Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 10 de 10
Filtrar
Más filtros










Base de datos
Intervalo de año de publicación
1.
Sex Transm Infect ; 96(5): 342-347, 2020 08.
Artículo en Inglés | MEDLINE | ID: mdl-32241905

RESUMEN

OBJECTIVES: In 2016, WHO estimated 376 million new cases of the four main curable STIs: gonorrhoea, chlamydia, trichomoniasis and syphilis. Further, an estimated 290 million women are infected with human papillomavirus. STIs may lead to severe reproductive health sequelae. Low-income and middle-income countries carry the highest global burden of STIs. A large proportion of urogenital and the vast majority of extragenital non-viral STI cases are asymptomatic. Screening key populations and early and accurate diagnosis are important to provide correct treatment and to control the spread of STIs. This article paints a picture of the state of technology of STI point-of-care testing (POCT) and its implications for health system integration. METHODS: The material for the STI POCT landscape was gathered from publicly available information, published and unpublished reports and prospectuses, and interviews with developers and manufacturers. RESULTS: The development of STI POCT is moving rapidly, and there are much more tests in the pipeline than in 2014, when the first STI POCT landscape analysis was published on the website of WHO. Several of the available tests need to be evaluated independently both in the laboratory and, of particular importance, in different points of care. CONCLUSION: This article reiterates the importance of accurate, rapid and affordable POCT to reach universal health coverage. While highlighting the rapid technical advances in this area, we argue that insufficient attention is being paid to health systems capacity and conditions to ensure the swift and rapid integration of current and future STI POCT. Unless the complexity of health systems, including context, institutions, adoption systems and problem perception, are recognised and mapped, simplistic approaches to policy design and programme implementation will result in poor realisation of intended outcomes and impact.


Asunto(s)
Prestación de Atención de Salud/organización & administración , Pruebas en el Punto de Atención/organización & administración , Enfermedades de Transmisión Sexual/diagnóstico , Infecciones por Chlamydia/diagnóstico , Infecciones por Chlamydia/tratamiento farmacológico , Infecciones por Chlamydia/prevención & control , Infecciones por Chlamydia/transmisión , Femenino , Gonorrea/diagnóstico , Gonorrea/tratamiento farmacológico , Gonorrea/prevención & control , Gonorrea/transmisión , Infecciones por VIH/diagnóstico , Infecciones por VIH/tratamiento farmacológico , Infecciones por VIH/prevención & control , Infecciones por VIH/transmisión , Humanos , Ciencia de la Implementación , Masculino , Infecciones por Mycoplasma/diagnóstico , Infecciones por Mycoplasma/tratamiento farmacológico , Infecciones por Mycoplasma/prevención & control , Infecciones por Mycoplasma/transmisión , Mycoplasma genitalium , Infecciones por Papillomavirus/diagnóstico , Infecciones por Papillomavirus/prevención & control , Infecciones por Papillomavirus/transmisión , Enfermedades de Transmisión Sexual/tratamiento farmacológico , Enfermedades de Transmisión Sexual/prevención & control , Enfermedades de Transmisión Sexual/transmisión , Sífilis/diagnóstico , Sífilis/tratamiento farmacológico , Sífilis/prevención & control , Sífilis/transmisión , Vaginitis por Trichomonas/diagnóstico , Vaginitis por Trichomonas/tratamiento farmacológico , Vaginitis por Trichomonas/prevención & control , Vaginitis por Trichomonas/transmisión
2.
Lancet Infect Dis ; 19(5): e172-e178, 2019 05.
Artículo en Inglés | MEDLINE | ID: mdl-30551872

RESUMEN

Global epidemics of infectious diseases are increasing in frequency and severity. Diagnostics are needed for rapid identification of the cause of the epidemic to facilitate effective control and prevention. Lessons learned from the recent Ebola virus and Zika virus epidemics are that delay in developing the right diagnostic for the right population at the right time has been a costly barrier to disease control and prevention. We believe that it is possible to accelerate and optimise diagnostic development through a five-pronged strategy: by doing a global landscape analysis of diagnostic availability worldwide; through strategic partnerships for accelerating test development, in particular with vaccine companies to identify novel diagnostic targets; by creating and sharing repositories of data, reagents, and well characterised specimens for advancing the development process; by involving key public and private stakeholders, including appropriate regulatory bodies and policy makers, to ensure rapid access for researchers to diagnostics; and last, by fostering an enabling environment for research and access to diagnostics in the countries that need them. The need is great, but not insurmountable and innovative and faster development pathways are urgently required to address current shortfalls.


Asunto(s)
Pruebas Diagnósticas de Rutina , Epidemias/prevención & control , Fiebre Hemorrágica Ebola/diagnóstico , Infección por el Virus Zika/diagnóstico , Bioensayo , Bases de Datos Factuales/provisión & distribución , Ebolavirus/aislamiento & purificación , Monitoreo Epidemiológico , Fiebre Hemorrágica Ebola/epidemiología , Fiebre Hemorrágica Ebola/virología , Humanos , Difusión de la Información/métodos , Asociación entre el Sector Público-Privado/organización & administración , Virus Zika/aislamiento & purificación , Infección por el Virus Zika/epidemiología , Infección por el Virus Zika/virología
3.
J Infect Dis ; 217(7): 1060-1068, 2018 03 13.
Artículo en Inglés | MEDLINE | ID: mdl-29294035

RESUMEN

Epidemics of dengue, Zika, and other arboviral diseases are increasing in frequency and severity. Current efforts to rapidly identify and manage these epidemics are limited by the short diagnostic window in acute infection, the extensive serologic cross-reactivity among flaviviruses, and the lack of point-of-care diagnostic tools to detect these viral species in primary care settings. The Partnership for Dengue Control organized a workshop to review the current landscape of Flavivirus diagnostic tools, identified current gaps, and developed strategies to accelerate the adoption of promising novel technologies into national programs. The rate-limiting step to bringing new diagnostic tools to the market is access to reference materials and well-characterized clinical samples to facilitate performance evaluation. We suggest the creation of an international laboratory-response consortium for flaviviruses with a decentralized biobank of well-characterized samples to facilitate assay validation. Access to proficiency panels are needed to ensure quality control, in additional to in-country capacity building.


Asunto(s)
Anticuerpos Antivirales/sangre , Dengue/diagnóstico , Infección por el Virus Zika/diagnóstico , Anticuerpos Antivirales/inmunología , Seguridad de Productos para el Consumidor , Dengue/historia , Dengue/virología , Virus del Dengue/genética , Virus del Dengue/inmunología , Virus del Dengue/aislamiento & purificación , Ensayo de Inmunoadsorción Enzimática/historia , Ensayo de Inmunoadsorción Enzimática/métodos , Ensayo de Inmunoadsorción Enzimática/tendencias , Historia del Siglo XX , Historia del Siglo XXI , Humanos , Vigilancia de la Población , Reacción en Cadena de la Polimerasa de Transcriptasa Inversa/historia , Reacción en Cadena de la Polimerasa de Transcriptasa Inversa/métodos , Reacción en Cadena de la Polimerasa de Transcriptasa Inversa/tendencias , Sensibilidad y Especificidad , Virus Zika/genética , Virus Zika/inmunología , Virus Zika/aislamiento & purificación , Infección por el Virus Zika/historia , Infección por el Virus Zika/virología
4.
Sex Transm Infect ; 93(S4): S69-S80, 2017 12.
Artículo en Inglés | MEDLINE | ID: mdl-29223965

RESUMEN

OBJECTIVES: Advancing the field of point-of-care testing (POCT) for STIs can rapidly and substantially improve STI control and prevention by providing targeted, essential STI services (case detection and screening). POCT enables definitive diagnosis and appropriate treatment in a single visit and home and community-based testing. METHODS: Since 2014, the WHO Department of Reproductive Health and Research, in collaboration with technical partners, has completed four landscape analyses of promising diagnostics for use at or near the point of patient care to detect syphilis, Neisseria gonorrhoeae, Chlamydia trachomatis, Trichomonas vaginalis and the human papillomavirus. The analyses comprised a literature review and interviews. Two International Technical Consultations on STI POCTs (2014 and 2015) resulted in the development of target product profiles (TPP). Experts in STI microbiology, laboratory diagnostics, clinical management, public health and epidemiology participated in the consultations with representation from all WHO regions. RESULTS: The landscape analysis identified diagnostic tests that are either available on the market, to be released in the near future or in the pipeline. The TPPs specify 28 analytical and operational characteristics of POCTs for use in different populations for surveillance, screening and case management. None of the tests that were identified in the landscape analysis met all of the targets of the TPPs. CONCLUSION: More efforts of the global health community are needed to accelerate access to affordable quality-assured STI POCTs, particularly in low- and middle-income countries, by supporting the development of new diagnostic platforms as well as strengthening the validation and implementation of existing diagnostics according to internationally endorsed standards and the best available evidence.


Asunto(s)
Infecciones por Chlamydia/diagnóstico , Gonorrea/diagnóstico , Infecciones por Papillomavirus/diagnóstico , Pruebas en el Punto de Atención/tendencias , Salud Pública , Salud Reproductiva , Sífilis/diagnóstico , Vaginitis por Trichomonas/diagnóstico , Adulto , Infecciones por Chlamydia/prevención & control , Pruebas Diagnósticas de Rutina , Femenino , Gonorrea/prevención & control , Humanos , Masculino , Infecciones por Papillomavirus/prevención & control , Reproducibilidad de los Resultados , Sífilis/prevención & control , Vaginitis por Trichomonas/prevención & control
6.
Nature ; 528(7580): S68-76, 2015 Dec 03.
Artículo en Inglés | MEDLINE | ID: mdl-26633768

RESUMEN

There are inefficiencies in current approaches to monitoring patients on antiretroviral therapy in sub-Saharan Africa. Patients typically attend clinics every 1 to 3 months for clinical assessment. The clinic costs are comparable with the costs of the drugs themselves and CD4 counts are measured every 6 months, but patients are rarely switched to second-line therapies. To ensure sustainability of treatment programmes, a transition to more cost-effective delivery of antiretroviral therapy is needed. In contrast to the CD4 count, measurement of the level of HIV RNA in plasma (the viral load) provides a direct measure of the current treatment effect. Viral-load-informed differentiated care is a means of tailoring care so that those with suppressed viral load visit the clinic less frequently and attention is focussed on those with unsuppressed viral load to promote adherence and timely switching to a second-line regimen. The most feasible approach to measuring viral load in many countries is to collect dried blood spot samples for testing in regional laboratories; however, there have been concerns over the sensitivity and specificity of this approach to define treatment failure and the delay in returning results to the clinic. We use modelling to synthesize evidence and evaluate the cost-effectiveness of viral-load-informed differentiated care, accounting for limitations of dried blood sample testing. We find that viral-load-informed differentiated care using dried blood sample testing is cost-effective and is a recommended strategy for patient monitoring, although further empirical evidence as the approach is rolled out would be of value. We also explore the potential benefits of point-of-care viral load tests that may become available in the future.


Asunto(s)
Infecciones por VIH/tratamiento farmacológico , Infecciones por VIH/virología , Medicina de Precisión/métodos , Carga Viral , Adolescente , Adulto , África , Anciano , Fármacos Anti-VIH/economía , Fármacos Anti-VIH/farmacología , Fármacos Anti-VIH/uso terapéutico , Análisis Costo-Beneficio , Infecciones por VIH/diagnóstico , Infecciones por VIH/economía , Humanos , Persona de Mediana Edad , Medicina de Precisión/economía , Carga Viral/efectos de los fármacos , Adulto Joven
7.
Int J Gynaecol Obstet ; 130 Suppl 1: S81-3, 2015 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-25983212

RESUMEN

Electronic readers and smartphones have the potential to standardize the interpretation of rapid diagnostic tests (RDTs) and provide timely surveillance program data. RDTs are widely used for HIV and are being increasingly used for syphilis screening in pregnant women. Following the WHO initiative for the validation of elimination of mother-to-child transmission of HIV and syphilis, there is a need for more extensive testing and data monitoring. However, access to timely and accurate data can be challenging once testing is decentralized as data quality at remote sites is often difficult to verify. Electronic RDT readers can help to ensure quality and allow automated data transmission, creating an opportunity for real-time surveillance to inform control strategies and assess intervention impact. Furthermore, by linking the data to existing supply chain management software, stockouts can be minimized. The present opinion piece looks at the opportunities and challenges of using these tools within national elimination programs.


Asunto(s)
Computadoras de Mano , Procesamiento Automatizado de Datos/métodos , Infecciones por VIH/transmisión , Transmisión Vertical de Enfermedad Infecciosa/prevención & control , Sífilis/transmisión , Exactitud de los Datos , Erradicación de la Enfermedad/métodos , Procesamiento Automatizado de Datos/normas , Femenino , Humanos , Tamizaje Masivo/métodos , Embarazo , Diagnóstico Prenatal/métodos
8.
Am J Clin Pathol ; 134(4): 550-5, 2010 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-20855635

RESUMEN

Accreditation is emerging as a preferred framework for building quality medical laboratory systems in resource-limited settings. Despite the low numbers of laboratories accredited to date, accreditation has the potential to improve the quality of health care for patients through the reduction of testing errors and attendant decreases in inappropriate treatment. Accredited laboratories can become more accountable and less dependent on external support. Efforts made to achieve accreditation may also lead to improvements in the management of laboratory networks by focusing attention on areas of greatest need and accelerating improvement in areas such as supply chain, training, and instrument maintenance. Laboratory accreditation may also have a positive influence on performance in other areas of health care systems by allowing laboratories to demonstrate high standards of service delivery. Accreditation may, thus, provide an effective mechanism for health system improvement yielding long-term benefits in the quality, cost-effectiveness, and sustainability of public health programs. Further studies are needed to strengthen the evidence on the benefits of accreditation and to justify the resources needed to implement accreditation programs aimed at improving the performance of laboratory systems.


Asunto(s)
Acreditación/normas , Laboratorios/normas , Atención al Paciente/normas , Recuento de Linfocito CD4 , Técnicas de Laboratorio Clínico/normas , Errores Diagnósticos/prevención & control , Infecciones por VIH/diagnóstico , Infecciones por VIH/terapia , Humanos , Laboratorios/organización & administración , Garantía de la Calidad de Atención de Salud/normas , Control de Calidad
9.
Am J Clin Pathol ; 131(6): 867-74, 2009 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-19461096

RESUMEN

Expanding health care services for HIV, tuberculosis, and malaria has increased the demand for affordable and reliable laboratory diagnostics in resource-limited countries. Many countries are responding by upgrading their public laboratories and introducing new technology to provide expanded testing services into more regions. This expansion carries the risk of increasing the diversity of an already highly diverse technology and testing platform landscape, making it more difficult to manage laboratory networks across different levels of the health care system. To prevent this trend, countries are recommended to implement policies and guidelines that standardize test menus, technology, platforms, and commodities across multiple laboratories. The benefits of standardization include rational prioritization of resources for capacity development and more efficient supply chain management through volume-based price discounts for reagents and instrument service. Procurement procedures, including specification, prequalification, and contract negotiation, need to align with the standardization policies for maximum benefit. Standardization should be adhered to irrespective of whether procurement is centralized or decentralized or whether carried out by national bodies or development partners.


Asunto(s)
Laboratorios/provisión & distribución , Laboratorios/normas , Salud Pública/normas , Garantía de la Calidad de Atención de Salud/métodos , Garantía de la Calidad de Atención de Salud/normas , Países en Desarrollo , Humanos
10.
Cytometry B Clin Cytom ; 74 Suppl 1: S123-30, 2008.
Artículo en Inglés | MEDLINE | ID: mdl-18348208

RESUMEN

The scale-up of HIV antiretroviral therapy in recent years has led to a rapid increase in CD4 and CD4% count capacity to meet the diagnostic needs of staging and monitoring disease progression and treatment efficacy in adults and infants. The speed of implementation of this technology has been unrivalled in recent years and has met challenges with technology selection, laboratory infrastructure development, human resource limitations, cost-effectiveness, instrument maintenance, and ensuring testing access and quality. The lessons learned from dealing with these challenges have helped strengthen existing laboratory systems for other diagnostics. They may also facilitate the implementation of new diagnostics in future.


Asunto(s)
Recuento de Linfocito CD4/métodos , Recursos en Salud , Recuento de Linfocito CD4/normas , Humanos , Laboratorios , Ciencia del Laboratorio Clínico , Sistemas de Atención de Punto , Control de Calidad
SELECCIÓN DE REFERENCIAS
DETALLE DE LA BÚSQUEDA