Interview with Albert S. Peeling, June 3, 1995

Albert S. Peeling was interviewed on June 3, 1995 by Michael J. Birkner & David Hedrick about his years as a student at Gettysburg College in the class of 1925. Peeling discusses his memories of the faculty as a history major and life at the college at the time, such as living quarters and athletics. Length of Interview: 57 minutes Collection Note: This oral history was selected from the Oral History Collection maintained by Special Collections & College Archives. Transcripts are available for browsing in the Special Collections Reading Room, 4th floor, Musselman Library. GettDigital contains the complete listing of oral histories done from 1978 to the present. To view this list and to access selected digital versions please visit -- http://gettysburg.cdmhost.com/cdm/landingpage/collection/p16274coll

External quality assurance for HIV point-of-care testing in Africa: A collaborative country-partner approach to strengthen diagnostic services

It is important to consider the role of diagnostics and the critical need for quality diagnostics services in resource-limited settings. Accurate diagnostic tests play a key role in patient management and the prevention and control of most infectious diseases. As countries plan for implementation of HIV early infant diagnosis and viral load point-of-care testing, the London School of Hygiene & Tropical Medicine has worked with countries and partners with an interest in external quality assurance to support quality point-of-care testing on the continent. Through a series of collaborative consultations and workshops, the London School of Hygiene & Tropical Medicine has gathered lessons learned, tools, and resources and developed quality assurance models that will support point-of-care testing. The London School of Hygiene & Tropical Medicine is committed to the continued advancement of laboratory diagnostics in Africa and quality laboratory services and point-of-care testing

Advancing prevention of sexually transmitted infections through point-of-care testing : target product profiles and landscape analysis

Objectives: Advancing the field of point-of-care testing (POCT) for STIs can rapidly and substantially improve STI control and prevention by providing targeted, essential STI services (case detection and screening). POCT enables definitive diagnosis and appropriate treatment in a single visit and home and community-based testing. Methods: Since 2014, the WHO Department of Reproductive Health and Research, in collaboration with technical partners, has completed four landscape analyses of promising diagnostics for use at or near the point of patient care to detect syphilis, Neisseria gonorrhoeae, Chlamydia trachomatis, Trichomonas vaginalis and the human papillomavirus. The analyses comprised a literature review and interviews. Two International Technical Consultations on STI POCTs (2014 and 2015) resulted in the development of target product profiles (TPP). Experts in STI microbiology, laboratory diagnostics, clinical management, public health and epidemiology participated in the consultations with representation from all WHO regions. Results: The landscape analysis identified diagnostic tests that are either available on the market, to be released in the near future or in the pipeline. The TPPs specify 28 analytical and operational characteristics of POCTs for use in different populations for surveillance, screening and case management. None of the tests that were identified in the landscape analysis met all of the targets of the TPPs. Conclusion: More efforts of the global health community are needed to accelerate access to affordable quality-assured STI POCTs, particularly in low-and middle-income countries, by supporting the development of new diagnostic platforms as well as strengthening the validation and implementation of existing diagnostics according to internationally endorsed standards and the best available evidence

Introducing new diagnostics into STI control programmes: the importance of programme science.

Many innovative diagnostic technologies will become commercially available over the next 5-10 years. These tests can potentially transform the diagnosis of sexually transmitted infections but their introduction into control programmes can be hampered by health system constraints, and political, cultural, socioeconomic and behavioural factors. We used the introduction of syphilis rapid tests to illustrate the importance of programme science to address the gap between accruing evidence of acceptable test performance and the complexity of programme design, implementation and evaluation of test deployment to address public health needs and improve patient-important outcomes

The impetus to Africa CDC's mandate in curbing the rising trend of Antimicrobial Resistance (AMR) in Africa: the launch of the Africa CDC AMR surveillance network during the 8th advanced course in diagnostics (ACDx).

The rise of antimicrobial resistance is a global threat and Africa like any other developing setting is heavily affected. As one of its missions, the Africa CDC is poised to ensure this rising trend takes a diminishing route in the few years ahead. Diagnostics obviously play a pivotal role in AMR control and the advanced course in diagnostics (ACDx) has been instrumental in training critical decision makers over the past 7 years. This commentary presents an analysis of discussions and exchanges during the launch of the Africa CDC AMR surveillance network at the ACDX and the way forward for its implementation. The diagnostics priorities are also highlighted

Sports foods and dietary supplements for optimal function and performance enhancement in track and field athletes

Numerous nutritional products are marketed with claims of optimizing athlete health and function and/or enhancing performance. Products that fall under the banner of “Sports Foods” or “Dietary Supplements,” may be used to support performance during training and competition or for enhancing aspects of training adaptation, recovery, immune function, and/or overall athlete health. Effective marketing campaigns and athlete endorsements may convince us that certain sports foods and supplements are fundamental in allowing athletes to reach their sporting goals. However, this approach is naive in understanding the true foundations of athlete success, such as the inherent genetic predisposition for athletic characteristics, the many hours of well-structured/periodized training, appropriate underlying nutrition, adequate sleep and recovery, and of course, good overall physical and mental health. Nevertheless, if these variables are all accounted for, there may be a role for sports foods and dietary supplements in an athlete’s training and competition routine, particularly within elite sport where marginal performance gains are pursued. The following review presents general considerations for track-and-field athletes using sports foods and dietary supplements to enhance performance, in addition to exploring the potential therapeutic/prophylactic use of these nutritional aids

The costs of accessible quality assured syphilis diagnostics: informing quality systems for rapid syphilis tests in a Tanzanian setting.

OBJECTIVES: To determine the costs of Rapid Syphilis Test (RSTs) as compared with rapid plasma reagin (RPR) when implemented in a Tanzanian setting, and to determine the relative impact of a quality assurance (QA) system on the cost of RST implementation. METHODS: The incremental costs for RPR and RST screening programmes in existing antenatal care settings in Geita District, Tanzania were collected for 9 months in subsequent years from nine health facilities that varied in size, remoteness and scope of antenatal services. The costs per woman tested and treated were estimated for each facility. A sensitivity analysis was constructed to determine the impact of parameter and model uncertainty. FINDINGS: In surveyed facilities, a total of 6362 women were tested with RSTs compared with 224 tested with RPR. The range of unit costs was $1.76-$3.13 per woman screened and $12.88-$32.67 per woman treated. Unit costs for the QA system came to $0.51 per woman tested, of which 50% were attributed to salaries and transport for project personnel. CONCLUSIONS: Our results suggest that rapid syphilis diagnostics are very inexpensive in this setting and can overcome some critical barriers to ensuring universal access to syphilis testing and treatment. The additional costs for implementation of a quality system were found to be relatively small, and could be reduced through alterations to the programme design. Given the potential for a quality system to improve quality of diagnosis and care, we recommend that QA activities be incorporated into RST roll-out

Improving access to new diagnostics through harmonised regulation: priorities for action.

A new generation of diagnostic tests is being developed for use at the point of care that could save lives and reduce the spread of infectious diseases through early detection and treatment. It is important that patients in developing countries have access to these products at affordable prices and without delay. Regulation of medical products is intended to ensure safety and quality whilst balancing the need for timely access to beneficial new products. Current regulatory oversight of diagnostic tests in developing countries is highly variable and weak regulation allows poor-quality tests to enter the market. However, inefficient or overzealous regulation results in unnecessary delays, increases costs and acts as a barrier to innovation and market entry. Setting international standards and streamlining the regulatory process could reduce these barriers. Four priority activities have been identified where convergence of standards and protocols or joint review of data would be advantageous: (1) adoption of a common registration file for pre-market approval; (2) convergence of quality standards for manufacturing site inspections; (3) use of common evaluation protocols, as well as joint review of data, to reduce unnecessary duplication of lengthy and costly clinical performance studies; and (4) use of networks of laboratories for post-market surveillance in order to monitor ongoing quality of diagnostic devices. The adoption and implementation of such measures in developing countries could accelerate access to new diagnostic tests that are safe and affordable

Rapid Syphilis Tests as Catalysts for Health Systems Strengthening: A Case Study from Peru.

OBJECTIVES: Untreated maternal syphilis leads to adverse pregnancy outcomes. The use of point of care tests (POCT) offers an opportunity to improve screening coverage for syphilis and other aspects of health systems. Our objective is to present the experience of the introduction of POCT for syphilis in Peru and describe how new technology can catalyze health system strengthening. METHODS: The study was implemented from September 2009-November 2010 to assess the feasibility of the use of a POCT for syphilis for screening pregnant women in Lima, Peru. Outcomes measured included access to syphilis screening, treatment coverage, partner treatment, effect on patient flow and service efficiency, acceptability among providers and patients, and sustainability. RESULTS: Before the introduction of POCT, a pregnant woman needed 6 visits to the health center in 27 days before she received her syphilis result. We trained 604 health providers and implemented the POCT for syphilis as the "two for one strategy", offering with one finger stick both syphilis and HIV testing. Implementation of the POCT resulted in testing and treatment on the first visit. Screening and treatment coverages for syphilis improved significantly compared with the previous year. Implementation of POCT has been scaled up nationally since the study ended, and coverages for screening, treatment and partner treatment have remained over 92%. CONCLUSIONS: Implementation of POCT for syphilis proved feasible and acceptable, and led to improvement in several aspects of health services. For the process to be effective we highlight the importance of: (1) engaging the authorities; (2) dissipating tensions between providers and identifying champions; (3) training according to the needs; (4) providing monitoring, supervision, support and recognition; (5) sharing results and discussing actions together; (6) consulting and obtaining feedback from users; and (7) integrating with other services such as with rapid HIV testing

Advancing point of care diagnostics for the control and prevention of STIs: the way forward.

WHO recognises the global impact of sexually transmitted infections (STIs) on global public health and individual sexual and reproductive health and well-being. As a component of the WHO Global Health Sector Strategy for the control and prevention of STIs, there has been a growing recognition of the importance of integrating point-of-care tests (POCTs) into overall strategic planning. The process of integrating STI POCTs, in addition to providing a definitive diagnosis and appropriate treatment in a single visit, also includes innovative delivery options, such as on-site delivery, community-based testing (including screening), as well as self-testing at home after purchase of a test online or over-the-counter. WHO organised two technical consultations in May 2014 and July 2015. This article summarises the discussions of the meeting participants on advancing the use of POCTs to control and prevent STIs. The following priorities were identified: the need for pathogens' target discovery; encouragement of multiplexing, miniaturisation, simplification and connectivity; promotion of standardisation of evaluation of new diagnostic platforms across all stages of the evaluation pipeline; the need for an investment case, modelling and scenarios to ensure buy-in among key stakeholders, including developers and the private sector; the need for norms and standards, including guidelines, to support introduction of STI POCTs in programmes; anticipating potential tensions between different parties at the implementation level; and leveraging on the global initiative, Sustainable Development Goals (SDGs)/global health sector STI strategy, to sustain investment in STI POCT programmes. There is a rich pipeline of diagnostic products, but some have stalled in development. An approach to accelerate the evaluation of new diagnostics is to set up a competent network of evaluation sites ahead of time, harmonise regulatory approval processes with development of models to estimate cost-effectiveness, informed by better STI data. This should result in accelerating policy development. Although it may be some time before good POCTs can be widely implemented in low resource settings, it is important to be a catalyst for continued development and use of these essential tools as an integral part of both the WHO Global Health Sector Strategy and the agenda for 2030