Abstract

New Diagnostic Tools for Managing Fever in MSF Settings

Ethan Guillen, Dx program manager, Médecins Sans Frontières (MSF)

Each year, hundreds of thousands of patients present in MSF settings with fevers that are difficult to diagnose and manage. Many pathogens cause fevers: treatment is often probabilistic in the case of upper respiratory tract infections or enteric diseases. However, many fevers have no focus and can be caused by a variety of bacteria or viruses which require different treatment and management strategies, and in the case of bacteria, adapted antibiotic treatment. In addition, there are difficulties in implementing diagnostic tools in resource-limited settings. These include servicing and maintaining multiple diagnostic platforms, assuring supply of assay cartridges, and having a broad menu adapted to patient needs. To address this, MSF is examining novel diagnostic tools. There is a need for affordable, robust, multiplex diagnostic platforms at the referral level that can simultaneously identify the fever-causing pathogen, identify antibiotic susceptibility, and identify bacterial versus non-bacterial infections. MSF believes that a fully- or semi-open source diagnostic system is preferred. A single manufacturer would design the instrument and an open, universal cartridge that accommodates assays developed by multiple manufacturers. This would provide redundant suppliers of assays, assay menus adapted to different epidemiological settings, and simplify service/maintenance and training issues. This type of diagnostic platform challenges the conventional closed systems and raises important questions about feasibility, liability, quality assurance, and intellectual property. MSF has worked with partners examining the business case for a semi-open diagnostic system as well as the potential barriers to such a system, and believes a coordinated effort can overcome them.