Improving the development and deployment of rapid diagnostic tests in South East Asia

The Academy of Medical Sciences, in collaboration with the Philippines National Academy of Science and Technology (NAST), convened a policy workshop on rapid diagnostic tests in South East Asia in Manila, Philippines on the 23-24 October 2018.

Ongoing

RDTs offer a significant opportunity to improve healthcare provision in low and middle income countries, for infectious and non-communicable diseases. They are revolutionising how disease is diagnosed and treated, and are helping to deliver higher standards of healthcare and greater efficiency across public and private health care sectors as well as at the community level. By identifying specific causes of infection (and in some cases antimicrobial resistance genes), such tests enable clinicians to prescribe the most appropriate treatment. This ensures that patients receive the optimal treatment more quickly.

Despite much scientific and technological progress, and some notable successes, the potential of rapid diagnostic tests has yet to be fully realised in LMICs. For RDTs to be optimally useful they need to be readily available, perform well and health workers who use them must be trained appropriately. Achieving this is dependent on barriers to development and deployment being identified and addressed, and all members of the community working collaboratively to support the process from discovery to deployment.

Rapid diagnostic tests hold enormous promise in the battle against infectious disease in LMICs. Multiple diagnostic tests have been developed for many pathogens, including those primarily affecting LMICs. Good progress has been made in the implementation of rapid tests for several infections, including HIV, malaria and tuberculosis (TB). South East Asia has experience a number of outbreaks of infectious diseases such as bird flu (H5H1) in Kong Kong, SARS outbreak in Southern China, and chickungunya in India, other infectious diseases such as Malaria are endemic to the region. RDTs offer the opportunity to quickly diagnose, treat patients and contain the spread of the disease. Point-of-care tests could also help to address issues with laboratory infrastructure, which is poorly resourced in many LMICs. Being largely autonomous, point-of-care rapid tests can provide effective diagnostic services even in settings with limited laboratory facilities. Hence RDTs will also be vital in the diagnosis and treatment of many non-communicable diseases.

In 2016, the Academy of Medical Sciences (AMS) in collaboration with the InterAcademy Partnership for Health held a workshop on ‘Improving the development and deployment of rapid diagnostic tests in LMICs’. The findings of the workshop examined a range of barriers that are limiting the development and deployment of rapid diagnostic tests, and discussed possible ways in which these barriers might be overcome, which were published in a report. Highlighted barriers included lack of financial investment, insufficient prioritisation on a national level, the challenging requirements of diagnostic tools in LMICs, complex and heterogeneous regulatory environments, lacking quality assurance systems, ensuring the involvement of both the public and private sectors and the fact that many RDTs are only designed to diagnose a single disease causing agent.

In 2018 the World Health Organization has published a list of essential diagnostic tests needed to improve diagnosis and treatment outcomes. The list includes several ‘tier I’ essential in vitro diagnostics to be used in primary healthcare settings with either no laboratories or only small laboratories with trained healthcare personnel but not trained laboratory technicians. This list should help with setting RDT development priorities.

This two-day workshop of key stakeholders from South East Asia and the UK stimulated thinking around diagnostics in the region focusing on the long term objective to make diagnostic technology accessible and usable for all. Through this workshop we moved beyond the approach of looking at only communicable or non-communicable diseases and to look at the patient holistically rather than just the condition, building on the AMS multimorbidity report ‘Multimorbidity: a priority for global health research’. The aims of the workshop were to:

  • Explore the current, and potential, impact of diagnostics in South East Asia.
  • Consider the state of the art, in terms of some of the key platforms and technologies under development in the region.
  • Identify barriers and challenges for developing and implementing diagnostics in South East Asia, and the potential impacts of efficient implementation.
  • Facilitate cross-sector discussion and identify areas which would benefit from greater collaboration.

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