Development, Clinical Validation, and Readiness for Implementation of a Novel Mp1p D4 Poin Diagnosis of Talaromycosist of Care Test for Rapid

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ABSTRACT Talaromycosis caused by the dimorphic fungus Talaromyces marneffei (Tm) is an invasive mycosis endemic in Southeast Asia. Tm causes a multi-organ disseminated infection that kills one in three affected persons with an immunocompromised condition despite antifungal therapy. Persons with advanced HIV disease (AHD, CD4<200 cells/L) have the greatest risk and account for 90% of diagnosed cases globally. In highly-endemic countries of Vietnam, Thailand, and China, Tm accounts for 18% of HIV-related hospital admissions and surpasses tuberculosis and cryptococcosis as the leading cause of AIDS deaths. An impediment to reducing talaromycosis mortality is our reliance on century-old diagnostic methods of culture which lack sensitivity and can take up to 28 days, leading to treatment delay and higher mortality. The scientific premise of this proposal is that early diagnosis of talaromycosis (up to 16 weeks before culture diagnosis) using a novel point-of-care test (POCT) is achievable, thus would enable early treatment and improve patient outcomes. We will engage multidisciplinary team science to translate a first-in-kind POC technology from bench to bedside to policy, and we will pave a way for an active screen-and-treat strategy to reduce disease burden and HIV mortality in Southeast Asia. Our objective is to develop, optimize, and validate a novel POCT for early diagnosis and for screening of talaromycosis, and to gather inputs from stakeholders to inform the development of a talaromycosis screening program in people with AHD. Contact MPI Le and colleagues have developed a sensitive and specific enzyme immunoassay (EIA) targeting a Tm-specific mannoprotein Mp1p abundantly secreted in patient blood and urine during infection. She has shown that Mp1p is a more sensitive biomarker than blood culture for diagnosis and can be detected up to 16 weeks before blood culture turns positive. MPI Chilkoti has pioneered the D4 POCT— a self-contained immunoassay that can quantify Mp1p levels in <30 minutes. Herein, we propose the translation of the Mp1p EIA onto the Mp1p D4 POCT to provide a rapid, cheap, and ultra-sensitive test for talaromycosis. AIM 1: Develop and optimize a Mp1p D4 point-of-care test (POCT) for early diagnosis of talaromycosis in human blood, serum, and urine. AIM 2: Determine the clinical utility of the Mp1p D4 POCT as a rapid diagnostic tool for symptomatic talaromycosis and as a screening tool for pre-clinical disease in two cohorts of patients with AHD. AIM 3: Determine the cost-effectiveness, feasibility, and acceptability of implementing a public health talaromycosis screening program. Impact: This proposal will translate a novel POC technology from ‘bench to bedside to policy’, forging a paradigm shift from passive treatment to an active screen-and-treat approach that will improve the individual patient outcome and reduce disease burden at the population level. It will build important partnerships with the health system and community and facilitate the implementation of a talaromycosis screening program in Vietnam.