Reducing technology cost and increasing availability of CD4 tests in rural communities :Reducing technology cost and increasing availability of CD4 tests in rural communities Bindley Bioscience Center, Discovery Park, Purdue University, West Lafayette, IN, USA J. Paul Robinson, PhD SVM Endowed Professor of Cytomics Director, Purdue University Cytometry Laboratories Past-President, International Society for Analytical Cytology Email: jpr@flowcyt.cyto.purdue.edu The Cytometry for Life Program at Purdue University Lova Rakotomalala Hildred Rochon Audio Introduction by:


INTRODUCTION :INTRODUCTION 21.0


Evaluation of CD4 :Evaluation of CD4 CD4-T cells are white blood cells They are destroyed by the HIV virus Without CD4-T cells your immunity is destroyed Normal levels of CD4 are 500-1500/microliter <200 CD4/uL you must go on therapy A CD4 test will occur every 3-4 months for patients on therapy The Bottom line: Ready access to CD4 counts is an absolute necessity in Africa


What is the problem with the present system? :What is the problem with the present system? Tests are still expensive Require complex, expensive instruments All current tests require significant infrastructure Tests can take several days to get results The Bottom line: We do not have a low cost, easy to use solution for CD4


The current “best-practice” model :The current “best-practice” model Large central labs in larger cities or towns Use complex, expensive instruments Need highly trained technicians Must ship all the samples to these sites Results have to somehow get back to patients The Bottom line: It may work for cities but does it really work for rural areas? Image: NATURE MEDICINE VOLUME 13 | NUMBER 10 | OCTOBER 2007


Three fundamental problems… :Three fundamental problems… Exclusively provides diagnostics to the cities and those institutions with extensive infrastructure Concentrates the testing frequently overloading the systems Over half of the candidates for testing, fail to gain access to simple diagnostics The Bottom line: Who will argue that this system is successful?


“Next-Gen” – solutions? :“Next-Gen” – solutions? “Lab-on-a-chip” – an instant solution to CD4? Micro-Chips – an instant solution to CD4? Nanomedicine – an instant solution to CD4? Hand-Held-Device - an instant solution to CD4?


What is reality? :What is reality? Public Perception Real Science Searches made Dec 2007 Table developed by J. Paul Robinson, Purdue University There is a big difference between perception and reality when it comes to promised technology solutions for Africa!!


What are we proposing? :What are we proposing? Achievement so far: Reduced size Reduced complexity Proof of principle Simplicity of operation Established chemistry Fundamental Principles Use the present well-accepted methods Innovate with consumer-type products Devise correct algorithm for CD4 quantification Provide a point-of-care –real time result Manual operation - easy to use and robust Early C4L prototype


Point of Care (test) solution :Point of Care (test) solution Take the instrument to the patient Provide immediate results Treat the patient


The C4L technology :The C4L technology 180/22 Portable Low Cost Single Purpose Accurate GPS Cell Phone Battery operated Ability to track instrument and CD4 count remotely for epidemiological purposes Identify areas of therapeutic need Potential for evaluation of drug resistance This simple instrument could be built today using well understood methods, chemistry and applications.


Cytometry for Life :Cytometry for Life A program to deal only with CD4 testing Create a low cost instrument ONLY for CD4 Make it small, robust and easy to use Focus on Point-of-Care testing www.cytometryforlife.org


How can you help us to implement this program? :How can you help us to implement this program? Convincing funding bodies to address present needs, not just future ideas Next-gen tools are important – but almost all are many years from realistic implementation Talk to some of our staff and let them know how you can participate Help us to make sure that we are addressing the real needs of rural communities ….many HIV/AIDS patients in rural areas do not have the luxury of waiting for next-gen technologies to arrive….


Slide 14:We need to provide the solution that solves the problem, not just off-the-shelf solutions Resource-limited regions need special solutions for special problems Current “solutions” don’t solve the problem Continuing to do what we are now doing is not acceptable


The Cytometry-For-Life team :The Cytometry-For-Life team Hildred Rochon Lova Rakotomalala J. Paul Robinson & Gary Durack “Don’t reinvent the wheel, just realign it” C4L Founders National Coordinator Postdoctoral Fellow And the many volunteers helping to make this project a reality in Africa www.cytometryforlife.org


Slide 16:An international consortium of scientists working to create solutions for those in need