Exploring the Frontiers of Innovation to Tackle Microbial Threats Proceedings of a Workshop (2020) / Chapter Skim
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3 Harnessing Lessons from Emerging Scientific, Technological, and Social Innovations
3 Harnessing Lessons from Emerging Scientific, Technological, and Social Innovations
Pages 19-36
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Nitika Pant Pai, associate professor a in the Department of Medicine, McGill University, examined the effect of digital process innovations for HIV self-testing on community-level health outcomes using evidence from Canada and South Africa.
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developed its global vector control response against this backdrop of stalled malaria control progress, continued reliance on insecticide-based interventions, and upward trends in insecticide resistance. Released in 2017, this strategic framework was designed to guide countries in how to address the growing threat of vector-borne diseases through 2030 (WHO, 2017a)
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Importance of Evidence-Based Innovations to Eliminate Malaria Lenhart emphasized that because current vector control tools are insufficient, innovation is essential if malaria is to be eliminated. A modeling study summarized the fractions in decreases in childhood malaria attributable to insecticide-treated bed nets, indoor residual spraying of insecticides, and combination therapies; they found that though progress has been made, the impacts of these interventions are still below the elimination target (Bhatt et al., 2015)
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Lenhart described the New Nets Project as a case example of innovation in malaria control. The program is led by the Innovative Vector Control Consortium in partnership with The Global Fund and Unitaid.
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One challenge in using risk maps for resource allocation is the global increase in travel, including international travel; internal migration; and large-scale population displacement following natural disasters or conflicts. For example, if the size of a catchment area is assumed based solely on clinic reporting, then it is probably much larger than assumed.
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She noted that owing to the ubiquity of mobile phones, they can serve as a useful source of this information. Mobile operators already collect these data routinely, providing scalable information about the location and travel patterns of millions of people in nearly real time.
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. In Bangladesh, researchers combined models and data sources, including mobile phone and genetic data, to produce a map that estimated the fraction of cases in a particular region that were thought to be imported (Chang et al., 2019)
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The first is that academic incentives are misaligned with translational goals. The incentives to write publications and secure grants are at odds with the translational goals of local capacity building, navigating regulatory and political issues, long-term engagement with infection control programs, and continuous methodological refinement.
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UNBIASED METAGENOMICS SEQUENCING TO COUNTER MICROBIAL THREATS: LESSONS FROM BANGLADESH Senjuti Saha described the development of a laboratory for metagenomic sequencing to counter microbial threats in Bangladesh to demonstrate the value of building capacity on site in countries that typically outsource this type of work. She explained that CHRF's mission is to improve the evidence needed to inform policy decisions that would improve child health in Bangladesh and around the world.
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During the first phase, 96 samples were collected and sent to the Biohub laboratories in San Francisco: 36 positive controls that were etiology-confirmed using standard laboratory techniques in Bangladesh; 36 negative controls that were noninfectious cases of meningitis and water samples; and 25 "mystery" idiopathic cases, in which etiology could not be attributed using standard laboratory techniques. They extracted RNA from all of the samples, prepared a library, and then sequenced and analyzed the samples.
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Instead, they optimized a low-cost qPCR method to test almost 500 stored cerebral spinal fluid samples from 2017. Using this method, they discovered that 12 percent of all meningitis cases that came into the hospital that summer were positive for chikungunya.
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DIGITAL PROCESS INNOVATIONS FOR HIV SELF-TESTING Nitika Pant Pai presented on how digital process innovations for HIV self-testing can affect health outcomes at the community level, drawing on experiences in South Africa and Canada. She explained that HIV self-testing is a self-screening process whereby end users perform the test on their own by collecting their own blood or oral samples, interpreting and recording their test results, and proactively seeking linkages to counseling and care.
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. Pant Pai explained that in process innovation, cohort study designs have advantages over randomized controlled trials in that they can capture how participants receive the innovation as well as the dimension of choice and other conceptual underpinnings that determine how participants integrate the innovation into their lives.
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HIV self-testing through the app became so popular among the community that they were able to discontinue the social media campaign advertising its benefits. Challenges and Opportunities in HIV Self-Testing Strategies Pant Pai described some of the challenges encountered in implementing HIV self-testing strategies.
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Eva Harris, director, Center for Global Public Health, University of California, Berkeley, asked Lenhart about community involvement in the New Nets Project. Lenhart explained that she is not part of the New Nets Project, but the communities receiving nets through the program are not doing so for the first time; they are receiving innovative replacement nets treated with dual insecticide.
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Espinal offered the example of Venezuelan migrants to Colombia, Ecuador, and Peru being blamed for bringing in diseases such as malaria, giving rise to serious human rights issues. Buckee added that policy makers' responses often depend on which level of government they are in; for example, in a national malaria control program, policy makers may be less interested in blaming people and more interested in trying to control the disease.
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Scott asked about the challenges and barriers encountered in each respective phase and about issues related to delivering at scale that occur despite the innovation of ideas and work to complete proof of principle. Pant Pai responded that universities and granting agencies are supporting innovation, but the support systems needed to scale an innovation are not in place.
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Pant Pai said that she only focused on linkage and retention, but the app could potentially be expanded to connect geolocation hotspots and use machine learning to predict outcomes. Pant Pai said that these types of innovations seem in line with the South African government's focus on simple solutions and the use of technology.
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