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Brighter Futures! Improving maternal health through innovative models for the uptake of POCTs Patricia J. Garca MD MPH PhD Facultad de Salud Pblica y Administracin Universidad Peruana Cayetano Heredia Lima, Per

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To identify barriers and opportunities for the introduction of POCTs in ANC and with this information, develop and evaluate innovative models for implementation Project goals

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Community Policy, laws, regulatory, surveillance, logistics Health guidelines Health providers Policy Makers Market opportunities (Private sector) Technologies New POCTs IT (cell phones) Models Validation Innovative models Brighter Futures Improvement of MDG 4, 5 and 6 Environment and structural support for Introduction of POCTs in maternal health Framework

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Where? 3 locations Ventanilla (Coast) Alt: 55m/a.s.l Mat mortality: 55.3 Population 75,000 Quispicanchis (Andes) Alt: 3158 m/a.s.l Mat mortality: 271.2 Population 30,000 Yurimaguas (Jungle) Alt: 148 m/a.s.l Mat mortality: 180.1 Population 63,000 Total Population 28 807 034 76% urban

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Ventanilla (Coast) Quispicanchis (Andes) Yurimaguas (Jungle)

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Community members.Tests needed HIV Anemia Urinary infection Hepatitis.Like technology.Willing to pay Local health providers.Tests needed Anemia HIV Urinary infx (E.coli) Asympt bacteriuria Preeclampsia Syphilis. Trust technology. Need fast results National experts.Test needed Urinary infx (E.coli) Preeclampsia Prematurity Chromosomal abnormalities. Technology does not always respond to what is needed Requests for packages of tests: eg. ANC tests as POCT: HIV, Syphilis, HCT, Glu, Urine & preeclampsia Tests that can help to reach more women and children Simple and cheap Can be used in the simplest health centers or posts, or even by health promoters or community health workers Business experts. Technology + health = great opportunity. Insurance & Microcredits. Bigger markets: -Family testing - Latin American region. Issues re importations We have explored and learned from different stakeholders

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Regulatory issues regarding diagnostics in Peru No complete definition of a diagnostic test, concept of POCT is absent Regulations do not reflect reality (e.g. inspections!) No local capacity for quality control Inappropriate requirements for local distributors, which increase prices Purchasing of diagnostic tests in Peru Currently fragmented, within and across systems

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Exploration about available technologies (POCT) One of the biggest challenges has been finding a POCT or a package of POCTs ready to take to the field and appropriate for a low-resource setting Experiences with POCT available : Dont do what they said should be doing Havent been validated Too complicated or too expensive

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There are important tests available or under development but they are: If available/on the market: Too expensive Too complicated to use Require continuous electricity or other infrastructure Dont do what they are supposed to do, not validated Not meant to be REALLY POCT OR Not yet available/on the market Even when third-party resources or developers may say that they are almost ready Exploration about available technologies (POCT)

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Understand the contexts where Point of Care Tests are needed, meet the people! Share and show the POCTs that could be part of the packages for the Brighter Futures business model Discuss possible models for implementing the POCT package Strengthen the link between POCT developers and implementers 17-24 March 2013 www.techfair.futurosbrillantes.org Tech Fair in Peru, March 2013

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Access, a big challenge

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TB laboratory

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Examples of good technologies in the wrong environment

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Brighter Futures Models

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Possible models for introduction of POCTs

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ANEMIA Duo test: HIV and syphilis Package of tests Hemoglobin analyzer cuvette

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Pharmacy Model ClientPharmacy/boticaBrighter Futures Pharmacy worker registers client and carries out tests. Worker provides results, referrals and suggestions test-by-test. 1. Client solicits a diagnostic test 2. Client requests another product Pharmacy worker offers Brighter Future products (tablet, test service) Data goes to database in real time. Brighter Futures provides technical support and maintains database.

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omen Beauty consultant for health Physician support Referal Explores clients needs Offers orientation and information POC: takes samples for screen and gets results Refers for management Tablets, cel phones, POCT Transmit results in real time Interpretation of results, support for beauty consultants, recommendations for client. Women beautiful and healthy Beauty consultant for health Package for the POC model: Training Certification Monitoring Tests, supplies, ICT

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Beauty Consultants for health Interested Want to learn, want to help! Women love technology! Already offering counseling to women, but not always the right kind I tell them that it is better to go to the health center just when they are ready to delivery, so they will not have to wait to be seen, they will be treated like a queen in an emergency Logo: Beauty comes from your inside, be beutiful and healthy! To be sustainable needs a package not only for women but for the family, products to offer.

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Model for the Ministry of Health Pregnant women Professional midwives Brilliant futures Midwive registers results in celphone, gives treatment, referral and recommendations Pregnant women in first ANC visit Midwives using POCT 3 tests for one finger stick anemia, HIV, syphilis Central procurement of tests instead of actual system (each center buys supplies)

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Training of Professional midwives

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Implementation

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Final reflexions

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Providers, policy makers and the general population like techology Identify needs and challenges We definitely need innovative POCTs Adequate for the needs LMIC Models for effective implementation We have identified Some models, need innovation here too , and include all players

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Muchas Gracias!! Thank you Muchas Gracias! patricia.garcia@upch.pe