Affordable near-patient diagnostics to distinguish infectious diseases in the Philippines (AND2ID in Ph)

急性发热可能由一系列病原体引起，但临床症状可能过于非特异性，无法区分病原生物，因此正确诊断需要病原体特异性诊断试验。这些诊断对于在资源有限的环境中常规使用来说过于昂贵。这意味着许多患者是经验性地使用广谱抗生素治疗，这可能是不必要的、有毒的，并增加了抗菌素耐药性的风险。相反，延迟诊断和治疗可能导致不良结果。菲律宾低成本诊断的障碍来自一个跨越世界的价值链，没有购买力平价（PPP）。如果我们能够使用可以在当地生产的技术，利用当地资源，那么我们就迈出了第一步，在资源贫乏的地区提供负担得起的诊断方法，并在发展当地经济的同时，持续改善医疗保健。我们已经制造出一种酶（boon -酶），它可以进行这些测试，并且几乎可以在任何地方生产，而无需特殊设施。我们已经把酶做成了粉红色，这样你就可以看到它已经生产出来了，我们有办法让它粘在沙子上，这样它就非常稳定。我们将使用其中一种酶——聚合酶链反应（PCR）中的BOON-Taq——在马尼拉圣托马斯大学对疑似登革热和钩端螺旋体病患者进行临床研究，以评估使用诊断方法对患者途径和疾病负担的影响。通过这些试验，我们将设计一种可以带到农村诊所的诊断试剂盒，并在农村诊所进行临床试验。我们将通过开发诊断对患者途径影响的医疗保健经济学模型来支持这项研究。

Acute fever may be caused by a range of pathogens, but clinical symptoms may be too non-specific to differentiate the causative organism, so correct diagnosis requires pathogen-specific diagnostic tests. These diagnostics are too expensive for routine use in resource-limited settings. This means that many patients are treated empirically with broad spectrum antibiotics, which may be unecessary, toxic, and increase the risk of antimicrobial resistance. Conversely delayed diagnosis and treatment may lead to poor outcomes. A barrier to low-cost diagnostics in the Philippines, arises from a value chain that spans the world, without Purchasing Power Parity (PPP). If we could use technologies that can be manufactured locally, using local resources, then we have the first step to providing affordable diagnostics in resource poor areas, and delivering a sustained improvement in healthcare, while also developing the local economy. We have made an enzyme (BOON-enzyme) that can do these tests and can be produced almost anywhere without special facilities. We have made the enzyme pink, so that you can see that it has been produced and we have a way of making it stick to sand so that it is very stable. We are going to use one of these enzymes - BOON-Taq in polymerase chain reaction (PCR) - to perform a clinical study in patients with suspected dengue and leptospirosis at the University of Santo Tomas in Manila, to assess the impact of the use of diagnostics on the patient pathway and the disease burden. As a result of these trials we will design a diagnostic kit that can be taken out to rural clinics and we will undertake clinical trials in such a clinic. We will support the study by developing a healthcare economics model of the impact of diagnostics on the patient pathway.