Integrated Human Practices
Right from the beginning of our work we had the aspiration to not only develop a detection system for chlamydia trachomatis but to adjust our approach to the requirements in developing countries, where trachoma is often still a public health concern. Furthermore we hold the opinion that we as scientists have a moral obligation to critically challenge our own projects. This goes especially for projects with applicational use containing GMOs, of which the general public is still very sceptical. To face both of these demands we set up an extensive integrated human practices project, including several interviews with national and international experts in this field.
Interviews with experts in Germany
To collect opinions and feedback from current experts in chlamydial diagnostics concerning our design we interviewed Emeritus Prof. Dr. Sachse in Jena and Dr. Meyer from the UKE in Hamburg, which gave valuable input and provided help in foreseeing possible problems regarding the project concept and design. An important issue Prof. Dr. Sachse emphasized, is, that a majority of chlamydia infections might be transmitted through animals. This raised discussions of modifying our device to also detect chlamydia in cattle.
Skype-interviews with international experts
Moreover we collected expert opinions from public health officials active in advising developing countries about chlamydial elimination strategies. Notable interviews were with Dr. Courtright, past director and founder of the Kilimanjaro Center for Community Ophthalmology (KCCO) in Tanzania and WHO advising associate, as well as with Dr. Keenan from the Lietman workgroup at the University of California, San Francisco, who develop, analyse and devise elimination strategies by conducting clinical studies in the field. Doing so we gained a detailed overview with current elimination strategies, the global progress of fighting chlamydial infections and problems that are still hindering the WHO target of elimination trachoma by 2020. We learned that the WHO target is aimed at eliminating the so-called public health problem, decreasing the rate of trachoma symptoms down to 5 % in districts. Therefore the actual root of the problem, namely the infection by chlamydia, is not being addressed directly. Therefore, even after ‘eradication’ of trachoma, there is still a fight against chlamydia that needs to be maintained for an indefinite timespan.
Research trip to Malawi
So we realized the presence of a constant market for a possible diagnostic product functioning as a test. But we also needed to research the current methods and strategies of medical professionals working in the field. To learn more about trachoma mapping and trachoma elimination in developing countries under the guidance of WHO, we visited the Blantyre Institute for Community Ophthalmology (BICO) in Malawi, Africa and met up with the Director and Founder of the Institute, Prof. Dr. Kalua. He told us that currently trachoma diagnosis only rely on examination of symptoms and that the patients, if showing those symptoms, would be treated on suspicion, even if uncertain, whether they were really caused by Chlamydia. Because of the lack of funding and due to the time intensive current diagnostic methods, they have thousands of patient samples collected over years, which they aren’t able to analyze and diagnose properly. He therefore showed great interest into a cheap and fast detection method for chlamydia trachomatis. Our device would meet this requirements as it is designed to be suitable for field operations and one microfluidic device will cost less than 0.10$. He also encouraged us to talk with his employees, namely the program manager of trachoma elimination, David Chinyanya and his data analysts. In this context we discussed the possibility of a collaboration, and a combination of the trachoma mapping app they are using in the field with our app for detecting chlamydial infections on the spot, using a lab-in-phone-device which can statistically diagnose patients for chlamydial infections, measuring our microfluidic diagnostic device. Upon inquiry, we were handed one of the phones, which are all Motorola ATRIX MB865, they are using in field operation, to which we then adjusted our Lab-in-phone-device. In addition we discussed the possibility of testing sensitivity/specificity after validation of our biosensor and possible funding opportunities over BICO. We also joined on a field trip, registering inhabitants of a village for mass drug administration (MDA) in the following week and interviewed Michael Masika, Co-Director of the Ophthalmology Health Ministry of Malawi, discussing possible restrictions, laws and other regulations for GMOs in diagnostic devices, designed for field use outside the laboratory. By seeing the circumstances and strategies at work in the field, we could improve our diagnostic device and logistical theorem, if this idea of an application would reach the status of a finished and marketable product.