Biting back

BY PETER FRETTY PHOTO BY TRACEY BROWN

Despite a 25 percent drop in malaria deaths around the world since 2000, the disease still takes a heavy toll, especially in sub-Saharan Africa. In 2010, more than 90 percent of the estimated 655,000 deaths from malaria occurred on the continent, causing a loss of US$12 billion, or 1.3 percent of Africa's GDP, due in large part to healthcare and related costs.

300 MILLION TO 500 MILLION Number of people who become ill with malaria annually

Source: The President's Malaria Initiative

It's a horrible and unnecessary burden, considering the disease is preventable and treatable. Caused by parasites transmitted to people through the bites of infected mosquitoes, malaria can be halted—with the right plan.

Knowing that early detection and treatment reduces transmission and improves patient prognoses, Amethyst Technologies launched a project to upgrade the quality of malaria testing in the continent's rural areas.

“Our role is to help provide quality diagnostics for people who don't have convenient access to hospitals,” says Kimberly Brown, CEO of the Baltimore, Maryland, USA-based biotech company.

The project is part of a US$1.2 billion program led by the U.S. Agency for International Development to help cut malaria-related deaths by 50 percent in 70 percent of at-risk populations in sub-Saharan Africa.

For Amethyst, the project started in Tanzania, with the long-term goal of establishing a consistent testing platform across Africa.

“We spend time training new staff and providing the needed assistance to ensure that lab results are accurate, false positives are minimized and documentation meets the required standards,” Ms. Brown explains.

Testing obviously plays a vital role in identifying and treating patients. But reducing false positives also helps doctors diagnose a person's actual condition and prevents patients from building up drug resistances during treatment for an illness they don't have.

The project team first assesses a lab's testing systems and the skills of the people performing malaria diagnostics by using on-site observation and a quiz. Amethyst then provides lab staff with standardized testing instructions and follows up on a quarterly basis to determine the need for additional training.

Early on, the language barrier emerged as one of the most significant project challenges, says Ms. Brown. So Amethyst translated its operating procedures into Kiswahili and uses a translator during all assessments and training sessions.

To keep up with current conditions on the ground, the company implemented a mobile tool that relies on text messages sent on standard mobile phones.

“This system provides real-time information on the number of patients with malaria and important information on the quality of diagnosis, equipment and stock supplies,” says Mike Sherwin, the Baltimore, Maryland, USA-based project manager. “The data provides an accurate picture of the malaria prevalence in the area, and information and feedback on quality-improvement measures.”

The company also developed a quality-assurance database containing key performance indicators for malaria diagnostics. Each time patients are tested for malaria, lab technicians use the text-messaging system to input crucial data, he explains.

“Success here has been about achieving a new level of consistency,” Mr. Sherwin says.

REPEAT AS NECESSARY

As is the case with so many projects in Africa, the infrastructure in areas where Amethyst works is inadequate or flat-out nonexistent.

“The sites are located in rural areas that don't have reliable or consistent power supply, which greatly affects the diagnostic quality of services delivered,” says Mr. Sherwin. The team's work-around? A ready supply of diesel fuel generators.

Travel between remote project sites has also proven difficult, especially during the rainy season. “There has been great focus on lessons learned with continuous improvement of routes traveled to minimize time on the road,” says Ms. Brown. “We've been fortunate to establish solid working relationships with a host of organizations throughout Tanzania, which has allowed us to work as one unit to address challenges and share best practices.”

Those relationships enabled Amethyst to provide training so other organizations can continue expanding the program.

Amethyst keeps project stakeholders from the U.S. government in the loop through quarterly assessments, weekly meetings in Tanzania and a monthly meeting with both inperson and virtual attendees in the United States.

Since the project launch in June 2010, Amethyst has trained and certified 100 lab staffers on malaria microscopy and quality control at 16 lab sites across Tanzania. In that time, false positives have been slashed by 55 percent, and overall accuracy has soared by 50 percent.

The next step calls for extending the work to include other countries and other diseases, including improvement of HIV diagnostics labs in Tanzania.

By training new and existing technicians on how to properly conduct tests, the project has helped build capacity for medical diagnostics not only in Tanzania but across the continent.

“This project has been instrumental in developing an easily repeatable system that governmental health organizations can repeat as needed in as many locations as conditions dictate,” says Ms. Brown. PM

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