University Of Pretoria Prof Highlights Democratising Healthcare Across Sub-Saharan Africa

Democratising healthcare access in Sub-Saharan Africa through research conducted by teams in Ghana, Rwanda, South Africa and globally since 2015 was the focus of the University of Pretoria’s Deputy Dean of Research and Postgraduate Studies in the Faculty of Health Sciences, Professor Tivani Mashamba-Thompson, in her inaugural address.

“The ultimate goal of our research is to democratise healthcare access through REASSURED diagnostics,” said Prof Mashamba-Thompson in her address on 11 July at the Tswelopele Building, Lecture Hall 1, attended by the university’s top brass.

“Our research emphasises the need for equitable access to quality diagnostics, leaving no one behind. Research on assessing the performance of POC [point-of-care] diagnostic tests with a focus on accuracy in SSA [Sub-Saharan Africa] is evident. Our previous and ongoing research reveals REASSURED diagnostics research blind spots and contributes to addressing the blind spots,” said Prof Mashamba-Thompson who, on 10 March, received a Bronze Scientific Achievement Award in recognition of her excellence in research from the South African Medical Research Council.

REASSURED is an acronym that stands for Real-time connectivity, Ease of specimen collection, Affordable, Sensitive, Specific, User-friendly, Robust and Equipment free and Delivered to end users. The REASSURED criteria guide the research focus on POC diagnostics.

Dignitaries present at the inaugural lecture included Deputy Vice-Chancellor: Academics Professor Loretta Feris, Faculty of Health Sciences Dean Professor Tiaan de Jager, Faculty of Health Sciences Deputy Dean Teaching & Learning Professor Vanessa Steenkamp, Faculty of Health Sciences Deputy Dean Research and Postgraduate Education Professor Flavia Senkubuge, as well as Faculty of Health Sciences school chairs. Interim Vice-Chancellor and Principal Professor Mosia and Deputy Vice-Chancellor: Research and Postgraduate Education Prof Sunil Maharaj attended virtually.

Promising healthcare innovation

Prof Mashamba-Thompson said access to high-quality and timely diagnostic services is essential for strengthening health systems.

However, she, cautioned that diagnostics services have traditionally received limited attention in global health compared to drug discovery and vaccine development.

Inadequate diagnostic systems and inequitable access to reliable tests often contribute to poor health outcomes, especially in settings with limited access to laboratory infrastructure.

However, she noted that POC diagnostics have emerged as a promising healthcare innovation to address these challenges. POC diagnostics are near-patient diagnostic devices that provide rapid results to guide clinical decisions.

Prof Mashamba-Thompson said the World Health Organization had defined criteria which should be met by POC diagnostics used in resource-limited settings. “We have identified that there is limited focus on sustainability of POC diagnostic tests that are deployed in resource-limited settings and limited focus on local infrastructure capability for sustainable delivering REASSURED POC diagnostic tests to end users.”

As part of the research, Prof Mashamba-Thompson recommended an increase in research resources investment on research focused on advancing local development and sustainable implementation of POC diagnostics that meet the WHO’s REASSURED criteria to ensure sustainable quality service delivery to improve health outcomes of underserved populations.

The research focus employs an implementation science approach to assess whether POC diagnostics, used in various SSA settings, meet the REASSURED criteria.

Global evidence on self-sampling

The Prof noted that tests must be connected to health data platforms in real-time to enable the reading of test results to provide required data to clinical decision-makers and for disease surveillance. Combining high-quality POC diagnostics devices with mobile health technologies offers novel ways to diagnose, track and control infectious diseases and improve the health system’s efficiency.

“Our Nature Review examined the promise of these technologies and discusses the challenges in realising their potential to increase patient’s access to testing, guide clinical decisions and improve the capability of public health authorities to monitor outbreaks, implement response strategies and assess the impact of interventions worldwide,” she added.

In addition, she added that tests should be designed for use with non-invasive specimen collection methods. At the same time, there had been a scoping review to systematically map global evidence on self-sampling to help diagnose sexually transmitted infections (STIs). Diagnosing STIs mostly requires physical examination of people who present to healthcare facilities. This practice is often seen as invasive and unattractive to many due to the social stigma associated with STIs. Delayed diagnosis and treatment of STIs often increase the risk of STI-related long-term health complications, including chronic pelvic pain, fertility issues, and cervical cancer development.

One of the key outcomes of the research relates to affordability. She added that tests should be affordable to end-users and the health system.

“The affordability of POC tests to end users and health systems is paramount. Globally, vulnerable populations face healthcare challenges such as limited access to diagnostics and poorer health outcomes,” she said.

Prof Mashamba-Thompson added that these challenges are more pronounced among vulnerable populations from low-and middle-income countries (LMICs), where the health system is fraught with inadequacies and lack of resources.

Transdisciplinary multi-country studies

During the early stages of the COVID-19 pandemic, researchers observed the financial challenges faced by the public health sector under pressure to meet the increasing need for tests. Fortunately, the private health sector played a crucial role in expanding COVID-19 testing capacity.

Prof Mashamba-Thompson acknowledged that the presented research emanated from the work that was done by the team that she led in UKZN and UP in partnership with the University of Washington, University College London, McMaster, McGill University and Imperial College London.

In respect of plans for the REASSURED diagnostics research team, which involve transdisciplinary multi-country studies in collaboration with other diagnostics researchers, locally and globally, Prof Mashamba-Thompson, said they were are in early stages of a project aimed at advancing the local development of microfluidics POC diagnostics for humans and animals with colleagues Professor Nicole Pamme from Stockholm, and Dr Jesse Gitaka from Mount Kenya University as well as UP Faculty of Veterinary Science’s Prof Daniel Qekwana.

“Our POC diagnostics research will also incorporate non-invasive sampling technologies, and we are collaborating with Prof Ashleigh Theberge’s lab at Washington University. We also plan to work on diagnostics for precision medicine, which will be enabled by our collaboration with NuMeRi [Nuclear Medicine Research Infrastructure] under Prof Sathekge’s leadership.” Prof Mike Sathekge is also Head of the Department of Nuclear Medicine at UP and Steve Biko Academic Hospital.

She said the team was also partnering with Edinburgh University to create a WHO collaborating platform for POC Diagnostics in SSA.

A partnership has also been reached with American multinational medical devices and health care company Abbott for a multi-country HCV POC diagnostics performance evaluation study, which started in West Africa, represented by Ghana.

It takes a village

In her address, the Prof paid tribute to her grandfather, who she said dared to dream that his grandchildren would one day be leaders in their fields of study. “Despite having no formal educational qualifications, working as a security officer in Johannesburg, leaving his family in rural Limpopo where access to quality education was limited, he made sacrifices and supplemented his salary through side hustles to send my mother to boarding school and teachers training college. Following that, he ensured that she had a better start in life by building her a comfortable starter home for her and her children. I dedicate this inaugural lecture to my late grandfather, Father Frank Maluleke, and to all the people who ensured that his dream came true.”

She was grateful too for the influence of her role model mom, Mihloti Mashamba, inspirational late grandmother Florah Maluleke, husband Rowan Thompson and children, Gabrielle Thompson, M’hloti Thompson and Frank Thompson.

She also thanked the University leadership and praised mentor Professor Lehana Thabane, colleagues, and Faculty of Health executives, with a special mention to Dean Professor Tiaan de Jager, “who puts up with having his lunch break disturbed every time I want to share something that cannot wait for him to finish his lunch and a constant request for selfies”.