Brighter Futures! Improving maternal health through innovative models for the uptake of POCTs...
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Brighter Futures! Improving maternal health through innovative models for the uptake of POCTs Patricia J. García MD MPH PhD Facultad de Salud Pública y
Brighter Futures! Improving maternal health through innovative
models for the uptake of POCTs Patricia J. Garca MD MPH PhD
Facultad de Salud Pblica y Administracin Universidad Peruana
Cayetano Heredia Lima, Per
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To identify barriers and opportunities for the introduction of
POCTs in ANC and with this information, develop and evaluate
innovative models for implementation Project goals
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Community Policy, laws, regulatory, surveillance, logistics
Health guidelines Health providers Policy Makers Market
opportunities (Private sector) Technologies New POCTs IT (cell
phones) Models Validation Innovative models Brighter Futures
Improvement of MDG 4, 5 and 6 Environment and structural support
for Introduction of POCTs in maternal health Framework
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Where? 3 locations Ventanilla (Coast) Alt: 55m/a.s.l Mat
mortality: 55.3 Population 75,000 Quispicanchis (Andes) Alt: 3158
m/a.s.l Mat mortality: 271.2 Population 30,000 Yurimaguas (Jungle)
Alt: 148 m/a.s.l Mat mortality: 180.1 Population 63,000 Total
Population 28 807 034 76% urban
Community members.Tests needed HIV Anemia Urinary infection
Hepatitis.Like technology.Willing to pay Local health
providers.Tests needed Anemia HIV Urinary infx (E.coli) Asympt
bacteriuria Preeclampsia Syphilis. Trust technology. Need fast
results National experts.Test needed Urinary infx (E.coli)
Preeclampsia Prematurity Chromosomal abnormalities. Technology does
not always respond to what is needed Requests for packages of
tests: eg. ANC tests as POCT: HIV, Syphilis, HCT, Glu, Urine &
preeclampsia Tests that can help to reach more women and children
Simple and cheap Can be used in the simplest health centers or
posts, or even by health promoters or community health workers
Business experts. Technology + health = great opportunity.
Insurance & Microcredits. Bigger markets: -Family testing -
Latin American region. Issues re importations We have explored and
learned from different stakeholders
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Regulatory issues regarding diagnostics in Peru No complete
definition of a diagnostic test, concept of POCT is absent
Regulations do not reflect reality (e.g. inspections!) No local
capacity for quality control Inappropriate requirements for local
distributors, which increase prices Purchasing of diagnostic tests
in Peru Currently fragmented, within and across systems
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Exploration about available technologies (POCT) One of the
biggest challenges has been finding a POCT or a package of POCTs
ready to take to the field and appropriate for a low-resource
setting Experiences with POCT available : Dont do what they said
should be doing Havent been validated Too complicated or too
expensive
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There are important tests available or under development but
they are: If available/on the market: Too expensive Too complicated
to use Require continuous electricity or other infrastructure Dont
do what they are supposed to do, not validated Not meant to be
REALLY POCT OR Not yet available/on the market Even when
third-party resources or developers may say that they are almost
ready Exploration about available technologies (POCT)
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Understand the contexts where Point of Care Tests are needed,
meet the people! Share and show the POCTs that could be part of the
packages for the Brighter Futures business model Discuss possible
models for implementing the POCT package Strengthen the link
between POCT developers and implementers 17-24 March 2013
www.techfair.futurosbrillantes.org Tech Fair in Peru, March
2013
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Access, a big challenge
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TB laboratory
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Examples of good technologies in the wrong environment
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Brighter Futures Models
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Possible models for introduction of POCTs
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ANEMIA Duo test: HIV and syphilis Package of tests Hemoglobin
analyzer cuvette
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Pharmacy Model ClientPharmacy/boticaBrighter Futures Pharmacy
worker registers client and carries out tests. Worker provides
results, referrals and suggestions test-by-test. 1. Client solicits
a diagnostic test 2. Client requests another product Pharmacy
worker offers Brighter Future products (tablet, test service) Data
goes to database in real time. Brighter Futures provides technical
support and maintains database.
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omen Beauty consultant for health Physician support Referal
Explores clients needs Offers orientation and information POC:
takes samples for screen and gets results Refers for management
Tablets, cel phones, POCT Transmit results in real time
Interpretation of results, support for beauty consultants,
recommendations for client. Women beautiful and healthy Beauty
consultant for health Package for the POC model: Training
Certification Monitoring Tests, supplies, ICT
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Beauty Consultants for health Interested Want to learn, want to
help! Women love technology! Already offering counseling to women,
but not always the right kind I tell them that it is better to go
to the health center just when they are ready to delivery, so they
will not have to wait to be seen, they will be treated like a queen
in an emergency Logo: Beauty comes from your inside, be beutiful
and healthy! To be sustainable needs a package not only for women
but for the family, products to offer.
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Model for the Ministry of Health Pregnant women Professional
midwives Brilliant futures Midwive registers results in celphone,
gives treatment, referral and recommendations Pregnant women in
first ANC visit Midwives using POCT 3 tests for one finger stick
anemia, HIV, syphilis Central procurement of tests instead of
actual system (each center buys supplies)
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Training of Professional midwives
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Implementation
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Final reflexions
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Providers, policy makers and the general population like
techology Identify needs and challenges We definitely need
innovative POCTs Adequate for the needs LMIC Models for effective
implementation We have identified Some models, need innovation here
too , and include all players