Strategies seek to forge the missing link between patients and diagnoses

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It’s one of weakest links in the health systems where limited resources and long distances separate sick people from the laboratories that could diagnose their ills: For want of a simple affordable system to get patient specimens from one place to another, infectious disease outbreaks and their impacts go undetected, untreated, and uncontrolled. It is a gap, an editorial in the new Clinical Infectious Diseases argues, that contributed to the nearly half of all Ebola cases that went unconfirmed in the recent outbreak, missed opportunities to identify more than 4 million undiagnosed cases of tuberculosis every year, and failures to monitor the effectiveness of antiretroviral  treatment of more than 6 million people living with HIV in Africa.

But it is a gap that systems using existing resources and technologies and serving programs responding to multiple diseases could fill, according to an article in the same issue. In Ethiopia, the authors of the article report, a collaboration between the national public health agency and the national postal service developed a system for transporting specimens  — dried blood spots, plasma, sputum, whole blood and serum — used to diagnose and monitor early infant HIV, tuberculosis and treatment effectiveness among HIV patients to district, regional, and central laboratories. In the process, postal system workers were trained on biosafety and provided with appropriate packaging and containers. Geographic information system software maximized the system’s efficiency by providing optimal routes. In Uganda, GIS software helped map routes — laid out as spokes — from a range of health care sites where samples were collected, to central health facilities — or hubs — where they could be tested.

The authors, led by Peter N. Funjungo of the U.S. Centers for Disease Control and Prevention, note that in addition to GIS software, Unmanned Aerial Vehicles — or drones — offer promise, and that community health workers, will continue to be critical. The article,Combatting Global Infectious Diseases: a Network Effect of Specimen Referral Systems is in the current edition of Clinical Infectious Diseases.

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