Digital Diagnostics for Africa Network

Preventable and treatable diseases cause a huge amount of illness and a huge number of deaths in Africa. Infectious diseases, like malaria, are some of the biggest killers. Not only do these diseases cause major health problems for those infected, they are also a major financial burden to individuals and communities, and they hinder economic and societal development for whole countries. The poorest and most marginalized communities are usually the worst affected, and so these diseases exacerbate inequalities associated with geography, gender and ethnicity.

Current strategies to tackle infectious diseases in the poorest settings rely on rudimentary approaches to diagnosis and treatment, such as reliance on a few clinical features (like fever, difficulty breathing or pallor) and very few simple tests to decide the treatment someone should receive. This approach is necessary because there are rarely diagnostic laboratories nearby to provide comprehensive testing, and even if there are, their services are often too expensive. Unfortunately, the simple methods of diagnosis often result in incorrect diagnosis, and provide little data from which to learn how to improve. A wrong diagnosis can mean the wrong treatment is given, resulting in prolonged illness or death, whilst at the same time encouraging overuse of some treatments like antibiotics or anti-malaria drugs, which can drive resistance to these drugs.

A revolutionary solution to this problem is to develop a new generation of digital diagnostic tests which can be used at the point-of-care in even the hardest-to-reach communities. These diagnostic tests are not only more accurate and faster than current alternatives but potentially cost saving. Digital diagnostics have the potential to transform the situation by linking the precision typical of an advanced laboratory with the portability, connectivity, analysis and support that can be provided through a modern smart phone. This means tests can be administered anywhere and anytime by a wide range of healthcare workers with minimal training.

For example, a drop of blood collected from the tip of the finger of child by a health worker in their community, could be applied to a tiny microchip powered by a mobile phone battery, and within 15-20 minutes a result could be available to make a diagnosis. The results are transmitted from the microchip to a smartphone via Bluetooth so no internet connection is required. If "Malaria" is detected, the device can notify the healthcare worker of the type of malaria and the correct treatment. The smartphone could also send the result and location data via the mobile network to a remote computer system, which could determine whether there is an unusually high level of malaria in that area and, if so, notify the national Malaria control program that extra resources are required to tackle an outbreak before it gets worse. Thus the child benefits from the right treatment, the community benefits from the intervention, and the health authorities benefit from being able to allocate the resources available to where they are most needed or will work best. The real-time data also allows international organizations to make more effective policies to tackle malaria and allocate funding.

In our proposal we are developing a network of scientists with diverse skills and expertise, joining them together with commercial companies that manufacture diagnostics, and organizations who work directly in African countries putting new disease control tools and strategies into practice. This network will plan how best to develop new digital diagnostic devices to tackle health problems in Africa. The network will test its strategies by specifically planning the development of a new digital diagnostic test device for malaria and drawing out a roadmap to its implementation.

This network, and the subsequent research and product development that it will enable, will have a wide range of beneficiaries. Academic beneficiaries are described in the preceding section of the application, and here we focus on beneficial impacts for other groups.

In the short term, individuals and communities in Africa participating in the digital molecular diagnostics studies will derive health benefits associated with study participation, such as better care, and access to resources which might otherwise not be available. In the longer term, as digital diagnostics are implemented within healthcare systems, we expect that many individuals in Africa and in other countries will benefit from improved diagnosis and therefore correct treatment. The greatest potential benefits to health will be for those who do not currently have access to good diagnostics, particularly those in the hard-to-reach, poor and marginalized communities.

National public health authorities, departments of health, governments, and international agencies like the World Health Organization will benefit from the development of digital molecular diagnostics which will provide them with new tools to use for disease control and elimination. The target product profiles we will develop and propose will be useful starting points for them to consider how they may use these diagnostics in their activities and what impact they may have.

Implementing digital molecular diagnostics as public health tools, for detection, molecular surveillance and data-driven control of malaria (and other diseases), has potential to benefit the health of entire populations. Reductions in malaria burden consistently produce greater benefits to health than those explained solely by incident malaria cases, and by driving down malaria cases towards elimination, there is the possibility to save huge amounts of health budget which can be spent tackling other diseases. Although we seek to develop digital molecular diagnostics for Africa in the present proposal, the same principles of development and even the same diagnostic devices could be used in any malaria endemic country (and many other countries) globally.

Individuals and populations stand to benefit economically. Rapid diagnosis and treatment produces better health outcomes, less expenditure on incorrect treatments and unnecessary diagnostic tests, faster return to work for patients and carers, and more productivity. Digital diagnostics which facilitate large reductions in malaria burden globally will have a huge economic benefits to countries as a whole, by ultimately reducing the need for expenditure on malaria treatment and prevention, and increasing Gross Domestic Product, thereby alleviating poverty. Potential economic benefits also extend to diagnostics manufacturers, and to the pharmaceutical industry. If our project catalyses wider adoption of digital diagnostics there will be greater opportunities for manufacturers to profit from their production. Pharmaceutical companies may benefit from the potential of digital molecular diagnostics to enable precision treatment with new drugs tailored to patient or pathogen genotype.

Our project will have short term societal benefits in African countries and the UK by building relationships with marginalized communities, promoting gender equality, encouraging the development of junior researchers, and reinforcing the importance of equitable partnerships. By highlighting these positive examples in our outreach activities we expect to raise their profile with the public in the countries in which we work. If mobile connected digital diagnostics start to become widely adopted, they may drive improvements in mobile data networks across Africa, which will facilitate social, educational and economic growth as a result of the same infrastructure, and improve equity of access for all communities.