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1.
EACL 2023 - 17th Conference of the European Chapter of the Association for Computational Linguistics, Proceedings of System Demonstrations ; : 1-10, 2023.
Article in English | Scopus | ID: covidwho-20232037

ABSTRACT

Open-retrieval question answering systems are generally trained and tested on large datasets in well-established domains. However, low-resource settings such as new and emerging domains would especially benefit from reliable question answering systems. Furthermore, multilingual and cross-lingual resources in emergent domains are scarce, leading to few or no such systems. In this paper, we demonstrate a cross-lingual open-retrieval question answering system for the emergent domain of COVID-19. Our system adopts a corpus of scientific articles to ensure that retrieved documents are reliable. To address the scarcity of cross-lingual training data in emergent domains, we present a method utilizing automatic translation, alignment, and filtering to produce English-to-all datasets. We show that a deep semantic retriever greatly benefits from training on our English-to-all data and significantly outperforms a BM25 baseline in the cross-lingual setting. We illustrate the capabilities of our system with examples and release all code necessary to train and deploy such a system1 © 2023 Association for Computational Linguistics.

2.
Int J Gynaecol Obstet ; 2023 May 02.
Article in English | MEDLINE | ID: covidwho-2320023

ABSTRACT

Data on mpox in pregnancy are currently limited. Historically, only 65 cases in pregnancy have been reported globally since mpox was discovered in 1958. This includes 59 cases in the current outbreak. Vertical transmission was confirmed in one patient. Pregnant women are at high risk of severe disease owing to immunological and hormonal changes that increase susceptibility to infections in pregnancy. African women appear to be at higher risk of mpox infection and adverse outcomes in pregnancy for epidemiological and immunologic reasons, in addition to the background high rates of adverse feto-maternal outcomes in the region. This risk is potentially heightened during the COVID-19 pandemic due to the possibility of mpox virus exportation/importation as a result of the lifting of movement restrictions and trans-border travels between countries affected by the current outbreak. Furthermore, coinfection with mpox and COVID-19 in pregnancy is possible, and the clinical features of both conditions may overlap. Challenges of diagnosis and management of mpox in pregnancy in Africa include patients concealing their travel history from healthcare providers and absconding from/evading isolation after diagnosis, shortage of personal protective equipment and polymerase chain reaction testing facilities for diagnosis, vaccine hesitancy/resistance, and poor disease notification systems. There is a need for local, regional and global support to strengthen the capacity of African countries to address these challenges and potentially reduce the disease burden among pregnant women in the continent.

3.
12th International Conference on Electrical and Computer Engineering, ICECE 2022 ; : 248-251, 2022.
Article in English | Scopus | ID: covidwho-2290742

ABSTRACT

Right at the end of 2019, the world saw an outbreak of a new type of SARS (severe acute respiratory syndrome) disease, SARS-Cov-2, or COVID-19. Even in 2022, around 1 million people worldwide are getting infected with the virus every day. To date, more than 6 million people have died as a result of the virus. To tackle the pandemic, the first step is to successfully detect the virus among the mass population. The most popular method is the RT-PCR test, which, unfortunately, is not always conclusive. The physicians thus suggest lung CT tests for the patients for clinical relevance. But the problem with lung CT scans for the detection of coronavirus is that the COVID-19 infected scan is very similar to community-affected pneumonia (CAP) infected scan, and the results in many cases get wrongly interpreted. In addition, the virus is always mutating into different strains, and the severity and infection pattern slightly change with each mutation. Because of this rapid mutation, a large and balanced dataset of lung CT scans is not always available. In this work, we systematically evaluate the accuracy of a deep 3D convolutional neural network (CNN) on a small-scale and highly imbalanced dataset of lung CT scans (the SPGC COVID 2021 dataset). Our experiments show that it can outperform previous state-of-the-art 3D CNN models with proper regularization, an appropriate number of dense layers, and a weighted loss function. Our research, therefore, suggests an effective solution for identifying COVID-19 in lung CT scans using deep learning for small and highly imbalanced datasets. © 2022 IEEE.

5.
Semin Nephrol ; 42(5): 151319, 2022 09.
Article in English | MEDLINE | ID: covidwho-2289123

ABSTRACT

Although medicinal plants are beneficial, they also can be important risk factors for the development of acute and chronic kidney injury, as well toxicity of other solid organs. There are a lack of reports of adverse kidney events and drug interactions resulting from medicinal plants owing to a lack of professional surveillance and specific data on kidney toxicity, especially in low-resource settings. Within the context of increased medicinal plant use and lack of effective regulatory control, safety is a key priority issue. We review the benefits and adverse effects of medicinal plants with particular reference to nephrotoxicity encountered in the Democratic Republic of Congo in sub-Saharan Africa.


Subject(s)
Plants, Medicinal , Humans , Plants, Medicinal/adverse effects , Democratic Republic of the Congo/epidemiology , Risk Factors
6.
Hum Resour Health ; 21(1): 18, 2023 03 06.
Article in English | MEDLINE | ID: covidwho-2279447

ABSTRACT

BACKGROUND: COVID-19 has created unprecedented challenges for health systems worldwide. Since the confirmation of the first COVID-19 case in Ghana in March 2020 Ghanian health workers have reported fear, stress, and low perceived preparedness to respond to COVID-19, with those who had not received adequate training at highest risk. Accordingly, the Paediatric Nursing Education Partnership COVID-19 Response project designed, implemented, and evaluated four open-access continuing professional development courses related to the pandemic, delivered through a two-pronged approach: e-learning and in-person. METHODS: This manuscript presents an evaluation of the project's implementation and outcomes using data for a subset of Ghanaian health workers (n = 9966) who have taken the courses. Two questions were answered: first, the extent to which the design and implementation of this two-pronged strategy was successful and, second, outcomes associated with strengthening the capacity of health workers to respond to COVID-19. The methodology involved quantitative and qualitative survey data analysis and ongoing stakeholder consultation to interpret the results. RESULTS: Judged against the success criteria (reach, relevance, and efficiency) the implementation of the strategy was successful. The e-learning component reached 9250 health workers in 6 months. The in-person component took considerably more resources than e-learning but provided hands-on learning to 716 health workers who were more likely to experience barriers to accessing e-learning due to challenges around internet connectivity, or institutional capacity to offer training. After taking the courses, health workers' capacities (addressing misinformation, supporting individuals experiencing effects of the virus, recommending the vaccine, course-specific knowledge, and comfort with e-learning) improved. The effect size, however, varied depending on the course and the variable measured. Overall, participants were satisfied with the courses and found them relevant to their well-being and profession. An area for improvement was refining the content-to-delivery time ratio of the in-person course. Unstable internet connectivity and the high upfront cost of data to access and complete the course online were identified as barriers to e-learning. CONCLUSIONS: A two-pronged delivery approach leveraged distinct strengths of respective e-learning and in-person strategies to contribute to a successful continuing professional development initiative in the context of COVID-19.


Subject(s)
COVID-19 , Humans , Child , Ghana , COVID-19/epidemiology , Learning , Educational Status , Health Facilities
7.
J Public Health Afr ; 13(3): 1465, 2022 Sep 07.
Article in English | MEDLINE | ID: covidwho-2201485

ABSTRACT

Within a short time, Coronavirus disease 2019 (COVID-19) has evolved into a pandemic spreading at a speed and scale that has been able to overwhelm even the most advanced health care systems quickly. Multiple guidelines published by organizations such as the WHO and US' CDC address the response to COVID-19 at the international, national, and local levels. Although these guidelines are meant to be globally accessible, implementing them is a challenge given the variability in the health care systems worldwide between low- and middleincome countries (LMIC) and high-income countries and even amongst different regions within each LMIC. We have chosen to evaluate the current guidelines focusing on LMIC and expand on the guidelines as necessary.

8.
16th International Conference on E-Learning 2022, EL 2022 - Part of the Multi Conference on Computer Science and Information Systems 2022, MCCSIS 2022 ; : 18-26, 2022.
Article in English | Scopus | ID: covidwho-2124634

ABSTRACT

In some low-resource settings, there are several challenges such as financial crisis, inadequate infrastructure facilities, personal skills efficiency and motivation that contribute or hinder the success of virtualization in an industry. This study investigates the factors that could influence the success of virtualization requirement in the learning industry during and after the COVID phase on students’ perceived usefulness and their intention to continue using electronic learning. A qualitative research was conducted among university students through several focus groups and one to one interviews. Several factors that are expected to influence students’ perceived usefulness and intentions to continue using online learning were identified and a trifold model was proposed based on three different theories to be empirically tested on a larger scale in the future. This study provides input to improving knowledge of e-learning for educational institutions in developing countries. © Proceedings of the International Conference on E-Learning 2022, EL 2022 - Part of the Multi Conference on Computer Science and Information Systems 2022, MCCSIS 2022. All rights reserved.

9.
JMIR Med Educ ; 8(3): e26419, 2022 Jul 29.
Article in English | MEDLINE | ID: covidwho-1974475

ABSTRACT

BACKGROUND: Health professionals in low- and middle-resource settings have limited access to up-to-date resources for diagnosing and treating illnesses, training medical staff, reviewing newly disseminated guidelines and publications, and preparing data for international disease reporting. A concomitant difficulty in high-resource settings is the need for continuing education and skills up-training in innovative procedures on unfamiliar social media platforms. These challenges can delay both patient care and epidemiological surveillance efforts. To overcome these challenges, health professionals have adapted WeChat Groups to implement timely, low-cost, and high-quality patient care. OBJECTIVE: The primary study aim was to describe the processes taken by medical professionals across their diverse physical and virtual networks in adapting a bottom-up approach to collectively overcome resource shortages. The secondary study aim was to delineate the pathways, procedures, and resource/information sharing implemented by medical professionals using an international publicly available popular social media app (WeChat) to enhance performance of facility-based procedures and protocols for improved patient care. METHODS: In-depth interviews, observations, and digital ethnography of WeChat Groups communications were collected from medical professionals in interconnected networks of health care facilities. Participants' WeChat Groups usage and observations of their professional functions in interconnected networks were collected from November 2018 to 2019. Qualitative analysis and thematic coding were used to develop constructs and themes in NVivo. Constructs incorporated descriptions for the implementation and uses of WeChat Groups for professional connections, health care procedures, and patient care. Themes supporting the constructs focused on the pathways and venues used by medical professionals to build trust, to establish and solidify online networks, and to identify requests and resource sharing within WeChat Groups. RESULTS: There were 58 participants (males 36 and females 22) distributed across 24 health care settings spanning geographical networks in south China. Analysis yielded 4 constructs and 11 themes delineating the bottom-up usage of WeChat Groups among clinicians, technicians, nurses, pharmacists, and public health administrators. Participants used WeChat Groups for collectively training hospital staff in complex new procedures, processing timely diagnoses of biological specimens, staying abreast of latest trends and clinical procedures and symptoms, and contributing to case reporting for emergent illnesses and international surveillance reporting. An unexpected strength of implementing clinical, training, and research support on a popular app with international coverage is the added ability to overcome administrative and geographic barriers in resource distribution. This advantage increased a network's access to WeChat Groups members both working within China and abroad, greatly expanding the scope of shared resources. CONCLUSIONS: The organic, bottom-up approach of repurposing extant social media apps is low cost and efficient for timely implementation to improve patient care. WeChat's international user base enables medical staff to access widespread professional networks across geographic, administrative, and economic barriers, with potential to reduce health disparities in low-resource settings.

10.
Optics and Biophotonics in Low-Resource Settings VIII 2022 ; 11950, 2022.
Article in English | Scopus | ID: covidwho-1846314

ABSTRACT

Lateral flow assays (LFA’s) are a common diagnostic test form, particularly in low-to-middle income countries (LMIC’s). Visual interpretation of LFA’s can be subjective and inconsistent, especially with faint positive results, and commercial readers are expensive and challenging to implement in LMIC’s. We report a phone-agnostic Android app to acquire images and interpret results of a variety of LFA’s with no additional hardware. Starting from the open-source “rdt-scan” codebase, we integrated new features and revamped the peak detection method. This included improved perspective corrections, phone level check to eliminate shadows, high resolution still-image capture besides existing video frame capture, and new peak detection method. This peak detection incorporated smoothing and baseline removal from the one-dimensional profiles of a given color channel’s intensity averaged across the read window’s width, with location and relative size constraints to correctly report locations and peak heights of control and test lines. The app was tested in a real-world setting in conjunction with an open-access LFA for SARS-CoV-2 antigen developed by GH Labs. The app acquired 155 images of LFA cassettes, and results were compared against both visual interpretation by trained clinical staff and PCR results from the same patients. With an appropriate setting for test line intensity threshold, the app matched visual read for all cases but one missed visual positive. From ROC analyses against PCR, the app outperformed visual read by 1-3% across sensitivity, specificity, and AUC. The app thus demonstrated promise for accurate, consistent interpretation of LFA’s while generating digital records that could also be useful for health surveillance. © 2022 SPIE

11.
2022 International Mobile and Embedded Technology Conference, MECON 2022 ; : 108-112, 2022.
Article in English | Scopus | ID: covidwho-1840277

ABSTRACT

Coronavirus, also known as covid-19, was a newly found disease in 2019. It is a highly transmissible virus that has a noxious effect on people all over the world. The most familiar indication of covid-19 are wheezing, cold and raised body temperature. Doctors and medical field experts need to assess at topmost priority a patient with symptoms relating to COVID-19. The most Critical task is to diagnose it with low resource settings. To help in detection of COVID-19, we propose the extraction of features from Chest X-ray images, a technology available at most hospitals and classifying them using machine learning. We compiled 3-class dataset of X-ray chest images including COVID-19, Viral pneumonia, normal cases. We labeled datasets then using Vertex AI and Vision AI trained the model. It automatically uses 80% of the dataset for training, 10% for corroborating and 10% for testing whereas Vision AI process the images for training. © 2022 IEEE.

12.
Med Teach ; 44(9): 1032-1036, 2022 09.
Article in English | MEDLINE | ID: covidwho-1805781

ABSTRACT

PURPOSE: Due to geopolitical and socioeconomic challenges, the Family Medicine (FM) speciality in Palestine is in early stages of development. Volunteer British General Practitioner (BGP) trainers worked with FM faculty to develop an online tutorial program (OTP) and a novel evaluation framework E-QUaL (Evaluation-Quality, Utilization and Learning) to enhance residents' patient-centered communication and clinical skills. MATERIALS AND METHODS: Three OTP cycles were facilitated and evaluated at An Najah National University (ANNU) in Palestine between 2017-2020. Qualitative data were collected during focus groups and online chats and analysed. RESULTS AND CONCLUSIONS: The development and joint facilitation of the OTP developed faculty skills and enhanced clinically oriented education. The collaborative (BGPs and ANNU faculty) approach and the use of the EQUaL framework helped to identify and address strengths and opportunities as well as the challenges and threats of the educational content and the virtual learning format with each iteration. The COVID pandemic provided a new and inexpensive platform which improved training quality. Issues such as the volunteer nature of BGPs, internet instability, and differing cultural approaches and expectations between physicians and patients were addressed in a continuous quality improvement approach and continues today. This may be a useful model in other low resourced settings.


Subject(s)
COVID-19 , Internship and Residency , Physicians , Clinical Competence , Family Practice/education , Humans
13.
Int J Environ Res Public Health ; 19(5)2022 02 25.
Article in English | MEDLINE | ID: covidwho-1736901

ABSTRACT

To improve the quality of intrapartum care in public health facilities of Bihar, India, a statewide quality improvement program was implemented. Nurses participated in simulation sessions to improve their clinical, teamwork, and communication skills. Nurse mentors, tasked with facilitating these sessions, received training in best practices. To support the mentors in the on-going facilitation of these trainings, we developed a digital, interactive, comic series starring "Super Divya", a simulation facilitation superhero. The objective of these modules was to reinforce key concepts of simulation facilitation in a less formal and more engaging way than traditional didactic lessons. This virtual platform offers the flexibility to watch modules frequently and at preferred times. This pilot study involved 205 simulation educators who were sent one module at a time. Shortly before sending the first module, nurses completed a baseline knowledge survey, followed by brief surveys after each module to assess change in knowledge. Significant improvements in knowledge were observed across individual scores from baseline to post-survey. A majority found Super Divya modules to be acceptable and feasible to use as a learning tool. However, a few abstract concepts in the modules were not well-understood, suggesting that more needs to be done to communicate their core meaning of these concepts.


Subject(s)
Mentors , Simulation Training , Communication , Humans , Pilot Projects , Quality Improvement
14.
Health Education ; 122(2):232-259, 2022.
Article in English | ProQuest Central | ID: covidwho-1735723

ABSTRACT

Purpose>Globally, cancer represents an increasing proportion of child mortality as progress against infectious causes is made. Approximately 400,000 children will develop cancer, each year, around the world. Only about half of these cancers will ever be diagnosed. In high-resource settings, 80% of children will survive, but only about 30% will survive in low-resource settings. Digital solutions have a valuable role in increasing health professional knowledge, skills and empowerment to diagnose, treat and otherwise care for children and adolescents with cancer. This review sought to identify digital resources that support the training and development of the paediatric oncology workforce in resource -poor settings.Design/methodology/approach>This paper presents a narrative descriptive review of peer-reviewed publications and digital platforms that contribute to health professionals' education and training regarding paediatric oncology, particularly in rural and other low-resource settings.Findings>Digital solutions were identified for building communities of practice, facilitating access to information and support and providing access to training, education and supervision specifically for paediatric oncology health professionals. A total of 33 resources are discussed in depth. A quality assessment of the digital resources is provided using the Currency, Relevance, Authority, Accuracy and Purpose (CRAAP) tool and suggestions to improve the quality of resources are discussed.Practical implications>The authors anticipate that this summary of digital resources for the global paediatric oncology professional community will inform digital health investments and design of digital innovations to meet emerging needs and will have an impact on the workforce in the real world. Ultimately, this work will contribute to an improvement in the diagnosis and treatment of children and adolescents with cancer in resource-poor settings.Originality/value>This is the first discussion and summary of digital education platforms which educate, train and offer support to health professionals with respect to paediatric oncology. These digital platforms are often aimed at, and are essential for, health professionals in rural and other low-resource settings.

15.
13th Annual First Year Engineering Experience, FYEE 2020 ; 2021.
Article in English | Scopus | ID: covidwho-1717493

ABSTRACT

Baylor University holds weekend-long Invitation to Excellence (I2E) events to recruit high-achieving high school seniors. Each prospective engineering student attends two engagement sessions: one hosted by the Department of Mechanical Engineering (ME) and the other by the Department of Electrical and Computer Engineering. In this work, we present design challenges from the ME engagement sessions. In the ME engagement session, students are assigned to teams for a design challenge. Each team receives 60 drinking straws plus one yard of duck tape with which they build a structure to support a stack of course catalogs over a wooden block. Teams are allowed 20 minutes for design-build after which all teams test their structures. The structure is placed over a wooden block. Course catalogs are stacked on it until either one of the catalogs falls to the floor or the structure contacts the top of the block. The engagement session concludes with sharing of reflections on the design experience and recognition of the winning team. Recently, we began providing some teams with tools (i.e., tape measures and scissors) to use during the design challenge. Anecdotally we observed during the January 2019 event that some teams spent excessive amounts of time using the tools to measure and cut straws while failing to complete their structures. Out of curiosity we planned the November 2019 and January 2020 I2E events to explore this phenomenon by using half of our ME breakout sessions as Control groups (No Tools) and the other half as Test groups (Tools). Our reported findings include analysis of differences between Control and Test groups in both load bearing capacity and variety of design concepts. Our null hypothesis was that there would be no difference in average load-bearing capacity between the Control and Test group's structures. With the COVID-19 global pandemic, we were tasked with providing a virtual design experience using Zoom sessions. We will also provide a discussion of the individual design challenges that involved building a bridge from 1/2 sheet of paper that spanned the opening of a ceramic mug and held as much ballast (in the form of coins) as possible without failing. © American Society for Engineering Education, 2021

17.
Am J Clin Pathol ; 156(2): 176-184, 2021 07 06.
Article in English | MEDLINE | ID: covidwho-1343617

ABSTRACT

OBJECTIVES: We review how the pandemic-related education disruption may interplay with pathology manpower worldwide and shifts in disease burden to identify workable solutions. METHODS: Literature related to pathology education, pathology services in low-resource settings, and application of digital tools to pathology education was reviewed for trends and training gaps. Publications covering pathology manpower and cancer incidence worldwide were also included to assess needs. RESULTS: Pandemic-related virtual teaching has produced abundant online training materials. Pathology learning resources in low- to middle-income countries remain considerably constrained and dampen pathology manpower growth to meet current needs. Projected increases in disease burden toward the developing world thus pose a major challenge. Digital pathology resources have expanded and are beginning to appear beyond the developed countries. CONCLUSIONS: This circumstance offers a unique opportunity to leverage digital teaching resources to enhance and equitize training internationally, potentially sufficient to meet the rising wave of noncommunicable diseases. We propose four next steps to take advantage of the current opportunity: curate and organize digital training materials, invest in the digital pathology infrastructure for education and clinical care, expand student exposure to pathology through virtual electives, and develop further competency-based certification pathways.


Subject(s)
Pathology/education , User-Computer Interface , Digital Technology/methods , Humans , Pathology/trends
18.
Antimicrob Resist Infect Control ; 10(1): 113, 2021 07 31.
Article in English | MEDLINE | ID: covidwho-1334760

ABSTRACT

BACKGROUND: The coronavirus disease-2019 (COVID-19) pandemic has again demonstrated the critical role of effective infection prevention and control (IPC) implementation to combat infectious disease threats. Standards such as the World Health Organization (WHO) IPC minimum requirements offer a basis, but robust evidence on effective IPC implementation strategies in low-resource settings remains limited. We aimed to qualitatively assess IPC implementation themes in these settings. METHODS: Semi-structured interviews were conducted with IPC experts from low-resource settings, guided by a standardised questionnaire. Applying a qualitative inductive thematic analysis, IPC implementation examples from interview transcripts were coded, collated into sub-themes, grouped again into broad themes, and finally reviewed to ensure validity. Sub-themes appearing ≥ 3 times in data were highlighted as frequent IPC implementation themes and all findings were summarised descriptively. RESULTS: Interviews were conducted with IPC experts from 29 countries in six WHO regions. Frequent IPC implementation themes including the related critical actions to achieve the WHO IPC core components included: (1) To develop IPC programmes: continuous advocacy with leadership, initial external technical assistance, stepwise approach to build resources, use of catalysts, linkages with other programmes, role of national IPC associations and normative legal actions; (2) To develop guidelines: early planning for their operationalization, initial external technical assistance and local guideline adaption; (3) To establish training: attention to methods, fostering local leadership, and sustainable health system linkages such as developing an IPC career path; (4) To establish health care-associated (HAI) surveillance: feasible but high-impact pilots, multidisciplinary collaboration, mentorship, careful consideration of definitions and data quality, and "data for action"; (5) To implement multimodal strategies: clear communication to explain multimodal strategies, attention to certain elements, and feasible but high-impact pilots; (6) To develop monitoring, audit and feedback: feasible but high-impact pilots, attention to methods such as positive (not punitive) incentives and "data for action"; (7) To improve staffing and bed occupancy: participation of national actors to set standards and attention to methods such as use of data; and (8) To promote built environment: involvement of IPC professionals in facility construction, attention to multimodal strategy elements, and long-term advocacy. CONCLUSIONS: These IPC implementation themes offer important qualitative evidence for IPC professionals to consider.


Subject(s)
COVID-19/prevention & control , Health Plan Implementation/standards , Infection Control/standards , World Health Organization , COVID-19/epidemiology , Cross Infection/prevention & control , Health Plan Implementation/statistics & numerical data , Health Resources/standards , Health Resources/statistics & numerical data , Humans , Infection Control/methods , Internationality , Qualitative Research
19.
Front Med (Lausanne) ; 7: 557797, 2020.
Article in English | MEDLINE | ID: covidwho-1186805

ABSTRACT

Introduction: For the COVID-19 (SARS-CoV-2) response, COVID-19 antigen (Ag), and antibody (Ab) rapid diagnostic tests (RDTs) are expected to complement central molecular testing particularly in low-resource settings. The present review assesses requirements for implementation of COVID-19 RDTs in sub-Saharan Africa. Methods: Review of PubMed-published articles assessing COVID-19 RDTs complemented with Instructions for Use (IFU) of products. Results: In total 47 articles on two COVID-19 Ag RDTs and 54 COVID-19 Ab RDTs and IFUs of 20 COVID-19 Ab RDTs were retrieved. Only five COVID-19 Ab RDTs (9.3%) were assessed with capillary blood sampling at the point-of-care; none of the studies were conducted in sub-Saharan Africa. Sampling: Challenges for COVID-19 Ag RDTs include nasopharyngeal sampling (technique, biosafety) and sample stability; for COVID-19 Ab RDTs equivalence of whole blood vs. plasma/serum needs further validation (assessed for only eight (14.8%) products). Sensitivity-Specificity: sensitivity of COVID-19 Ag and Ab RDTs depend on viral load (antigen) and timeframe (antibody), respectively; COVID-19 Ab tests have lower sensitivity compared to laboratory test platforms and the kinetics of IgM and IgG are very similar. Reported specificity was high but has not yet been assessed against tropical pathogens. Kit configuration: For COVID-19 Ag RDTs, flocked swabs should be added to the kit; for COVID-19 Ab RDTs, finger prick sampling materials, transfer devices, and controls should be added (currently only supplied in 15, 5, and 1/20 products). Usability and Robustness: some COVID-19 Ab RDTs showed high proportions of faint lines (>40%) or invalid results (>20%). Shortcomings were reported for buffer vials (spills, air bubbles) and their instructions for use. Stability: storage temperature was ≤ 30°C for all but one RDT, in-use and result stability were maximal at 1 h and 30 min, respectively. Integration in the healthcare setting requires a target product profile, landscape overview of technologies, certified manufacturing capacity, a sustainable market, and a stringent but timely regulation. In-country deployment depends on integration in the national laboratory network. Discussion/Conclusion: Despite these limitations, successful implementation models in triage, contact tracing, and surveillance have been proposed, in particular for COVID-19 Ab RDTs. Valuable experience is available from implementation of other disease-specific RDTs in sub-Saharan Africa.

20.
J Clin Microbiol ; 59(5)2021 04 20.
Article in English | MEDLINE | ID: covidwho-1083610

ABSTRACT

Community-based health care clinics and hospital outreach services have the potential to expand coronavirus disease 2019 (COVID-19) diagnostics to rural areas. However, reduced specimen stability during extended transport, the absence of a cold chain to centralized laboratories, and biosafety concerns surrounding specimen handling have limited this expansion. In the following study, we evaluated eNAT (Copan Italia, Brescia, Italy) as an alternative transport system to address the biosafety and stability challenges associated with expanding COVID-19 diagnostics to rural and remote regions. In this study, we demonstrated that high-titer severe acute respiratory virus syndrome coronavirus 2 (SARS-CoV-2) lysate placed into eNAT medium cannot be propagated in cell culture, supporting viral inactivation. To account for off-site testing in these settings, we assessed the stability of contrived nasopharyngeal (NP) specimens stored for up to 14 days in various transport media (eNAT, eSwab, viral transport medium [VTM], saline, and phosphate-buffered saline [PBS]) at 4°C, 22 to 25°C, and 35°C. The molecular detection of SARS-CoV-2 was unaffected by sample storage temperature over the 2 weeks when stored in eNAT or PBS (change in cycle threshold, ≤1). In contrast, variable stability was observed across test conditions for other transport media. As eNAT can inactivate SARS-CoV-2, it may support COVID-19 diagnostics at the point of care. Evaluation of compatibility of eNAT with Cepheid Xpert Xpress SARS-CoV-2 assay demonstrated diagnostic accuracy and sensitivity equivalent to those of VTM. Taken together, these findings suggest that the implementation of eNAT as a collection device can expand COVID-19 testing to areas with limited health care access.


Subject(s)
COVID-19 Testing , COVID-19/diagnosis , Culture Media , Specimen Handling/standards , Humans , Sensitivity and Specificity , Temperature
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