Infectious diseases remain a source of concern in the EU due to the emergence of new resistance to anti-infective drugs. The EU is supporting the deployment of innovative solutions in low resource settings in the world with the aim to help the local populations avoid the emergence of new resistance that can spread across borders.
Healthcare delivery in low resource settings presents a number of challenges. First and foremost is the availability of diagnostic tools, as resource constraints and lack of trained personnel are often a limiting factor. Through the work and support of a number of foundations, NGOs or other donors and the private sector, the development of simple diagnostic tools and the implementation of global health programs are helping the populations in need to have access to these new technologies. The portability, ease of use and accuracy of such tests are key features, however speed to result in such environments is also of utmost importance as illustrated in the examples below:
- Tuberculosis: the conventional diagnostic technologies either show poor performance or require weeks to generate a result. Most of the time, the patient comes to give the sputum sample and leaves the health center, resulting in a significant percentage of those patients being lost, never receiving their results or getting a treatment. Since the end of 2010 WHO endorsed a new, rapid, accurate and easy to use cartridge based molecular technology, that delivers the result in less than 2 hours, allowing the patient to stay until the result is generated and the course of action defined. This has tremendous implications for the patient and for the people living in its close proximity. The patient will be started on the right treatment early on and increase his/her chances of cure. It is also critical to know that on average a non-diagnosed active TB patient contaminates 10- 15 other patients in the course of one year (1). This means that an early diagnostic result leads to an early start of the treatment which in turns rapidly reduces the rate of contamination and therefore the disease burden in the target population.
- Malaria: Malaria can only be distinguished from other causes of fever by using diagnostic tests to detect parasites in the blood (2). Given the time it takes to run a microscopy test, physicians confronted with patients showing malaria-like febrile illness in endemic countries often simply prescribe anti-malarial drugs, which do not help the patient, increase both the risk to develop drug resistance and the cost burden to the system. In a study run in Senegal in 2007 (3), the use of Rapid Diagnostic Tests that deliver an accurate result in about 15 minutes from a droplet of blood has allowed to increase the parasite-based diagnosis from 3.9% of reported malaria-like febrile illness to 86% over a 3 year period. The prescription of anti-malarial drugs dropped from 72.9% to 31.5% in the same period, averting the inappropriate use of 516,576 courses of therapy and saving US $ 1.57million, while the patients could be treated for the right cause of fever.
Tuberculosis and malaria are two examples that show how the implementation of rapid diagnostic tools has the potential to curb the burden of diseases in endemic, low resource countries.
(1) WHO – Fact sheet N°104
(2) Bell D, et al. (2012)FIND Malaria strategy
(3) Thiam S, Thior M, Faye B, Ndiop M, Diouf ML, et al. (2011) Major reduction in Anti-Malarial Drug Consumption in Senegal after Nationwide Introduction of Malaria Rapid Diagnostic Tests.