Response to "Requirements for high impact diagnostics in the developing world", by Urdea

Kesaobaka Modukanele

Blog Post for November 10 readings

The common saying prevention is better than cure is often used in HIV/AIDS campaigns, to encourage people to avoid infection through behavior change. These two phenomena, prevention and treatment, are often used by epidemiologists to measure success at combating a virus. However, the paper “Requirements for high impact diagnostics in the developing world” by Mickey Urdea et al, shows a pitfall in the ‘prevention’ and ‘treatment’ indexes, and this pitfall lies in overlooking the issue of diagnosis. Diagnosis and treatment are complementary, which seems like an intuitive fact. However, it is amazing that even after the development of drugs that prevent mother to child transmission, “2.3 million children worldwide were living with HIV/acquired immunodeficiency syndrome (AIDS).” Diagnosis of a disease is obviously the first step toward treatment of diseases like HIV/AIDS, malaria and TB, however, it is also crucial because it helps reduce prevalence on different levels. Firstly, some diseases are not mutually exclusive of each other. Therefore, diagnosis of one disease could be a clue that the patient might have another disease. This is the case with HIV/AIDS and TB, and therefore, the paper discusses that “whenever TB is suspected, the HIV status needs to be considered simultaneously.” Similarly, STI’s like syphilis, gonorrhea or Chlamydia are clinically related and could be diagnosed in one test. This ability to multi-diagnose clinically related diseases is very important in decreasing prevalence, especially among high-risk populations. Secondly, diagnosis tests are very important because they could prevent misdiagnosis. For example, without such tests, children who have symptoms indicative of ARI are often given antimicrobials without any investigation, and this type of misdiagnosis could be deadly. Another importance of properly diagnosing diseases, are economical considerations. What a waste of resources it would be, if an individual not suffering from a disease was treated, while an infected person did not receive any treatment!

Although this paper does highlight the importance of diagnosis, and ways that different diseases could be diagnosed, it felt very stagnant while I was reading it. I kept wondering, what are the steps forward for resource poor countries? Unfortunately, the paper did not reach that point for me. It highlighted the problems, but offered very few if at all, any solutions to the problem of resource-limitation.