Point of Care

 Soil-transmitted helminths, schistosomiasis and trachoma Togo

Diagnostics have traditionally been developed for single pathogens and using multiple different technological platforms. The BMGF approach to investment in diagnostics research is proposing to move away from single tests for a single outcome to an integrated platform with tests for multiple outcomes using multiple technologies.

Current challenges in Point of Care research

The BMGF move to invest in an integrated platform for diagnostic tests raises a number of questions:

  • Where in the health system should investments in point-of-care (POC) diagnostic platforms be targeted to maximise impact?
  • What infections should be tested for using these devices?
  • What is the appropriate balance between test performance, reliability and cost?

The public health impact and cost-effectiveness of different diagnostic strategies depends critically on a number of health system variables:

  • Where do people access care? To what extent are etiological versus prognostic indicators used in clinical decision making?
  • To what extent do health care workers adhere to the diagnostic outcome?
  • What is the clinical outcome of the diagnostic-based decision?
  • In addition, they depend on the burden and distribution of underlying etiological causes of disease.

Project Methodology

The Diagnostics Modelling Consortium is undertaking a preliminary scoping exercise to map out methods for modelling the complex systems that interact to determine the cost-effectiveness of POC diagnostics.The project will draw together previous decision-tree models that have been developed for either individual pathogens (malaria and pneumonia) or for integrated community case management of fever (ICCM) and apply these to settings in which the etiological pathogens underlying under five fevers have been well documented. Parameters on fever and treatment-seeking rates will be based on recent DHS surveys whilst parameters on the prescriber adherence to diagnostic outcomes will be based on recent systematic reviews.

Key Research Questions

The primary research question aims to address "What is the most appropriate product profile  for a POC diagnostic for under-five fevers in resource-poor settings?"

Key people: 
Prof Azra Ghani
Dr Christine Rousseau
Dr Melissa Mugambi