Suzanne Smith
University of Pretoria (South Africa)
Printed functionality for point-of-need diagnostics in resource-limited settings
The work presented details micro and nano technologies for point-of-need health and environmental diagnostics in resource-limited settings, specifically in Southern Africa. The challenges faced in these settings have limited the effectiveness of point-of-need diagnostic solutions. By combining the growing fields of paper-based diagnostics and printed electronics, the extensive possibilities of printed functionality can be utilized to develop novel, low-cost solutions for improving the quality of life of those who need it most. Point-of-care diagnostic testing in resource-limited settings – including many of the clinics found across Southern Africa – remains a challenge. Current constraints, such as cost, infrastructure and trained staff have limited the effective implementation of diagnostics at the point-of-care. The primary technical challenges lie in the accurate readout and communication of results from clinics, hospitals and laboratories, and the maintenance of equipment [1]. In recent years, there has been a drive to develop low-cost, innovative point-of-care diagnostics to reach populations such as these where the burden of disease is greatest and resources are fewest. These developments have been guided by the WHO through formalization of the ASSURED criteria, to which these diagnostics should conform if they are to be successful in resource-limited settings. More recently, the REASSURED principles have been defined as an update to the ASSURED criteria to incorporate newer technologies and important factors, including Real-time connectivity, Ease of specimen collection, and Environmental friendliness [2]. Although these guidelines were developed specifically for disease diagnostics, a similar approach can be applied to point-of-need solutions for environmental diagnostics, which are of increasing importance in terms of water quality in resource-limited settings. For both health and environmental point-of-need diagnostics, paper-based solutions have developed rapidly in recent years [3]. Paper is well suited to meeting many of the REASSURED aspects, as it is low-cost, disposable and provides automated fluidic handling and visual readout (e.g. typical lateral flow test (LFT) formats, such as pregnancy tests). Although these devices can be effective, they are prone to user error and lack the accuracy and quantitative capabilities afforded by external instrumentation. At the same time, automated and sophisticated equipment can introduce a number of challenges in resource-limited settings, including the need for an electricity supply, regular maintenance and user training. Limited network and maintenance infrastructure, intermittent power, and issues with theft in resource-limited settings create challenges in the successful implementation of instrumented solutions. This highlights the need for various functional components to be integrated into low-cost, automated and maintenance-free or low-maintenance systems. By combining the emerging fields of printed electronics with paper-based diagnostics, unique and integrated printed functionality solutions can be realized, where components and systems are printed directly onto paper and other low-cost, flexible substrates. The aim is to develop intelligent systems that are packaged into low-cost and maintenance-free solutions, focusing on point-of-need health and environmental diagnostics, and with high impact in developing settings. A number of locally developed components and solutions have been developed towards this goal, including fully printed and hybrid printed solutions for fluidics, sensing, readout and wireless communication [4]. In addition, the long-term goal is to enable distributed manufacturing, utilizing cost-effective methods that could be deployed at various sites for local manufacturing in Southern Africa at the point-of-need. The scalability of these technologies using locally available processes has been initially explored towards the goal of distributed manufacturing for developing local solutions to solve local challenges. The presented work illustrates how multidisciplinary approaches need to be leveraged to develop novel and high impact solutions. South African-based research affords the opportunity to understand first-hand the challenges faced and the potential to make a difference where it matters most. Printed functionality provides a powerful platform on which to develop a multitude of solutions for different applications, with emphasis on developing continents such as Africa.
ABSTRACT