Part I The Health of Low? and Middle?Income Countries Today 1 1 The Burden of Communicable Diseases in Low? and Middle?Income Countries 3 Kerry Atkinson and David Mabey 1.1 Introduction 4 1.2 Definition of a Communicable Disease 4 1.3 Definition of Low? to Middle?Income Countries 4 1.4 Definition of Burden of Disease 5 1.5 Definition of Disease Elimination 7 1.6 Definition of Disease Eradication 7 1.7 Definition of the Primary Point?of?Care 7 1.

8 The 2000 Millennium Development Goals (MDGs) and Their Outcomes 7 1.9 Major Individual Diseases in the LMICs: The Big Three ? Malaria, HIV/AIDS and Tuberculosis 9 1.10 Other Important Communicable Diseases in the LMICs 17 1.11 Neglected Tropical Disease (NTDs) Prioritized by the World Health Organisation 29 1.12 A Comparison of Health Metrics in an LMIC (Papua New Guinea) and a Developed Country (Australia) with a 7 km Distance Between them 31 1.13 Conclusions 32 Bibliography 32 Webliography 35 2 The Burden of Non?communicable Diseases in Low? and Middle?Income Countries 37 Heiner Grosskurth 2.1 Introduction 38 2.2 Common Non?communicable Diseases in Low- and Middle-Income Countries 38 2.

3 NCD Epidemiology 38 2.4 Prevention of Non?communicable Diseases 44 2.5 The Relationship Between Communicable and Non?communicable Diseases 44 2.6 The Health System Burden of NCDs 46 2.7 The Economic Impact of NCDs 47 2.8 The Response to the NCD Epidemic in LMICs 48 2.9 The Readiness of Primary Healthcare Services in LMICs to Cope with the NCD Burden 50 2.10 Introducing Effective NCD Control at Primary Care Services: A Practical Approach 52 2.

11 The Role of Primary Healthcare Services in Cancer Prevention and Care 67 2.12 Evaluating Programmes to Strengthen NCD Services at Primary Care Level 70 2.13 Conclusions 70 Bibliography 70 Webliography 78 Part II How to improve healthcare in low? and middle?income countries by primary point?of?care rapid diagnostic testing 81 3 The Optimal Features of a Rapid Point-of-Care Diagnostic Test 83 David Mabey and Rosanna Peeling 3.1 Introduction 83 3.2 Accuracy Versus Accessibility 83 3.3 Quality Assurance 84 3.4 The Importance of Connectivity 85 3.5 Environmental Friendliness 86 References 86 Webliography 87 4 Revolutionizing HIV Healthcare Delivery Through Rapid and Point?of?Care Testing 88 Catherine J.

Wedderburn, Debrah I. Boeras, and Rosanna W. Peeling 4.1 Synopsis 88 4.2 Introduction 89 4.3 Diagnostic Tests in Resource?Limited Settings 89 4.4 Challenges of Using Rapid and Point?of?Care Testing Within the Context of the Healthcare System 92 4.5 Recent Advances in HIV Diagnosis and Monitoring and Their Impact 93 4.

6 WHO Recommendations: POC Diagnostics for Achieving the 90?90?90 Goals 98 4.7 Remaining Challenges - Human Resources, Quality Assurance, and Test Selection and Placement 98 4.8 Moving Forward 99 4.9 Conclusions 100 Bibliography 101 Webliography 103 5 Rapid Point?of?Care Diagnostic Tests for Tuberculosis 105 Richard Lessells 5.1 Introduction 105 5.2 The Need for Rapid Point?of?Care TB Diagnostic Tests 106 5.3 Weaknesses in the TB Diagnostic Cascade 106 5.4 Potential Impact of Rapid Point?of?Care Diagnostic Tests 107 5.

5 Defining the Diagnostic Needs 107 5.6 Smear Microscopy 107 5.7 Molecular Diagnostic Tests 109 5.8 Loop?Mediated Isothermal Amplification (LAMP) 112 5.9 Line Probe Assays 113 5.10 Other Molecular Tests 113 5.11 Antigen Tests 114 5.12 Combination Diagnostic Packages 115 5.

13 Next Generation Sequencing 117 5.14 Diagnostic Imaging 117 5.15 Other Diagnostics 118 5.16 Conclusions 118 References 119 6 Rapid Diagnostic Tests for Syphilis 126 David Mabey, Michael Marks, and Rosanna W. Peeling 6.1 Introduction 126 6.2 The Diagnosis of Syphilis 129 6.3 The Impact of POC Testing for Syphilis 131 6.

4 Challenges in the Implementation of POC Testing 133 6.5 The Future 134 References 134 7 Point?of?Care and Near?Point?of?Care Diagnostic Tests for Malaria: Light Microscopy, Rapid Antigen?Detecting Tests and Nucleic Acid Amplification Assays 137 Heidi Hopkins, and Jane Cunningham 7.1 Introduction 137 7.2 Diagnosis of Malaria 138 7.3 Light Microscopy of Blood Smears 139 7.4 Rapid Diagnostic Tests for Malaria (mRDTs) 140 7.5 Nucleic Acid Amplification?Based Tests (NAATs) for Malaria 142 7.6 Impact of Point?of?Care Testing for Malaria 143 7.

7 Challenges in Implementation of POC Testing for Malaria 144 7.8 The Future 146 Biblography 146 Webliography 156 8 Rapid Diagnostic Tests for Human African Trypanosomiasis 159 Veerle Lejon, Epco Hasker, and Philippe Büscher 8.1 Introduction 159 8.2 The Early Introduction of Immunodiagnostic Tests in the Diagnosis of HAT 160 8.3 CATT/T.b. gambiense: A Breakthrough in the Immunodiagnosis of Gambiense?HAT 161 8.4 The Changing Epidemiology of Gambiense?HAT: The Need for Improved Rapid Diagnostic Tests 163 8.

5 Second Generation RDTs for HAT 165 8.6 Future Perspectives and Challenges 165 References 166 Webliography 169 9 Rapid Diagnostic Tests for Visceral Leishmaniasis 170 Marleen Boelaert, Suman Rijal, and François Chappuis 9.1 Introduction 170 9.2 Parasitology, a Reference Standard? 171 9.3 Serological Assays 172 9.4 The First Serological Test for Field Use: The Direct Agglutination Assay 173 9.5 The Early Development an Immunochromatographic Test Using the Recombinant Leishmania Antigen rK39 174 9.6 Impact of the VL RDT 174 9.

7 Challenges 175 9.8 Other Tests 175 9.9 Discussion 176 9.10 Conclusions 177 References 177 10 A Rapid Diagnostic Test for Dengue 181 Claire Mullender, and James Whitehorn 10.1 Introduction 181 10.2 Clinical Features of Dengue 182 10.3 The Importance of Making a Rapid Diagnosis 183 10.4 The Host Response to Infection 184 10.

5 Existing Diagnostic Strategies 184 10.6 Review of Existing Rapid Diagnostic Tests 186 10.7 Future Directions 188 10.8 Conclusions 188 References 188 11 Rapid Diagnostic Tests for Influenza 191 A.C. Hurt, and I.G. Barr 11.

1 Introduction 191 11.2 Overview of RIDTs 192 11.3 Antigen Detection?based RIDTs 195 11.4 Nucleic Acid Detection?based RIDTs 197 11.5 Factors that Alter RIDTs Performance 198 11.6 The Use of RIDTs in LMICs 198 11.7 Conclusions 199 Acknowledgment 199 References 200 12 A Rapid Diagnostic Test for Ebola Virus Disease 202 Catherine Houlihan and Colin Brown 12.1 Case Report 202 12.

2 Introduction 203 12.3 Diagnostic Methods to Detect Ebola Virus Disease 203 12.4 Rapid Diagnostic Tests for Ebola Virus Disease for Use in a Point?of?Care Facility 206 12.5 Conclusions 209 Bibliography 210 Webliography 212 13 Rapid Diagnostic Tests for Yaws 213 Michael Marks 13.1 Introduction 213 13.2 Epidemiology 214 13.3 Clinical Features 215 13.4 Diagnostic Quandaries 217 13.

5 Diagnostic Tests for Yaws 217 13.6 Rapid Diagnostic Tests for Yaws 218 13.7 Molecular Assays 219 References 221 14 Rapid Diagnostic Tests for the Detection of Sickling Hemoglobin 224 Amina Nardo?Marino and Tom N. Williams 14.1 Sickle Cell Disease 224 14.2 Diagnosing Sickle Cell Disease 225 14.3 Conclusions 229 Bibliography 229 15 Progress Toward the Development of Rapid Diagnostic Tests for Lymphatic Filariasis and Onchocerciasis 231 Roger B. Peck, Dunia Faulx, and Tala de los Santos 15.

1 Introduction 231 15.2 The Development of Rapid Diagnostic Tests 234 15.3 Rapid Diagnostic Tests for Lymphatic Filariasis 234 15.4 Rapid Diagnostic Tests for Onchocerciasis 236 15.5 Next tests and Steps 240 Bibliography 240 Webliography 242 Part III Other tests that can be performed rapidly at the primary?point?of-care 245 16 Point?of?Care Testing for Blood Counts, HbA1c, Renal Function, Electrolytes, Acid-Base Balance and Hepatitis 247 Mark Shephard, Lara Motta, Brooke Spaeth, Heather Halls, and Lauren Duckworth 16.1 Introduction 248 16.2 Point?of?Care Testing for Blood Counts 248 16.3 Point?of?Care Testing for HbA1c 252 16.

4 Point?of?Care Testing for Renal Function 254 16.5 Point?of?Care Testing for Electrolytes and Acid-Base Balance 257 16.6 Point?of?Care Testing for Hepatitis 261 16.7 Conclusions 265 Bibliography 266 Webliography 268 17 Microscopy Skills: Cell Counts, Gram Stains, Ziehl?Neelsen Staining (ZN) and Blood Films 270 Michael Harrison 17.1 Introduction 270 17.2 Microscopy 271 17.3 Microscopy in a POC Testing Laboratory 273 17.4 Gram Staining 274 17.

5 Ziehl?Neelsen Stain (ZN) for Mycobacterium tuberculosis 275 17.6 Blood Film Preparation, Staining and Reporting 276 17.7 Conclusions 278 Bibliography 280 Webliography 2.