international research: medical devices for limited-resource settings david kelso biomedical...
TRANSCRIPT
International Research:Medical Devices for
Limited-Resource Settings
David KelsoBiomedical Engineering Department
McCormick School of Engineering11 June 2014
2
Center for Innovation inGlobal Health Technologies
Industry
Academia
Philanthropy
Key Contributions:• Technology, Manufacturing, Regulatory,
Distribution,Current Partners:
Key Contributions:• Project Coordination, New Technology, Market Research and
Product Development, Field ExperienceCurrent Partners:• McCormick School of Engineering – Center for Innovation in Global
Health Technology (CIGHT)• Kellogg School of Management – Global Health Initiative (GHI)• Feinberg School of Medicine
Key Contributions:• R&D Funding, Mission,
Field ExperiencePartners:
HIV p24 infant rapid test
Need for point-of-care early infant HIV diagnostic, EID
4
• 1.4 million infants were born to HIV-positive women in 2007• 390 thousand infants infected• If not diagnosed and started on antiretroviral therapy,
35% of infected infants will die by age 1 year, 52% by age 2
• 2.8 million adjusted life years could be saved annuallyassuming 100% sensitivity and availability of ART
Plasma without centrifugationby filtration
Variation of plasma volume
Disrupt immune complexby heat shock
Effects of heat shock
• Disrupts antibody-antigen complex• 90-95 °C for 5 min required for high
avidity patients• p24 antigen refolds, epitopes of test
antibodies intact• Gel forms in specimens with high
IgG levels
By SafeTech capillary By absorbent pad By unit dose dispenser
Transfer liquids without pipets
Detect p24 antigenby immunochromatographic assay
Cape Town NHLS Verification
Sensitivity: 93.8 – 100%Specificity: 99.3%
p24 antigen correlation with viral load• 18 samples tested with viral loads 345 to 2 million• All samples positive except the 3 with the lowest viral loads• Lowest viral load detected was 6,580 copies/ml
Communicate with central lab
Cellular modem with SIM cardPush buttons to enter P, N, IResults stored in flash memoryPhones lab at pre-scheduled timeTransmits results
HIV p24 rapid test
Technical Issues• Sensitivity/specificity • Reaction
Temperature/Power consumption
• Communications protocol• Performance for 2 day old
Clinical Issues• Heelsticks• User errors• Daily reporting• Improved outcomes• Cure if detect at birth
HIV p24 rapid test
Business Issues• Small market• Low margins• Large investment• NGOs finance technical & market
development
Point of care HIV viral load
Sample in – Answer Out
Copyright © 2012 AIDS. Published by Lippincott Williams & Wilkins. 19
Global trends in molecular epidemiology of HIV-1 during 2000–2007 Hemelaar, Joris; Gouws, Eleanor; Ghys, Peter D; Osmanov, Saladin; WHO-UNAIDS Network for HIV Isolation and CharacterisationAIDS. 25(5):679-689, March 13, 2011.doi: 10.1097/QAD.0b013e328342ff93
Point of care HIV viral load
Technical Issues• Sample volume• Linear range• LoQ• Viral diversity
Clinical Issues• Venipuncture/fingerstick• Adherence counseling• Therapy failure• CD4 testing• Chemistries• Dx decisions• Improved outcomes
Point of care HIV viral load
Business Issues• No US market• Low margins• Large investment• NGOs finance technical & market
development
Up Skill Healthcare Workers: IMCI tablet
IMCI tablet
Technical Issues• User interface• Print out• File sharing• Android/iOS• MDM• Security
Clinical Issues• Faster than paper• Improved Dx• Improved outcomes• Non-professional users
Neonatal Intensive Care
0 10 20 30 40 50 60 70
25
30
35
40
45
heat pack water
Time (min)
Tem
p (
C)
Neonatal Intensive Care
BiliBlanket
Neonatal Intensive Care
• Know your users and use environment• KMC ward device needs:
Breathing monitor CPAP EEG
• Developing world NICU needs• High-income country needs
Mike Hoaglin
2006Northwestern University
BS, Biomedical Engineering
http://www.practicefusion.com/http://www.quantifiedcare.com/
2014Practice Fusion
SmartPhone Physical
Mike HoaglinThe SmartPhone Physical
Blood Pressure
SpO2Eye Exam
ECG
Ultrasound
Visual Acuity
http://www.smartphonephysical.org/