systems ◽  
Molecular Tests ◽  
Rapid Tests

The transmission of Tuberculosis (TB) is very rapid and the burden it places on health care systems is felt globally. The effective management and prevention of this disease requires that it is detected early. Current TB diagnostic approaches, such as the culture, sputum smear, skin tuberculin, and molecular tests are time-consuming, and some are unaffordable for low-income countries. Rapid tests for disease biomarker detection are mostly based on immunological assays that use antibodies which are costly to produce, have low sensitivity and stability. Aptamers can replace antibodies in these diagnostic tests for the development of new rapid tests that are more cost effective; more stable at high temperatures and therefore have a better shelf life; do not have batch-to-batch variations, and thus more consistently bind to a specific target with similar or higher specificity and selectivity and are therefore more reliable. Advancements in TB research, in particular the application of proteomics to identify TB specific biomarkers, led to the identification of a number of biomarker proteins, that can be used to develop aptamer-based diagnostic assays able to screen individuals at the point-of-care (POC) more efficiently in resource-limited settings.

scholarly journals 3D Printed Imaging Platform for Portable Cell Counting

The Analyst ◽  
2021 ◽  
Author(s):  
Diwakar M. Awate ◽  
Cicero C. Pola ◽  
Erica Shumaker ◽  
Carmen L Gomes ◽  
Jaime Javier Juarez
Keyword(s):  
3D Printing ◽  
Point Of Care ◽  
Cost Effective ◽  
Cell Counting ◽  
Biomedical Sciences ◽  
Widespread Application ◽  
Resource Limited ◽  
Cost Effective Approach ◽  
3D Printed

Despite having widespread application in the biomedical sciences, flow cytometers have several limitations that prevent their application to point-of-care (POC) diagnostics in resource-limited environments. 3D printing provides a cost-effective approach...

Multi-Angle Lensfree Holographic Imaging for 3-D Cytometry on a Chip

2010 ◽  
Author(s):  
Ting-Wei Su ◽  
Serhan O. Isikman ◽  
Waheb Bishara ◽  
Derek K. Tseng ◽  
Anthony Erlinger ◽  
...  
Keyword(s):  
Optical Microscopy ◽  
Biomedical Applications ◽  
Point Of Care ◽  
Resource Limited Settings ◽  
Holographic Imaging ◽  
Essential Tool ◽  
Resource Limited

Optical microscopy is an essential tool for many biomedical applications. Although commonly-used in laboratory settings, conventional optical microscopes are bulky and relatively costly to use in resource-limited settings which partially limit their use in point-of-care applications.

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