PharmAccess Foundation, AHTC Tower 4C, Paasheuvelweg 25, 1105 BP, Amsterdam, The Netherlands.
PharmAccess Foundation Kenya, New Rehema House, Rhamta Road, Westlands, Nairobi, Kenya.
BMC Med Inform Decis Mak. 2019 Jul 22;19(1):139. doi: 10.1186/s12911-019-0854-4.
Despite WHO guidelines for testing all suspected cases of malaria before initiating treatment, presumptive malaria treatment remains common practice among some clinicians and in certain low-resource settings the capacity for microscopic testing is limited. This can lead to misdiagnosis, resulting in increased morbidity due to lack of treatment for undetected conditions, increased healthcare costs, and potential for drug resistance. This is particularly an issue as multiple conditions share the similar etiologies to malaria, including brucellosis, a rare, under-detected zoonosis. Linking rapid diagnostic tests (RDTs) and digital test readers for the detection of febrile illnesses can mitigate this risk and improve case management of febrile illness.
This technical advance study examines Connected Diagnostics, an approach that combines the use of point-of-care RDTs for malaria and brucellosis, digitally interpreted by a rapid diagnostic test reader (Deki Reader) and connected to mobile payment mechanisms to facilitate the diagnosis and treatment of febrile illness in nomadic populations in Samburu County, Kenya. Consenting febrile patients were tested with RDTs and patient diagnosis and risk information were uploaded to a cloud database via the Deki Reader. Patients with positive diagnoses were provided digital vouchers for transportation to the clinic and treatment via their health wallet on their mobile phones.
In total, 288 patients were tested during outreach visits, with 9% testing positive for brucellosis and 0.6% testing positive for malaria. All patients, regardless of diagnosis were provided with a mobile health wallet on their cellular phones to facilitate their transport to the clinic, and for patients testing positive for brucellosis or malaria, the wallet funded their treatment. The use of the Deki Reader in addition to quality diagnostics at point of care also facilitated geographic mapping of patient diagnoses in relation to key risk areas for brucellosis transmission.
This study demonstrates that the Connected Dx approach can be effective even when addressing a remote, nomadic population and a rare disease, indicating that this approach to diagnosing, treatment, and payment for healthcare costs is feasible and can be scaled to address more prevalent diseases and conditions in more populous contexts.
尽管世界卫生组织（WHO）的指南建议在开始治疗前对所有疑似疟疾病例进行检测，但在一些临床医生中，以及在某些资源有限的环境中，推测性疟疾治疗仍然是常见做法。这可能导致误诊，导致因未检测到的疾病而导致发病率增加，增加医疗保健成本，并可能导致耐药性。由于多种疾病与疟疾具有相似的病因，包括布鲁氏菌病，这是一种罕见的、未被充分发现的动物传染病，因此这尤其成问题。将快速诊断检测（RDT）与数字检测读取器结合起来，用于检测发热疾病，可以降低这种风险，并改善发热疾病的病例管理。
本技术进步研究考察了连接诊断（Connected Diagnostics）方法，该方法结合使用针对疟疾和布鲁氏菌病的即时检测 RDT，由快速诊断测试读取器（Deki Reader）进行数字解释，并与移动支付机制相连接，以促进肯尼亚桑布鲁县游牧人口的发热疾病的诊断和治疗。同意参加的发热患者接受 RDT 检测，患者的诊断和风险信息通过 Deki Reader 上传到云数据库。检测结果呈阳性的患者通过其手机上的健康钱包获得前往诊所的数字代金券，并接受治疗。
在实地考察期间，共有 288 名患者接受了检测，9%的患者检测出布鲁氏菌病阳性，0.6%的患者检测出疟疾阳性。所有患者，无论诊断结果如何，都在其手机上获得了移动健康钱包，以方便他们前往诊所就诊，对于布鲁氏菌病或疟疾检测结果呈阳性的患者，钱包为他们的治疗提供资金。除了在护理点进行高质量诊断外，使用 Deki Reader 还便于在布鲁氏菌病传播的关键风险区域内对患者的诊断进行地理映射。
这项研究表明，即使在处理偏远的游牧人口和罕见疾病时，连接诊断方法也可以有效，这表明这种诊断、治疗和支付医疗费用的方法是可行的，并可以扩展到更流行的疾病和更人口稠密的环境中。
