Patricia Connolly of the University of Strathclyde and colleagues in the United Kingdom will develop a low-cost, wearable skin patch that can continuously monitor metabolite levels in newborns without the need for blood sampling, and can alert mothers and health workers to potential problems via mobile phone. Changes in metabolites such as those of hemoglobin and bilirubin are used to assess many aspects of newborn health, but current methods require invasive blood sampling and access to laboratory analysis, which is often unavailable in low-resource settings. To address this, in consultation with users in Sierra Leone, Vietnam and India, they will develop a flat patch incorporating their new technology, which painlessly enhances the flow of analytes through the skin for detection, and a Bluetooth connector that can communicate levels to a smartphone. The prototype patch will be laboratory tested to refine the design.

Joanna Bichsel of Kasha in Rwanda will adapt their mobile ecommerce platform to enable women in Kenya to confidentially order health products such as contraceptives and sanitary pads by mobile phone. There are many social barriers preventing women in developing countries from accessing products at health clinics. Their platform, Kasha, requires only a mobile phone to order and pay for products that are then delivered to local pick-up points. They have successfully implemented Kasha in Rwanda and will now perform a pilot study in several counties in Kenya. They will customize the platform to the language and existing technology in Kenya, and develop private and public partnerships to tap into existing distribution networks, thereby minimizing costs. Their pilot study will evaluate how well the platform is received by Kenyan women, and how effective it is at delivering products.

Bulara Mpiti of the Clinton Health Access Initiative (CHAI) in the U.S. will use the clinical sample transportation network in Lesotho to increase the efficiency of delivering viable vaccines to local health facilities. Most health facilities in Lesotho experience stock-outs of essential vaccines, which are caused by weak supply chains from the stores at district offices. The health facilities are also visited at least once per week by motorcyclists from delivery agencies to pick-up clinical samples for rapid transport to diagnostic laboratories, which are located in the same district offices as the vaccine stores. They will engage these delivery agencies to also manage the ordering and transport of vaccines in the other direction, from district stores to health facilities. To test their approach, they will perform a pilot in selected districts and train vaccine supply managers, health workers, and sample transporters.

Mitesh Thakkar and Harsh Shetty of Arthify Inc. in the U.S. will use radio-frequency identification tags (RFID) on vaccine packages that can be detected by near-field communication (NFC) now found on most smartphones to better track vaccines and improve supply chains in developing countries. They will develop an application for health workers to automatically read the tags and store the data in a cloud, which can then be used to take inventories. They will also build a website so that the data can be easily monitored by supply chain managers to analyze performance and predict demand. They will test their platform for accuracy, feasibility, and cost in a network of 20 primary health centers with 100 sub-centers.

Zawadi Mageni of the Ifakara Health Institute in the United Republic of Tanzania will train local shopkeepers to deliver essential medical supplies to remote areas. Delivery of health products to hard-to-reach areas is problematic due to the poor surrounding transport infrastructure, which suffers further during the rainy seasons. This often means that essential products are out of stock. However, shopkeepers in these areas, with their local knowledge and support, still regularly travel to their central suppliers to maintain their own stocks. These shopkeepers could also be used to deliver medical supplies. They will identify test villages in Tanzania, and the location of medical stores for pick-up points. They will develop a database to map the local health centers and establish an inventory of their medical supplies. Selected shopkeepers will be enrolled and trained, and they will evaluate their approach for avoiding stock-outs of medical products.

Drew Arenth, Benjamin Fels, and Suvrit Sra of Macro-Eyes in the U.S. are applying a statistical machine learning approach to the immunization supply chains of health facilities in Tanzania that accurately and continuously predicts demand to ensure the right vaccines and levels are being stocked. Currently, vaccine supply is largely fixed or driven by depleted stocks. This leaves children unable to be vaccinated due to stock outs at clinics, as well as often high levels of waste, which could both be overcome by better forecasting vaccination needs for individual clinics. In Phase I, they worked with an NGO and the Ministry of Health to access routinely-collected daily vaccination data from 710 health facilities spread across Tanzania. These data were then used to train algorithms to identify predictive patterns that were tested on independent datasets. This led to a model that could accurately forecast future vaccine consumption. In Phase II, they will work out how best to integrate their approach as an automated component within the existing supply chain infrastructure in Tanzania and develop tools and train advocates to demonstrate its value and encourage implementation and adoption.

Andrew Ellington of the University of Texas at Austin in the U.S. and the Alliance for Global Health will create stable enzymes that can be produced in developing countries and used directly in diagnostic assays to reduce costs. Enzymes are required in many diagnostic tests to detect pathogens such as malaria and HIV. However, they can be very expensive to buy and require refrigerated transport, making the tests prohibitively expensive in many developing countries where they are often most needed. Current enzymes, which are made by bacteria, can only be produced in sophisticated laboratories. They will adapt a novel, heat-stable enzyme to enable simple, on-site production for diagnostic tests at low cost and with minimal infrastructure. These features will facilitate accessibility and use in resource-poor conditions.

Cheikh Tidiane Diagne of the Institut Pasteur de Dakar in Senegal will enable real-time remote sensing and monitoring of specimens during transport to laboratories in low-resource settings to facilitate diagnosis and assist researchers and health workers. Containing outbreaks during epidemics requires the early detection and rapid identification of pathogens, which means quickly and carefully collecting and transporting samples to laboratories. They will develop smart biosample preservation and transportation tools that can be monitored in real time with a remote digital interface. They will evaluate their platform for delivery of samples from several rural locations to a centralized laboratory.

Katherine Klapperich of Boston University in the U.S. will develop a simple device that prepares and stores nucleic acid molecules from the blood for diagnostic testing without the need for a cold chain. Current costs for tests such as those to detect HIV are high, due largely to the need to keep the samples cold during transport to district laboratories. Removing the cold chain would also enable samples to be taken at more widespread locations and transported in batches to further reduce transport costs. They will develop a flexible, layered plastic and paper fluidic card that uses a specialized lysis buffer to extract the nucleic acids from small volumes of blood that are then cleaned and dried on a membrane for transport. The nucleic acids can be easily extracted from the membranes, reducing processing costs in the laboratory, and the flexibility of the materials means that they can be processed as reels to reduce manufacturing costs. They will test the cards using blood spiked with HIV and assess the heat stability of the samples.

Ruth Betchel of VillageReach in the U.S. will create a hub to coordinate and track the transport of clinical samples from health facilities to laboratories for diagnosis in Mozambique so that diseases such as HIV and tuberculosis can be identified and treated earlier. Timely diagnosis of disease is also critical for preventing spread. In Mozambique, the existing transport system for patient samples relies on outside providers and is largely uncoordinated, unreliable, and inefficient. They will create a transport coordinating center equipped with an information system to enable dispatchers to match the planned transport routes of a network of existing drivers with samples waiting to be transported. They will also build a sample tracking tool that works via a smartphone application for health workers to request transport and to monitor samples during transport. This will help identify ways to increase the efficiency and speed of delivery.

Natasha Gous of SystemOne in the U.S. will develop a mobile application and digital platform to support people testing themselves for HIV by sending them reminders, offering guidance, and reporting the results. Simple and rapid diagnostic tests and self-testing are now being used across low-resource settings to improve the diagnosis of HIV infections. However, results need to be interpreted manually, which can be difficult for uneducated users, and linked with health facilities so the appropriate care can be given. To address these issues, they will develop a downloadable application so that users can enter their personal data, such as age, sex, and location, and receive instructions on how to perform the test. They will also develop a secure, online database that collects the test results, provides custom reporting, and integrates with the existing laboratory information systems so that health coordinators can monitor testing uptake and disease incidence, and HIV positive users can be informed of where to receive care. They will pilot test their approach for usability and accuracy of reporting with 300 individuals in a clinic in South Africa.

Sara Grobbelaar of Stellenbosch University in South Africa will develop a platform that can analyze existing real-time data on the stocks of health products at clinics across South Africa and present it to all players in the supply chain to ensure products are available when needed. In partnership with a Northern academic institution they will collect and sort relevant data, analyze trends, and develop decision-making tools. The platform will allow analysis, modeling, and forecasting in the health product supply chain so that unexpected changes such as supply disruptions or epidemics can be accommodated.