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Point-of-care Ebola virus disease diagnostic testing for treatment centres
This study trialed a new 15 minute test for Ebola virus point-of-care detection in Guinea treatment centres.
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Principal Investigator: Amadou A. Sall, Institut Pasteur de Dakar
What did the study set out to achieve?
Real‐time Reverse Transcription Polymerase Chain Reaction(RT-PCR) was used as the standard method for Ebola virus (EBOV) molecular diagnosis during the 2014 outbreak in West Africa. However this method has limitations in terms of cost, equipment, and turnaround time. In contrast, isothermal recombinase polymerase amplification (RPA) is six times faster than RT- PCR while yielding the same analytical sensitivity and specificity. In addition, the RPA assay uses smaller equipment and reagents which are cold chain independent, making rapid on-site testing feasible and affordable. The project investigated the use of RPA for Ebola virus point-of-care detection in Guinea treatment centres.
An existing Ebola virus Recombinase polymerase amplification (RPA) assay was adapted to the outbreak strain and mobilised into a suitcase laboratory combined with a mobile glovebox for biosafety sample extraction. Specifically, so called primer–in pellets were developed in collaboration with the company Twist DX, allowing for cooling chain independent and simple use of reagents. The RPA assay was deployed in Conakry as well as during campaigns organised by the coordination committee in the Forecariah, Coyah, Dubreka and Boke prefectures. During these campaigns, 2,509 samples were tested and the results were available within 30 minutes upon sample receipt.
What does this mean for policymakers and practitioners?
Local teams were trained in the use of the mobile laboratory in Guinea. The trained staff supported the laboratory deployment in Conakry (Ratoma municipality) and were involved in the different campaigns organized by the Ebola Task Force in Guinea., Additional local teams were also trained in hospitals localised in the prefectures of Boke and Nzerekore. The newly trained staff went on to use the RPA test for Ebola Surveillance in Guinea.
Representatives from five African countries (Guinea, Sierra Leone, Democratic Republic of Congo, Mali and Senegal) and one European country (Germany) participated in a dissemination day organised in February 2016. The Senegalese Ministry of Health as well as international agencies (WHO, MSF and UNAIDS) were also represented at this meeting.
MSF expressed interest in using the RPA for i) salivary tests on living people as it is a less intrusive sampling method, ii) a multiplex approach in order to test various diseases quickly in EVD suspected negative cases, as a differential diagnostic tool.
Discussions continued on adapting RPA to test other diseases in the field and to identify commercial companies to invest into RPA assays
The project is focussing on developing suitcase labs which can speed up testing. The portable labs are testing after death and producing results in between six to ten minutes which means that burials can take place faster and within culturally sensitive time frames.
In August 2014, the Ebola Outbreak in West Africa was declared an International Health Emergency by WHO and within a couple of weeks ELRHA launched a rapid-response call for research to combat the crisis. The UK Department for International Development (DFID), the Wellcome Trust and ELRHA opened a special funding window through the Research for Health in Humanitarian Crises (R2HC) programme.
The aim of this emergency call was both to produce robust research findings that could contribute to the effectiveness of the response to the current outbreak and help to draw lessons for future outbreaks of Ebola and other communicable diseases. The projects funded will strengthen the evidence base for the Ebola response in topics ranging from diagnostics to anthropology, surveillance and disease control.
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