Point of care tests for invasive fungal infections: a blueprint forincreasing availability in Africa

摘要

Invasive fungal infections (IFIs) such as cryptococcosis, disseminatedhistoplasmosis, and chronic pulmonary aspergillosis are significant causes ofmorbidity and mortality in Africa. Lack of laboratory infrastructure andlaboratory personnel trained in diagnostic mycology hamper prompt detection andmanagement of IFIs on the continent. Point-of-care tests (POCT) obviate the needfor complex infrastructure, skilled technicians, and stable electricity and havehad major impacts on the diagnosis of bacterial, viral, and parasitic infectionsin low- and middle-income countries. Over the last 10 years, POCTs for IFIs havebecome increasingly available and they have the potential to revolutionize themanagement of these infections if scaled up in Africa. At the beginning of 2021,the World Health Organization (WHO) Essential Diagnostic List (EDL) included acryptococcal antigen test for the diagnosis of cryptococcosis,Histoplasma antigen test for the diagnosis of disseminatedhistoplasmosis, and Aspergillus-specific test for the diagnosisof chronic pulmonary aspergillosis. All of these are available in formats thatmay be used as POCTs and it is hoped that this will improve the diagnosis ofthese life-threatening IFIs, especially in low- and middle-income countries.This perspective review discusses commercially available POCTs and outlinesstrategies of a blueprint to achieve their roll-out in Africa. The strategiesinclude raising awareness, conducting research that uncovers the exact burden ofIFIs, increasing advocacy, integrating diagnosis of IFIs into existing publichealth programs, adoption of the WHO EDL at country levels, and improvinglogistics and supply chains.