A holistic approach in patient management and epidemic surveillance through convergence of diagnostic technologies, capacity building and stakeholder engagement (HoliCare)

Research on Poverty-Related Diseases (PRDs) in sub-Saharan Africa suffers from major technological and non-technological challenges that prevent high quality healthcare to reach many areas. Not only their performance, but also the affordability, manufacturability, suitability for Low- and Middle-Income Countries (LMICs) and deployment of the (few) available diagnostics are main barriers to ensure good quality of healthcare in sub-Saharan Africa. The HoliCare project aims to tackle such challenges from a holistic perspective, by bridging the gap between technological excellence, available infrastructures, capacity, and local uptake of new technologies. We have chosen to work with lower respiratory infections as a blueprint for our new approach due to their huge clinical and socioeconomic impact, and relevance to the SARS-CoV-2 pandemic. Technology-wise, we propose a 2-tiered, digitally interfaced diagnostic approach that will start in the field using multiplexed lateral flow tests for rapid screening and triage, followed by a referral to a hospital (when needed) and a follow-up detailed diagnosis using a POC-Instrument performing simultaneous nucleic acid amplification (LAMP) for pathogen identification and immunoassays for host biomarker quantitation. Digital and manufacturing infrastructures will encompass these technology innovations to ensure future local product development. Quality controlled biobanks will be developed for executing reliable clinical studies. Training and human capital investment will be achieved by focussed and high-level training activities. Adoption and implementation activities will pave the way for the proposed diagnostic solutions to be successfully deployed, fitting the purpose of the local populations. Our developments will be scalable, adaptable and transferrable to other diseases and national (eco) systems, aiming to contribute to the improvement of healthcare delivery in sub-Saharan Africa.