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Background

Capacity building represents skill acquisition in disease diagnosis, management prevention and control designed to ensure the critical mass of skilled experts are made from on numerous unskilled population per unit time and per unit area.

There are stages in disease diagnosis all can be broadly divided in to two main group, Phenotypic and genotypic methods. Phenotypic includes but not limited to Biochemical identification, serological identification, cultural identification, Microscopic identification. Gentypic identification involves all the molecular techniques adopted in disease diagnosis.

Most molecular diagnostic devises which forms part of our capacity building techniques  have been reduced into point of care (POC) diagnostics mostly used by the bedsides of the patients. It makes it possible for clinicians to take fast decision. Principles of some point of care diagnostics.

Current and available ways we can train locale capacity to take up the challenge of disease diagnosis in resources limited setting is by workshops, seminars, role plays and so on,

Point of Care Diagnostics

Selected point of care diagnosis and working principles in our capacity building include

1. Transcription-mediated amplification (TMA)/
2. Nucleic acid sequence-based amplification (NASBA)
3. Signal mediated amplification of RNA technology (SMART).
4. Recombinase polymerase amplification (RPA)
5. Helicase-dependent amplification (HDA)
6. Rolling circle amplification (RCA)
7. Ramification amplification (RAM)
8. Loop mediated amplification (LAMP)
9. Cross priming amplification (CPA)
10. Smart amplification (SMART-AMP)
11. Strand displacement amplification (SDA)
12. Nicking enzyme amplification reaction (NEAR)/nicking enzyme mediated amplification (NEMA)
13. Isothermal chain amplification (ICA)
14. Exponential amplification reaction (EXPAR)

Newer non-specific POC NAAT platforms that have been developed

1. The LIAT analyzer automates all the nucleic acid testing processes without further operator intervention. The test is completed within 20 min (Sha et al, 2007)
2. MDx (Biocartis Molecular Diagnostics). (Zhang et al, 2012)
3. FL/ML (Enigma) (Veigas et al, 2012)
4. A.P.I.D. BioDetection System (Biofire Diagnostics Inc; formally the Idaho Rapid Tech System) Augustynowicz-Kopec and Zwolska, 2007
5. Twista (TwistDX; uses RPA) with completion of DNA amplification in as little as 10 min using a portable system Chin et al, 2011
6. Genie II (OptiGene) Schmidt et al, 2011
7. SAMBA (Diagnostics for the Real World Ltd)
8. BART (Lumora, UK) BART system. 2012.

Diagnostic alternative

Alternative detection technologies that may facilitate capacity building in POC testing also as part of the training

1. NAAT product-based lateral flow readouts incorporating antigenic labels (e.g. BESt Cassette detection platform) Rotherham et al, 2012 and other simple NAAT readouts including turbidity, bioluminescence, electrochemical and calorimetric microparticle-based systems (Zhang et al, 2012)
2. Detection of SNP encoding rifampicin resistance using gold nanoparticles and a calorimetric readout Veigas et al 2010
3. M-chip platform using an optical density detector. Chin et al, 2011
4. FLISA that allows detection of fluorescent signals three orders of magnitude below ELISA. Schmidt et al, 2011
5. Bio-sensors using electrochemical, piezoelectric quartz crystal, and magneto elastic readouts
6. SERS (surface enhance Raman spectroscopy) is a label-free way to detect unique signatures generated by photons of light striking a pre-coated metallic surface. Hand held SERS sensors to detect explosives have been developed.