NEW YORK — FIND, the global alliance for diagnostics, will use a recent investment to expand an initiative to optimize diagnostics use in low- and middle-income countries over the next few years.
The Geneva, Switzerland-based nonprofit has already piloted its approach in four countries: Burkina Faso and Zambia in Africa and Bangladesh and Vietnam in Asia. With $3.9 million it received last month from the Bill & Melinda Gates Foundation, FIND plans to expand its activities around its diagnostic network optimization, or DNO, process, including the use of its OptiDx platform, to 15 more countries.
DNO is a geospatial network analysis approach that provides an assessment of a diagnostic network in a country and recommends the type and amount of test systems, as well as where to place them, to maximize efficiency and access. OptiDx is a tool created by FIND and its partners to help planners work through scenarios and designs to arrive at the best network arrangements.
Heidi Albert, head of FIND South Africa and its DNO lead, said that its efforts should empower countries to better understand how their diagnostic systems are performing as well as how to improve cost efficiency and improve access to diagnosis, with the goal of reaching country disease targets such as universal health coverage and equity.
"It can empower countries with data for evidence-based decision-making, which can help across the board including in discussions with suppliers," said Albert, who is based in Cape Town. "This is really a way to look across different platforms and devices and come up with the best mix of technologies to meet the country's needs."
FIND's activities around DNO began about five years ago and were inspired in part by similar undertakings in the private sector to conduct geospatial network analyses to determine where to invest. The nonprofit believed the same approach could be used by countries to determine how to arrange their diagnostics networks.
"This has been industry best practice in terms of big corporate understanding and optimizing their supply chain for years," said Albert. "They use it to maximize profits and reduce costs and to make sure you have inventory where you need it to serve customers," she gave as an example.
Albert said that DNO is now helping countries change the way they think about strengthening their diagnostic systems in a similar way, whether it's by better using an existing installed base or placing systems into the regions where they are needed. DNO can also help countries gain more information about which systems they need to acquire and to justify the need for funding.
"This allows you to get a local context, not a one-size-fits-all approach but an understanding of where the need is, and match that with what capacity you have," said Albert. "Historically, it's been about buying new devices, and not thinking about if they are being well utilized or are in the right place," Albert said. "DNO allows you to have a real, tailored approach based on local context and local data."
FIND together with its partners — the US Agency for International Development, the Gates Foundation, the Integrated Diagnostics Consortium, and the African Society for Laboratory Medicine — also recently published a DNO guidance document. The tightly crafted, 29-page document is aimed at health officials and other stakeholders that would like to implement DNO at home. The guidance illustrates the value of geospatial analysis, from flagging tuberculosis hotspots in Malaysia to determining patient waiting times for obstetric care in Nigeria based on location.
By better understanding turnaround times, budget constraints, service challenges, and other parameters, countries that undertake DNO can determine if it makes sense to relocate a lab, or where to send specimens for testing, or if systems installed can be repurposed for other indications.
Albert said that the COVID-19 pandemic in part has illuminated the value of DNO, as countries have been forced to use existing platforms used primarily for, say, TB testing, to test for SARS-CoV-2. Via DNO, they have gained visibility on available capacity and identified where the same systems can be used for other diseases. "Often, there are already testing devices in the country that are being used for something else," said Albert. "The question is how to optimize the mix, what tests to do where."
The recent guidance provided some detail on the use of DNO in some countries, one of which is Zambia, a nation of 18 million people in southern Africa. According to FIND, the aims in Zambia were to improve access to HIV testing for newborns and mothers and to conduct an analysis of molecular testing devices, as well as TB, HIV, and SARS-CoV-2 testing demand. The analysis determined that Zambia's installed base of Cepheid GeneXpert instruments were only being used for TB testing and system utilization was low. By integrating TB and other tests onto one platform, Zambia was able to improve testing and save money through budget sharing.
Powell Choonga, a laboratory adviser in the Zambian Ministry of Health, based in the capital Lusaka, said that Zambia had just adopted multiple disease testing on the GeneXpert platform when approached by FIND about taking part in a DNO pilot project.
"We had no information on utilization rates of the GeneXpert for us to make decisions on which GeneXperts to use for multi-disease testing," noted Choonga. "Further, there are no standards or guidelines for equipment forecasting, procurement and placement," he said.
Choonga said that adopting DNO and using FIND's OptiDx tool has been a "game changer" in Zambia that has "answered all of these challenges," and that the country is now using GeneXpert for TB, COVID-19, HIV, including viral load testing, and for HPV testing.
Vietnam has also been an early adopter of OptiDx, Hung Nguyen, head of the country's National Tuberculosis Reference Laboratory, said that Vietnam is committed to ending TB by 2030 and is "taking all measures to ensure all patients are quickly and correctly diagnosed using a rapid molecular test."
According to Nguyen, Vietnam maintains a "robust network of GeneXpert devices," which it is working to further strengthen. It is also introducing other technologies such as TB-LAMP, Molbio Diagnostics' real-time PCR-based Truenat-TB test, and Cepheid's Xpert MTB-XDR.
"Along with our partners, we have used OptiDx to conduct a Diagnostic Network Optimization in nine provinces to support these efforts," commented Nguyen. "It's encouraging to see how this approach can help us fully utilize our existing testing capacity while simultaneously planning for future testing needs for TB as well as COVID-19."
OptiDx is a tool to implement DNO. FIND developed the web-based, open-access tool with USAID and Llamasoft, a supply chain planning company that San Mateo, California-headquartered Coupa Software snatched up last year for $1.5 billion. OptiDx relies on national data to create a model of a country's diagnostic network, including such data as location and capacity of services, forecasted needs for testing, and connections between sites. The tool can then run different scenarios to allow users to settle on the best combination of access, efficiency, and cost-effectiveness. The Gates Foundation also contributed to the development of OptiDx as a funding partner.
"For one country, you can adjust the assumptions and inputs you put into the model to say that maybe this rural area is a different context to an urban setting," noted Albert of the OptiDx tool. "It can allow you to be quite granular in the inputs that you make."
Albert said that FIND is working with countries and national and academic partners to support the implementation of DNO and OptiDx and to keep improving the tool as well as the value of the process.
OptiDx will become a centerpiece in FIND's outreach to the 15 new countries, supported through the recent Gates Foundation grant. Albert noted that they will be engaging with countries and partners to identify countries for the planned expansion of DNO. "We will see where there is demand for this kind of analysis and where it could have the greatest impact," she said.