From the bench to the field in low-cost diagnostics: two case studies.

Despite the growth of research in universities on point-of-care (POC) diagnostics for global health, most devices never leave the laboratory. The processes that move diagnostic technology from the laboratory to the field--the processes intended to evaluate operation and performance under realistic conditions--are more complicated than they might seem. Two case studies illustrate this process: the development of a paper-based device to measure liver function, and the development of a device to identify sickle cell disease based on aqueous multiphase systems (AMPS) and differences in the densities of normal and sickled cells. Details of developing these devices provide strategies for forming partnerships, prototyping devices, designing studies, and evaluating POC diagnostics. Technical and procedural lessons drawn from these experiences may be useful to those designing diagnostic tests for developing countries, and more generally, technologies for use in resource-limited environments.

[1]  Charles R. Mace,et al.  Aqueous multiphase systems of polymers and surfactants provide self-assembling step-gradients in density. , 2012, Journal of the American Chemical Society.

[2]  S. Hay,et al.  Global Burden of Sickle Cell Anaemia in Children under Five, 2010–2050: Modelling Based on Demographics, Excess Mortality, and Interventions , 2013, PLoS medicine.

[3]  Dennis A. Pitta,et al.  The quest for the fortune at the bottom of the pyramid: potential and challenges , 2008 .

[4]  D. Altman,et al.  Measuring agreement in method comparison studies , 1999, Statistical methods in medical research.

[5]  N. Engel,et al.  Point-of-Care Testing for Infectious Diseases: Diversity, Complexity, and Barriers in Low- And Middle-Income Countries , 2012, PLoS medicine.

[6]  Andrew Ustianowski,et al.  Tropical infectious diseases: Diagnostics for the developing world , 2004, Nature Reviews Microbiology.

[7]  Carmen R. Wilson VanVoorhis,et al.  Understanding Power and Rules of Thumb for Determining Sample Sizes , 2007 .

[8]  Samuel K Sia,et al.  Commercialization of microfluidic point-of-care diagnostic devices. , 2012, Lab on a chip.

[9]  J. J. Henning,et al.  Guidelines for the Use of Antiretroviral Agents in HIV-Infected Adults and Adolescents, January 28, 2000 , 1998, HIV clinical trials.

[10]  P. Sperryn,et al.  Blood. , 1989, British journal of sports medicine.

[11]  G. Whitesides,et al.  Simple telemedicine for developing regions: camera phones and paper-based microfluidic devices for real-time, off-site diagnosis. , 2008, Analytical chemistry.

[12]  E Vichinsky,et al.  Prophylaxis with oral penicillin in children with sickle cell anemia. A randomized trial. , 1986, The New England journal of medicine.

[13]  G. Whitesides,et al.  Three-dimensional microfluidic devices fabricated in layered paper and tape , 2008, Proceedings of the National Academy of Sciences.

[14]  George Whitesides The lab finally comes to the chip! , 2014, Lab on a chip.

[15]  C. Metz Basic principles of ROC analysis. , 1978, Seminars in nuclear medicine.

[16]  R. Rosenfeld Nature , 2009, Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery.

[17]  D. Tosteson,et al.  Acid pH induces formation of dense cells in sickle erythrocytes. , 1989, Blood.

[18]  Bill Bynum,et al.  Lancet , 2015, The Lancet.

[19]  Brian A. Nosek,et al.  Power failure: why small sample size undermines the reliability of neuroscience , 2013, Nature Reviews Neuroscience.

[20]  BH Weigl,et al.  Simplicity of use: a critical feature for widespread adoption of diagnostic technologies in low-resource settings , 2009, Expert review of medical devices.

[21]  P. Yager,et al.  Point-of-care diagnostics for global health. , 2008, Annual review of biomedical engineering.

[22]  Bernhard H. Weigl,et al.  Field Evaluation of a Prototype Paper-Based Point-of-Care Fingerstick Transaminase Test , 2013, PloS one.

[23]  Samuel K Sia,et al.  Lab-on-a-chip devices for global health: past studies and future opportunities. , 2007, Lab on a chip.

[24]  Paul A Estabrooks,et al.  Practical Clinical Trials for Translating Research to Practice: Design and Measurement Recommendations , 2005, Medical care.

[25]  R. Nagel,et al.  Dense cells in sickle cell anemia: the effects of gene interaction. , 1984, Blood.

[26]  Subra Suresh,et al.  Measuring single-cell density , 2011, Proceedings of the National Academy of Sciences.

[27]  David L. Vaux,et al.  Research methods: Know when your numbers are significant , 2012, Nature.

[28]  Charles R. Mace,et al.  Enrichment of reticulocytes from whole blood using aqueous multiphase systems of polymers , 2015, American journal of hematology.

[29]  Nathan Rosenberg,et al.  Special Issue on University Entrepreneurship and Technology Transfer: How Do University Inventions Get Into Practice? , 2002, Manag. Sci..

[30]  George M Whitesides,et al.  Density-based separation in multiphase systems provides a simple method to identify sickle cell disease , 2014, Proceedings of the National Academy of Sciences.

[31]  G. Whitesides,et al.  Measuring markers of liver function using a micropatterned paper device designed for blood from a fingerstick. , 2012, Analytical chemistry.

[32]  G. Whitesides,et al.  Patterned paper as a platform for inexpensive, low-volume, portable bioassays. , 2007, Angewandte Chemie.

[33]  C. Brugnara,et al.  Sickle cell disease: from membrane pathophysiology to novel therapies for prevention of erythrocyte dehydration. , 2003, Journal of pediatric hematology/oncology.

[34]  Dominique Guellec,et al.  Pre-emptive patenting: securing market exclusion and freedom of operation , 2012 .

[35]  Andrew Phillips,et al.  Hepatotoxicity in HIV-1-infected patients receiving nevirapine-containing antiretroviral therapy , 2001, AIDS.

[36]  Deepak Somaya Patent Strategy and Management , 2012 .

[37]  J. Lachin Introduction to sample size determination and power analysis for clinical trials. , 1981, Controlled clinical trials.

[38]  R. Ware,et al.  Sickle-cell disease: an ounce of prevention, a pound of cure , 2009, The Lancet.

[39]  George M. Whitesides,et al.  Evaluation of a Density-Based Rapid Diagnostic Test for Sickle Cell Disease in a Clinical Setting in Zambia , 2014, PloS one.

[40]  H B Weems,et al.  Erythrocyte density distribution in sickle cell anemia. , 1984, Acta haematologica.

[41]  S. Hawkes,et al.  Mapping the landscape of diagnostics for sexually transmitted infections: key findings and recommendations. , 2004 .

[43]  Gary Maartens,et al.  Guidelines for antiretroviral therapy in adults , 2012 .

[44]  Y. K. Cheung,et al.  1 Supplementary Information for : Microfluidics-based diagnostics of infectious diseases in the developing world , 2011 .

[45]  N. Mohandas,et al.  Concurrent sickle cell anemia and alpha-thalassemia. Effect on pathological properties of sickle erythrocytes. , 1984, The Journal of clinical investigation.

[46]  Samuel K Sia,et al.  Microfluidics and point-of-care testing. , 2008, Lab on a chip.

[47]  Guosheng Yin,et al.  Fundamentals of Clinical Trials , 2012 .

[48]  G. Whitesides,et al.  Diagnostics for the developing world: microfluidic paper-based analytical devices. , 2010, Analytical chemistry.

[49]  George M. Whitesides,et al.  A Paper-Based Multiplexed Transaminase Test for Low-Cost, Point-of-Care Liver Function Testing , 2012, Science Translational Medicine.

[50]  Isma'il ibn Ali al-Sadiq AIDS , 1986, The Lancet.

[51]  A. Kratz,et al.  Case records of the Massachusetts General Hospital. Weekly clinicopathological exercises. Laboratory reference values. , 2004, The New England journal of medicine.

[52]  A. Caldwell,et al.  Global Health Technology 2.0 , 2011, IEEE Pulse.

[53]  R. Peeling,et al.  Point-of-care tests for diagnosing infections in the developing world. , 2010, Clinical microbiology and infection : the official publication of the European Society of Clinical Microbiology and Infectious Diseases.

[54]  D. Vaux,et al.  Error bars in experimental biology , 2007, The Journal of Cell Biology.