Recognizing Essential Diagnostics in Global Health

 The  World Health Organization (WHO) has released a Model List of Essential  Diagnostics in an effort to strengthen clinical diagnostic testing in low- and  middle-income countries. In these regions, particularly in sub-Saharan Africa,  the issue of insufficient laboratory testing capacity to support hospitals and  primary care is widely known. Lee Schroeder, MD, PhD, Assistant Professor at the  University of Michigan and Timothy Amukele, PhD, MD, Assistant Professor at  Johns Hopkins University, will present a roadmap to the creation and  implementation of the essential diagnostics list in their plenary session,  “Essential Diagnostics: Meeting the Needs of a Global Population.”  

“We  hope to pull back the curtain on the advocacy work that supported this movement  and show what it takes to move an issue forward,” Amukele said. “The idea of a  list of essential diagnostics has moved quickly—from a proposal in a high-impact  journal to a WHO recommendation.”

Children  with pneumonia, malaria, or bacterial sepsis can be indistinguishable in their  clinical presentation, but if diagnosed properly, would have very different  courses of treatment. In low-resource settings, patients must be diagnosed  solely on their clinical symptoms, and healthcare providers are unable to use  the power of diagnostic testing to direct their treatment. As a result, there is  widespread overuse of antibiotics fueling resistance, patients may receive the  unnecessary or the wrong treatment, and have poorer outcomes. Without proper  diagnostic testing, clinicians are “left with poor-quality healthcare, wasted  money, and unnecessary suffering,” Amukele said.

Taking  a public health approach, the essential diagnostics list identifies a broad list  of essential high-quality in vitro diagnostic tests for healthcare facilities  with and without clinical laboratories. The essential diagnostics list  prioritizes diagnostic testing for high-burden diseases in routine patient care  such as HIV, tuberculosis, malaria, hepatitis B and C viruses, human papilloma  virus, and syphilis. It also includes tests useful for common conditions like  diabetes, cardiovascular disease, and liver disease.

The  speakers will illustrate how the essential diagnostics list is critical to the  delivery of effective and efficient clinical diagnostics in resource-poor health  systems and discuss the barriers healthcare professionals in these settings must  overcome. Schroeder will describe how laboratory medicine has too often been  deprioritized as compared to therapeutics, when public health authorities  dedicate resources. “The creation of the essential diagnostics list has firmly  established laboratory diagnostics as essential to the global health agenda and  it cements the value of diagnostics in the care cascade,” Schroeder said. “We  hope people gain a deeper understanding of the value our discipline brings to  patients, in all settings.”

Like  the WHO Model List of Essential Medicines, the essential diagnostics list aims  to streamline funding mechanisms and focus the efforts of governments and other  stakeholders to make the most effective investments in laboratory medicine.  Supporters believe that it will help facilitate building and maintaining  infrastructure: improve supply chains, identify necessary target products, and  ensure high-quality testing. The essential diagnostics list will be updated  annually and expanded significantly over the next few years, incorporating other  important conditions. Additionally, the WHO will be accepting applications for  tests to be added, such that anyone can have an impact on the provision of  global laboratory diagnostics.