Innovative Diagnostic Technologies Research Articles

Multinodular and Vacuolating Neuronal Tumor – Challenges and Perspectives

A multinodular and vacuolating neuronal tumor (MVNT) is a rare non-malign central nervous system tumor. The cerebral cortex of young to middle-aged adults is affected and seizures and focal neurological deficits could reveal it. Despite being considered a low-grade tumor, MVNT can be challenging to diagnose and manage due to its histopathological similarities to other neuronal tumors. The limited number of reported cases makes it difficult to establish definitive guidelines for treatment and follow-up. Given the relatively recent discovery of MVNT, there is a need for further research to better understand its pathogenesis, optimal treatment and long-term strategies. Furthermore, studying MVNT can contribute to the broader understanding of brain tumor biology and the intricacies of tumor heterogeneity. This paper explores the challenges and perspectives surrounding MVNT to improve clinical decision-making and patient outcomes. Based on the present narrative review, advancements in diagnostic technologies have shown promise in addressing the challenges associated with diagnosing MVNTs. Liquid biopsy is an innovative and non-invasive diagnostic tool that analyzes biomarkers to provide information about tumors, and radiomics is a method that extracts quantitative data from medical images to provide detailed insights into tumor characteristics. Such innovative diagnostic technologies are important because they have the potential to significantly improve the current diagnostic landscape for MVNTs, allowing for earlier detection, accurate classification, and personalized treatment strategies.

Features of Prenatal Ultrasound Diagnosis of Fetal Tachyarrhythmias (literature review)

Timely prenatal diagnosis of various pathological conditions of the fetal heart is a particularly important problem of obstetric practice. For this purpose, the most frequently used are innovative ultrasound diagnostic technologies that give the opportunity to timely detect various fetal arrhythmias. Clinically significant arrhythmias are established to develop in fetuses and newborns in 1 out of 4,000 live births and are one of the causes of morbidity and mortality. About 10% of fetal arrhythmias require intrauterine treatment or constant monitoring, and they may also indicate the presence of serious hereditary syndromes associated with cardiac rhythm disorders and the likelihood of sudden infant death. The purpose of the review is to study the material of literature sources devoted to the primary prenatal ultrasound diagnosis of clinically significant fetal arrhythmias and dynamic echographic control in the management of pregnant women with fetal tachyarrhythmia. During the research, available domestic and foreign sources were used, which presented the features of the course of fetal cardiac arrhythmias, their types, and the possibilities of prenatal ultrasound diagnosis of this pathology. The search for publications is performed in databases eLIBRARY.RU , RSCI, PubMed, Embase. Based on the results of the analysis and generalization of the studied publications, it was found that ultrasound examination of the fetal heart plays a key role in the diagnosis of arrhythmias, it helps to determine the main mechanism of rhythm disturbance, assess the effect of arrhythmia on the fetal heart's functioning, exclude possible structural changes in the fetal heart, as well as enables to monitor the fetal condition during antiarrhythmic therapy. If fetal arrhythmias are suspected, an urgent ultrasound examination with ultrasound Dopplerography is recommended with an extension of the standard protocol for examining the fetal heart with an assessment of the frequency of atrial and ventricular contractions.

Innovative diagnostic technologies: navigating regulatory frameworks through advances, challenges, and future prospects.

Diagnostic tools are key to guiding patient management and informing public health policies to control infectious diseases. However, many diseases still do not have effective diagnostics and much of the global population faces restricted access to reliable, affordable testing. This limitation underscores the urgent need for innovation to enhance diagnostic availability and effectiveness. Developing diagnostics presents distinct challenges, especially for innovators and regulators. Unlike medicines, regulatory pathways for diagnostics are often less defined and more complex due to their diverse risk profiles and wide range of products. These challenges are amplified in low-income and middle-income countries, which often do not have regulatory frameworks for this specific purpose. In the UK, initiatives aim to support innovation by providing clearer regulatory pathways and ensuring that diagnostics are safe and effective. Regulators are also collaborating internationally to expedite diagnostics for high-need regions. Harmonised standards, regulatory frameworks, and approval processes are essential to ensure consistent quality and safety across regions and facilitate faster development and global access. This Series paper explores the regulatory challenges in infectious disease and antimicrobial resistance diagnostics, focusing on the UK's response and the broader global efforts to address these issues.

Emerging public health strategies in malaria control: innovations and implications.

Malaria remains a significant global health challenge, particularly in regions with limited resources and tropical climates. Despite extensive efforts, the disease continues to cause significant morbidity and mortality, with ~229 million cases and 409000 deaths reported in 2020. However, recent years have seen promising advancements in public health strategies aimed at malaria control and elimination. Technological advancements have played a crucial role in improving malaria control efforts. Genomic surveillance techniques enable the monitoring of malaria parasite populations, aiding in the detection of drug resistance and informing targeted interventions. Additionally, innovative diagnostic technologies, such as rapid diagnostic tests (RDTs) and molecular assays, have enhanced the speed and accuracy of malaria diagnosis, facilitated prompt treatment and reduced transmission. These tools are instrumental in achieving the WHO goals of reducing malaria cases and deaths by at least 90% by 2030. Novel vector control methods offer innovative approaches to reduce malaria transmission. Insecticide-treated nets (ITNs) and indoor residual spraying (IRS) remain foundational strategies, with advancements including the development of next-generation insecticides and long-lasting insecticidal nets (LLINs). Furthermore, genetic modification of mosquitoes, such as gene drive technology, holds promise for reducing mosquito populations and interrupting malaria transmission. These vector control innovations complement other strategies, contributing to comprehensive malaria control efforts aimed at achieving sustainable disease reduction and eventual elimination.

Insights Into the Research Landscape of Biomedical Physics: A Bibliometric Inquiry.

Biomedical physics is the interdisciplinary field that links the scientific concepts in physics to the practice of medicine and biology, in an effort to understand biological processes, help in the development of medical technologies, to improve human health. This bibliometric study investigates the interdisciplinary field of biomedical physics, which integrates the principles of physics with biological and medical sciences to develop innovative diagnostic and therapeutic technologies. Utilizing the Web of Science database for bibliographic data collection, the analysis employs advanced bibliometric software tools, including Biblioshiny and VOSviewer, to comprehensively map the research landscape. Our findings delineate the annual scientific production, highlighting growth trends and identifying the most influential authors and key publication venues in the field. A thematic analysis reveals prevailing research topics and the evolution of scientific interests over time, providing insights into the shifting focus areas within biomedical physics. The factorial analysis goes further to clarify the conceptual structure of the discipline by providing a topological image of how the different research areas are involved. It helps to recognize topical fields and the possibility of the topicalization of other subjects. Keyword co-occurrence assumes the leading themes and measures the value of the topology. Meanwhile, bibliographical information defines the authors' network, and co-citation analysis identifies the critical authors' pool. The last points to the topic dependence and the network of research collaboration on a global scale. As a result, a survey identifies the deficits and rules of recommendations for the further development of research. It adds practical implications that are necessary for the development and identifies influences for popularization that it might have in the future.

Exploring fluoropolymers for fabrication of femtoliter chamber arrays used in digital bioanalysis

The global supply of fluoropolymers and fluorinated solvents is decreasing due to environmental concerns regarding polyfluoroalkyl substances. CYTOP has been used for decades primarily as a component of a femtoliter chamber array for digital bioanalysis; however, its supply has recently become scarce, increasing the urgency of fabricating a femtoliter chamber array using alternative materials. In this study, we investigated the feasibility of fabricating a femtoliter chamber array using four types of fluoropolymers in stable supply as candidate substitutes and verified their applicability for digital bioanalysis. Among these candidates, Fluorine Sealant emerged as a viable option for fabricating femtoliter chamber arrays using a conventional photolithography process. To validate its efficacy, we performed various digital bioanalysis using FP-A-based chamber arrays with model enzymes such as CRISPR–Cas, horseradish peroxidase, and β-galactosidase. The results demonstrated the similar performance to that of CYTOP, highlighting the broader utility of FP-A in digital bioanalysis. Our findings underscore the potential of FP-A to enhance the versatility of digital bioanalysis and foster the ongoing advancement of innovative diagnostic technologies.

Deciphering the progression of fine-needle aspiration: A bibliometric analysis of thyroid nodule research.

This study aims to dissect the evolution and pivotal shifts in Fine-Needle Aspiration (FNA) research for thyroid nodules over the past 2 decades, focusing on delineating key technological advancements and their impact on clinical practice. A comprehensive bibliometric analysis was conducted on 5418 publications from the Web of Science Core Collection database (2000-2023). Publications were rigorously selected based on their contributions to the advancement of FNA techniques and their influence on thyroid nodule management practices. Our analysis uncovered significant breakthroughs, most notably the incorporation of ultrasound and molecular diagnostics in FNA, which have markedly elevated diagnostic accuracy. A pivotal shift was identified towards minimally invasive post-FNA treatments, such as Radiofrequency Ablation, attributable to these diagnostic advancements. Additionally, the emergence of AI-assisted cytology represents a frontier in precision diagnostics, promising enhanced disease identification. The geographical analysis pinpointed the United States, Italy, and China as key contributors, with the United States leading in both publication volume and citation impact. This bibliometric analysis sheds light on the transformative progression in FNA practices for thyroid nodules, characterized by innovative diagnostic technologies and a trend towards patient-centric treatment approaches. The findings underscore the need for further research into AI integration and global practice standardization. Future explorations should focus on the practical application of these advancements in diverse healthcare settings and their implications for global thyroid nodule management.

Machine Learning for Prediction of Tuberculosis Detection: Case Study of Trained African Giant Pouched Rats.

Technological advancement has led to the growth and rapid increase of tuberculosis (TB) medical data generated from different health care areas, including diagnosis. Prioritizing better adoption and acceptance of innovative diagnostic technology to reduce the spread of TB significantly benefits developing countries. Trained TB-detection rats are used in Tanzania and Ethiopia for operational research to complement other TB diagnostic tools. This technology has increased new TB case detection owing to its speed, cost-effectiveness, and sensitivity. During the TB detection process, rats produce vast amounts of data, providing an opportunity to identify interesting patterns that influence TB detection performance. This study aimed to develop models that predict if the rat will hit (indicate the presence of TB within) the sample or not using machine learning (ML) techniques. The goal was to improve the diagnostic accuracy and performance of TB detection involving rats. APOPO (Anti-Persoonsmijnen Ontmijnende Product Ontwikkeling) Center in Morogoro provided data for this study from 2012 to 2019, and 366,441 observations were used to build predictive models using ML techniques, including decision tree, random forest, naïve Bayes, support vector machine, and k-nearest neighbor, by incorporating a variety of variables, such as the diagnostic results from partner health clinics using methods endorsed by the World Health Organization (WHO). The support vector machine technique yielded the highest accuracy of 83.39% for prediction compared to other ML techniques used. Furthermore, this study found that the inclusion of variables related to whether the sample contained TB or not increased the performance accuracy of the predictive model. The inclusion of variables related to the diagnostic results of TB samples may improve the detection performance of the trained rats. The study results may be of importance to TB-detection rat trainers and TB decision-makers as the results may prompt them to take action to maintain the usefulness of the technology and increase the TB detection performance of trained rats.

Prospects for the development of adaptive medical immunology

The processes of adaptation of the human immune system to negative internal and external influences, including stress, infectious, environmental factors, are controlled by the neuroimmunoendocrine complex (NIEC). The normal functioning of the NIEC is the close interaction between the nervous, immune and endocrine systems. The normal NIEC allows the immune system show its adaptive capabilities, remain resistant to various negative influences, while maintaining the ability to repel attacks of various pathogens, neutralize allergic and autoimmune reactions. In case of violations of the normal functioning of the NIEC, adaptive processes in the immune system, the interaction of the immune, nervous and endocrine systems suffer, which leads to persistent violations of the functioning of the immune system and can manifest the formation of diseases of the immune system, including acquired immunodeficiency. We have justified the need to create a new promising scientific direction – adaptive medical immunology, which is based on the study of the features of disorders of the human immune system under acute or chronic exposure to negative internal and external, stressful, infectious, urban factors, resulting in a “breakdown of the adaptive capabilities of the immune system” and, as a result, the diseases exist of the immune system, including acquired immunodeficiency and related immune-dependent diseases. The aim of adaptive medical immunology is to develop an algorithm for complex immunodiagnostics and to create integrative interdisciplinary programs for correction immune system, including immunotherapeutic approaches that affect acquired disorders and restore an adaptive activities of the immune system. The main task is the restoration of an adequate response of the immune system to the existing atypically occurring acute or chronic infectious and inflammatory process, as well as the leveling of disorders of the nervous and endocrine systems with restoration their balanced interaction in the NIEC. Such an integration approach contributes to the restoration of the normal functioning of the immune system, the formation of positive clinical efficacy and the exit of patients into long-term clinical remission. Another task of adaptive medical immunology is the creation of promising innovative diagnostic technologies and, on this basis, the development of new integration programs for targeted restoration of damage to the immune system, as well as the nervous and endocrine systems in immunocompromised patients suffering from various immune-dependent diseases.

Nonimmune binding of human immunoglobulins G and A by <i>Streptococcus pyogenes</i>: the role of this phenomenon in pathology

M and M-like proteins are key pathogenicity factors of Streptococcus pyogenes, a widely prevalent and potentially lethal bacterium. These proteins confer resistance to the hosts innate and adaptive immune response by attracting specific human proteins to the streptococcal surface. The nonimmune binding of host immunoglobulins G (IgG) and A (IgA) to M and M-like proteins via their Fc domains was first described over 50 years ago, but its role in the pathogenicity of S. pyogenes remains unclear. This discovery has had a significant impact on the development of innovative diagnostic approaches, technologies, and tools in microbiology, immunology, and molecular biology. The nonimmune binding of immunoglobulins has been suggested to play a role in immune conditions on mucosal surfaces and their secretions, but not in blood plasma, while other studies suggest it protects microbes from phagocytosis in the hosts nonimmune blood. The Fc-binding effect has been shown to increase the pathogenicity of streptococci, contributing to the development of autoimmune diseases and tissue damage in experimental animals. The experimental autoimmune process can be prevented by administering purified Fc fragments of immunoglobulins to animals. Streptococcal diseases play a significant role in the pathogenesis of IgA-nephropathy (IgAN), a mesangial proliferative process caused by initial IgA-Fc deposition in renal mesangium cells. Literature suggests a relevance of recent ideas about the important role of nonimmune Ig binding in streptococcal diseases, and further efforts are required to study the binding of Fc fragments of IgG and IgA to M and M-like proteins of S. pyogenes, with the aim of developing preventive and potentially therapeutic applications. The paper speculates on the role of nonimmune Ig binding in streptococcal diseases, including cases with various mechanisms of development. These studies also focuses on preventive and potentially therapeutic applications of Fc fragments of IgG to M or M-like proteins of S. pyogenes.

Paper-based biosensors as point-of-care diagnostic devices for the detection of cancers: a review of innovative techniques and clinical applications.

The development and rapid progression of cancer are major social problems. Medical diagnostic techniques and smooth clinical care of cancer are new necessities that must be supported by innovative diagnostic methods and technologies. Current molecular diagnostic tools based on the detection of blood protein markers are the most common tools for cancer diagnosis. Biosensors have already proven to be a cost-effective and accessible diagnostic tool that can be used where conventional laboratory methods are not readily available. Paper-based biosensors offer a new look at the world of analytical techniques by overcoming limitations through the creation of a simple device with significant advantages such as adaptability, biocompatibility, biodegradability, ease of use, large surface-to-volume ratio, and cost-effectiveness. In this review, we covered the characteristics of exosomes and their role in tumor growth and clinical diagnosis, followed by a discussion of various paper-based biosensors for exosome detection, such as dipsticks, lateral flow assays (LFA), and microfluidic paper-based devices (µPADs). We also discussed the various clinical studies on paper-based biosensors for exosome detection.

Thermally Degradable Split-Ring Resonator Made on a Gelatin Substrate with Enhanced Dielectric and Conductive Properties

Ingestible electronics, taken orally for monitoring organs, bacteria, and cells, are innovative wireless diagnostic and therapeutic technologies. Whereas residual in-body devices may require surgical removal, food-based sensors are seen as a way of ensuring safety. This study reports a split-ring resonator (SRR) whose resonance can be observed wirelessly. It is fabricated on a thermoresponsive gelatin substrate with a collaged edible metal leaf. Gelatin is a highly water-absorbing material, which may affect the resonator performance. According to high-frequency structural simulations, this resonator requires a low dielectric loss, <0.05, and high conductivity, >106 S/m. We found that these targets were achieved by completely drying the gelatin film and transferring multiple stacked metal leaves onto the film. Thin metal sheets were glued using an oleogel made of beeswax and olive oil, and the use of a hydrophobic material also aided in the transfer. Thus, we gained insights into the criteria for fabricating transient resonators with thermodegradability. SRRs made with edible materials are a technology that works in harmony with people and the environment and could lead to wireless devices or micromachines for the healthcare, agriculture, and livestock industries.

Innovative Ultrasound Diagnostic Technologies for Chronic Kidney Disease in Children

The most pressing problems facing modern pediatrics and nephrology is chronic kidney disease (CKD) which is associated with an orderly onset of disorders in patients in childhood, a constant increase in the incidence of chronic progressive kidney disease and the occurrence of chronic renal failure (CRF). Despite recent advances in nephrology, reducing the risk of problems associated with delayed CRF and reduced kidney function remains a challenge in the early detection and prevention of kidney disease of various etiologies.

Innovative Diagnostic Peptide-Based Technologies for Cancer Diagnosis: Focus on EGFR-Targeting Peptides.

Active targeting using biological ligands has emerged as a novel strategy for the targeted delivery of diagnostic agents to tumor cells. Conjugating functional targeting moieties with diagnostic probes can increase their accumulation in tumor cells and tissues, enhancing signal detection and, thus, the sensitivity of diagnosis. Due to their small size, ease of chemical synthesis and site-specific modification, high tissue penetration, low immunogenicity, rapid blood clearance, low cost, and biosafety, peptides offer several advantages over antibodies and proteins in diagnostic applications. Epidermal growth factor receptor (EGFR) is one of the most promising cancer biomarkers for actively targeting diagnostic and therapeutic agents to tumor cells due to its active involvement and overexpression in various cancers. Several peptides for EGFR-targeting have been identified in the last decades, which have been obtained by multiple means including derivation from natural proteins, phage display screening, positional scanning synthetic combinatorial library, and in silico screening. Many studies have used these peptides as a targeting moiety for diagnosing different cancers in vitro, in vivo, and in clinical trials. This review summarizes the progress of EGFR-targeting peptide-based assays in the molecular diagnosis of cancer.

Implementing molecular tuberculosis diagnostic methods in limited-resource and high-burden countries.

Tuberculosis (TB) is one of the deadliest infectious diseases in the world with more than a million people dying of TB each year. Accurate and timely TB diagnosis has the potential to alleviate the global TB burden; therefore, one of the pillars of the End TB Strategy developed by the World Health Organization (WHO) is the early diagnosis of TB, including universal drug-susceptibility testing (DST). The WHO emphasises the importance of DST before treatment initiation, using molecular WHO-recommended rapid diagnostic tests (mWRDs). Currently available mWRDs are nucleic acid amplification tests, line probe assays, whole genome sequencing, and targeted next-generation sequencing. However, implementing the sequencing mWRDs in routine laboratories in low-income countries is constrained by the existing infrastructure, high cost, the specialised skills needed, data storage, and the current delay in results compared with other routine methods. These limitations are pronounced in resource-limited settings, which often have a high TB burden and need for innovative TB diagnostic technologies. In this article we propose several possible solutions, like adapting infrastructure capacity to needs, advocating for lowering costs, building bioinformatics and laboratory capacity, and increasing the use of open-access resources for software and publications.

BASIC CONCEPTS OF STATE GOVERNANCE OF DEPARTMENTAL MEDICINE IN UKRAINE

The article is devoted to the study of the categorical-conceptual apparatus of state governance in the field of health care and departmental medicine in Ukraine. The article highlights the definitions, principles of functioning of the health care sector, state governance of the health care sector and state governance of departmental medicine, which is a functional entity that is able to unify approaches to medical care, its availability and quality. The study of the problem of state governance of departmental medicine in Ukraine in wartime necessitated the analysis of scientific interpretations of the basic concepts: “medicine”, ”departmental medicine”, ”health care», «state governance”, “state governancein the field of health care “I”. The current state of the medical industry in Ukraine is characterized by low efficiency of available financial and economic, logistical and human resources, slow pace of change in the implementation of innovative diagnostic methods and technologies and lack of understanding of standards and indicators of quality and management in providing medical services to all patients. departmental health care. The Sustainable Development Strategy “Ukraine – 2030” envisages the implementation of reforms and programs of state development and reform of the health care system: creation of a patient-oriented system capable of providing medical care for all citizens of Ukraine at the level of developed European countries; increasing the personal responsibility of citizens for their own health (Strategy-of-sustainable-development-of-Ukraine-until-2030, 2017). Which prompted the study of the problem of state governance of Ukrainians departmental medicine.

ANALYSIS OF STATE GOVERNANCE IN THE FIELD OF HEALTHCARE IN UKRAINE AND FOREIGN COUNTRIES

The current state of health care in Ukraine is characterized by low efficiency of available logistical using and human resources, slow pace of change in the introduction of innovative diagnostic methods and technologies and lack of understanding of the implementation of standards and indicators of quality and effective management of health services. The goals of health care are to improve health and meet the needs of consumers. The state of the population health depends not only on the provided medical services, but to a large extent on other factors, including the state of the environment, individual heredity, behavioral risk factors, socio-economic status of society and the state of the health care system (Obolenskyi O.Iu., 2007:191). Health care activities should be based on the end results, namely: improving the health of the population; cost and quality of medical services, their availability; fairness and efficiency in the provision of medical services; the effectiveness of mechanisms to protect citizens from financial risk in case of disease (Surmin Yu. P. 2006:307) The authors emphasize the unity of the approach to health care reform in Ukraine at all levels of departmental and national medicine. The study highlights the causes, conditions of formation and functioning of departmental medicine in Ukraine and around the world. The article uses methods of generalization and systematization, grouping and comparison, classification and analogy and systems analysis, as well as the dialectical method and the method of forecasting. The authors analyze the state of health care reform over the past 10 years in countries with high (Britain, France, USA) and low economies (India), with ongoing military conflicts (Israel), with high life expectancy (Italy), with transition economy (Croatia) and in the post-Soviet countries that joined the European Union (Lithuania). The study focuses on the rating indicators of gross domestic product (GDP) and life expectancy, according to analytical reports of international organizations WHO, OECD, International Commonwealth Fund and others.

Research fronts of Chemical Biology

Abstract Over the past decades, researchers have witnessed substantially increasing and ever-growing interests and efforts in Chemical Biology studies, thanks to the development of genome and epi-genome sequencing (revealing potential drug targets), synthetic chemistry (producing new medicines), bioorthogonal chemistry (chemistry in living systems) and high-throughput screening technologies (in vitro cell systems, protein binding assays and phenotypic assays). This report presents literature search results for current research in Chemical Biology, to explore basic principles, summarize recent advances, identify key challenges, and provide suggestions for future research (with a focus on Chemical Biology in the context of human health and diseases). Chemical Biology research can positively contribute to delivering a better understanding of the molecular and cellular mechanisms that accompany pathology underlying diseases, as well as developing improved methods for diagnosis, drug discovery, and therapeutic delivery. While much progress has been made, as shown in this report, there are still further needs and opportunities. For instance, pressing challenges still exist in selecting appropriate targets in biological systems and adopting more rational design strategies for the development of innovative and sustainable diagnostic technologies and medical treatments. Therefore, more than ever, researchers from different disciplines need to collaborate to address the challenges in Chemical Biology.

The Evolving Clinical Management of Genitourinary Cancers Amid the COVID-19 Pandemic.

Coronavirus disease–2019 (COVID-19), a disease caused by Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infection, has become an unprecedented global health emergency, with fatal outcomes among adults of all ages throughout the world. There is a high incidence of infection and mortality among cancer patients with evidence to support that patients diagnosed with cancer and SARS-CoV-2 have an increased likelihood of a poor outcome. Clinically relevant changes imposed as a result of the pandemic, are either primary, due to changes in timing or therapeutic modality; or secondary, due to altered cooperative effects on disease progression or therapeutic outcomes. However, studies on the clinical management of patients with genitourinary cancers during the COVID-19 pandemic are limited and do little to differentiate primary or secondary impacts of COVID-19. Here, we provide a review of the epidemiology and biological consequences of SARS-CoV-2 infection in GU cancer patients as well as the impact of COVID-19 on the diagnosis and management of these patients, and the use and development of novel and innovative diagnostic tests, therapies, and technology. This article also discusses the biomedical advances to control the virus and evolving challenges in the management of prostate, bladder, kidney, testicular, and penile cancers at all stages of the patient journey during the first year of the COVID-19 pandemic.

Implementation of GeneXpert for TB Testing in Low- and Middle-Income Countries: A Systematic Review

Current evidence indicates that the impact of GeneXpert for diagnosing TB in low- and middle-income countries (LMICs) has not demonstrated equivalent outcomes when compared to Xpert evaluations in upper-middle-income countries. Challenges associated with implementation are possible contributing factors preventing this innovative diagnostic technology from achieving more significant public health outcomes. This review aimed to assess the use of implementation science frameworks when reporting the enablers and barriers for the implementation of GeneXpert for diagnosing TB in LMICs. We conducted a qualitative systematic review of the peer-reviewed literature using PubMed, Medline, and Scopus. Eligible articles were those published between January 2010 and March 2020 that identified enablers and barriers to GeneXpert implementation, as well as the implementation approach delivered in an LMIC. Eleven studies were included in the review. Implementation barriers were found to be relatively consistent across studies and included patient-level factors, human resources, material resources, service implementation, service coordination, and technical operations. Few studies (n=5) identified enabling factors in the implementation of Xpert for TB testing. Identified enablers included strategies such as active case finding, expanding diagnostic algorithms, and daily transport of samples. The public health impact of Xpert TB testing interventions was commonly influenced by implementation barriers (n=4). Of the 11 studies, only 3 reported against an implementation framework. This review identified a commonality in implementation barriers and enablers that influenced the overall public health impact of GeneXpert. With greater transparency of these barriers and enablers, program planners can promote a more collaborative approach and adapt interventions. It is recommended that program planners use implementation science frameworks when conducting research and publishing. This will build an evidence base focused on implementation and thereby support programs to address implementation barriers and include enabling factors in program design.