A model for point of care testing for non-communicable disease diagnosis in resource-limited countries

Malcolm, Stuart; Cadet, J.; Crompton, Lindsay; DeGennaro, Vincent

doi:10.1017/gheg.2019.6

Cited by 14 publications

(18 citation statements)

References 28 publications

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“… 147 Integrating biochemical testing for key chronic conditions into plans for laboratory strengthening could promote whole-patient care as well as economies of scale, but selection of appropriate NCD indicators can be complicated because some are better suited to clinical rather than laboratory testing. Malcolm et al 148 discussed testing for 3 indicators that may, in some circumstances, be candidates for inclusion in the set of core JEE diagnostic tests in resource-limited environments: creatinine for kidney disease, cholesterol for dyslipidemias, and hemoglobin A 1c for diabetes.…”

Section: Integrating Ncds Into Technical Areas For Actionmentioning

confidence: 99%

The Role of Noncommunicable Diseases in the Pursuit of Global Health Security

et al. 2021

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Noncommunicable diseases and their risk factors are important for all aspects of outbreak preparedness and response, affecting a range of factors including host susceptibility, pathogen virulence, and health system capacity. This conceptual analysis has 2 objectives. First, we use the Haddon matrix paradigm to formulate a framework for assessing the relevance of noncommunicable diseases to health security efforts throughout all phases of the disaster life cycle: before, during, and after an event. Second, we build upon this framework to identify 6 technical action areas in global health security programs that are opportune integration points for global health security and noncommunicable disease objectives: surveillance, workforce development, laboratory systems, immunization, risk communication, and sustainable financing. We discuss approaches to integration with the goal of maximizing the reach of global health security where infectious disease threats and chronic disease burdens overlap.

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Section: Integrating Ncds Into Technical Areas For Actionmentioning

confidence: 99%

The Role of Noncommunicable Diseases in the Pursuit of Global Health Security

et al. 2021

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“…In addition, the use of POC creatinine testing has already proven feasible in some cross-sectional studies from LMICs. 68,70 Overarching healthcare provider training initiatives may be the most feasible and affordable first step, although implementation of efforts to improve AKI diagnostic capabilities should be adapted based on local infrastructure, cultural beliefs, and current facility capabilities to be most effective.…”

Section: Aki Treatment Dialysismentioning

confidence: 99%

“…For example, expansion of POC serum creatinine testing, a relatively affordable diagnostic tool, could facilitate earlier AKI identification in the community setting and expedite time to treatment; however, the proper and safe use of POC testing requires access to electricity, specific storage conditions, trained personnel, and expensive calibration equipment. 66 – 68 A 2019 comparative cost analysis of clinic-based POC versus centralized laboratory-based testing to monitor HIV treatment in South Africa found clinic-based POC testing to be more expensive than centralized laboratory-based creatinine testing, costing USD$9 per patient versus $3/patient. 69 Despite the higher cost per patient, POC creatinine testing might still be more immediately feasible in some settings, as expansion of centralized laboratory testing capabilities would require more resources, infrastructure, and up-front costs.…”

Section: Questionsmentioning

confidence: 99%

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Pragmatic Recommendations for the Prevention and Treatment of Acute Kidney Injury in Patients with COVID-19 in Low- and Middle-Income Countries

Rudd

Çizmeci

Galli

et al. 2021

The American Journal of Tropical Medicine and Hygiene

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. Current recommendations for the management of patients with COVID-19 and acute kidney injury (AKI) are largely based on evidence from resource-rich settings, mostly located in high-income countries. It is often unpractical to apply these recommendations to resource-restricted settings. We report on a set of pragmatic recommendations for the prevention, diagnosis, and management of patients with COVID-19 and AKI in low- and middle-income countries (LMICs). For the prevention of AKI among patients with COVID-19 in LMICs, we recommend using isotonic crystalloid solutions for expansion of intravascular volume, avoiding nephrotoxic medications, and using a conservative fluid management strategy in patients with respiratory failure. For the diagnosis of AKI, we suggest that any patient with COVID-19 presenting with an elevated serum creatinine level without available historical values be considered as having AKI. If serum creatinine testing is not available, we suggest that patients with proteinuria should be considered to have possible AKI. We suggest expansion of the use of point-of-care serum creatinine and salivary urea nitrogen testing in community health settings, as funding and availability allow. For the management of patients with AKI and COVID-19 in LMICS, we recommend judicious use of intravenous fluid resuscitation. For patients requiring dialysis who do not have acute respiratory distress syndrome (ARDS), we suggest using peritoneal dialysis (PD) as first choice, where available and feasible. For patients requiring dialysis who do have ARDS, we suggest using hemodialysis, where available and feasible, to optimize fluid removal. We suggest using locally produced PD solutions when commercially produced solutions are unavailable or unaffordable.

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“…Such patients face greater difficulty in properly managing their condition because of the difficulty in accessing medical care and a lack of regular monitoring of glycated hemoglobin (HbA1c) levels and therapeutic drugs ( 2 ). Among the most recent technologies developed for the care of patients with DM, point-of-care devices for the estimation of HbA1c levels have been shown to have the potential to improve access to regular monitoring of HbA1c levels for people with difficulty in accessing health services ( 3 , 4 ). Further, people who live far from urban centers are at a significantly higher risk of not having their health problems properly diagnosed or monitored ( 5 ).…”

Section: Introductionmentioning

confidence: 99%

Improving Access to the Glycated Hemoglobin Test in Rural Communities With Point-of-Care Devices: An Application Study

et al. 2021

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Background: Living in a rural or remote area is frequently associated with impaired access to health services, which directly affects the possibility of early diagnosis and appropriate monitoring of diseases, mainly non-communicable ones, because of their asymptomatic onset and evolution. Point-of-care devices have emerged as useful technologies for improving access to several laboratory tests closely patients' beds or homes, which makes it possible to eliminate the distance barrier.Objective: To evaluate the application of point-of-care technology for glycated hemoglobin (HbA1c) estimation in the assessment of glycemic control and identification of new diagnoses of diabetes in primary care among rural communities in a Brazilian municipality.Materials and Methods: We included individuals aged 18 years or older among rural communities in a Brazilian municipality. From September 2019 to February 2020, participants were assessed for anthropometrics, blood pressure, and capillary glycemia during routine primary care team activities at health fairs and in patient groups. Participants previously diagnosed with diabetes but without recent HbA1c test results or those without a previous diagnosis but with random capillary glycemia higher than 140 mg/dL were considered positive and were tested for HbA1c by using a point-of-care device.Results: At the end of the study, 913 individuals were accessed. Of these, 600 (65.7%) had no previous diagnosis of diabetes, 58/600 (9.7%) refused capillary glycemia screening and 542/600 (90.7%) were tested. Among tested individuals, 73/542 (13.5%) cases without a previous diagnosis of diabetes, were positive for capillary glycemia. Among positives, 31/73 (42.5%) had HbA1c levels that were considered indicative of prediabetes and 16/73 (21.9%) were newly diagnosed with diabetes. Among the participants, 313/913 (34.3%) were previously diagnosed with diabetes. Recent HbA1c results were unavailable for 210/313 (67.1%). These individuals were tested using point-of-care devices. Among them, 143/210 (68.1%) had HbA1c levels higher than target levels (>7% and >8% for adults and elderly individuals, respectively.Conclusion: The application of point-of-care devices for HbA1c level measurement improved the access to this test for people living in rural or remote areas. Thus, it was possible to include this technology in the routine activities of primary health care teams, which increased the rates of new diagnoses and identification of patients with uncontrolled glycemia.

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A model for point of care testing for non-communicable disease diagnosis in resource-limited countries

Cited by 14 publications

References 28 publications

The Role of Noncommunicable Diseases in the Pursuit of Global Health Security

The Role of Noncommunicable Diseases in the Pursuit of Global Health Security

Pragmatic Recommendations for the Prevention and Treatment of Acute Kidney Injury in Patients with COVID-19 in Low- and Middle-Income Countries

Improving Access to the Glycated Hemoglobin Test in Rural Communities With Point-of-Care Devices: An Application Study

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