Based on their field observations in West-Africa during the 2014-2016 Ebola epidemic and driven by the ambition to bring advanced technologies to the communities who need it the most, the Praesens Foundation developed a truck-based mobile biosafety laboratory (MBS-Lab) that included an isolator for safe handling of samples and a fully automated molecular diagnostic platform. The goal was to develop an additional tool for better preparedness and faster response to outbreaks and epidemics. The purpose was to fill the gap between the so-called suitcase-based or boxed field mobile laboratories and the much larger container-based laboratories.
The MBS-lab aims to provide an innovative platform for the immediate detection and identification of pathogens in clinical samples of patients living in hard to reach regions with very limited to non-existent healthcare infrastructure.
The key objective of the study was to train a local African team that subsequently performed an extensive field evaluation of the MBS-Lab, mainly focusing on testing its operational readiness under variousfield conditions: robustness, technical and operational sustainability, autonomy, connectivity, maintenance, biosafety procedures, logistics, turnaround times and communication of test results.With its current ecosystem of fixed laboratories, field stations, national surveillance network and experience in responding in various outbreaks, the Institut Pasteur de Dakar (IPD), that hosts a WHO Collaborating Center for arboviruses and haemorrhagic fever viruses, was chosen as a partner to evaluate this MBS-Lab.
This MBS-Lab can be considered an off-grid solution that addresses field challenges with regard to mobility, deployment, environment and personnel safety and operator working conditions. Permanent connectivity by using the cellular and satellite network connection makes the transmission of data and providing real-time information possible. Its design offers safe and comfortable working conditions for the operators. This MBS-Lab solution designed for and tested by African experts has demonstrated successful local ownership and management. Placing patients, their healthcare providers and local communities at the center of these activities have contributed to local support of both political and medical authorities, which proved to be key factors for a successful initiative. Acting under the auspices of the Senegalese Ministry of Health and local health authorities, the MBS-Lab was fully integrated and embedded in the local health system to reinforce capacity building.
The pilot study met the overall objective of cutting down time of diagnostic testing from (at least) one week to hours, through decentralization testing at the most remote level and on-site multiplex testing using molecular platforms at the sentinel sites that serve as satellite health posts. No extensive set-up or installation time is required, once on-site the MBS-Lab can be operational within the hour and moves easily between sites, which is useful during an epidemic investigation. By avoiding the need for transportation of infectious clinical samples to centralised laboratories, this dramatically reduces the time to generate actionable results and reduces the logistical burden. This approach led to better-informed decision-making and improved case management, even of highly mobile populations. Relying on an accurate diagnosis, treatments were more targeted and not based on clinical symptoms only. More than 1300 samples have been safely handled inside the MBS-Lab, including blood samples and nasopharyngeal swabs for the detection of pathogens associated with main tropical infectious diseases.
Prior to the deployment, no local laboratory capacity was available in selected sites and samples had to be sent to the Institut Pasteur de Dakar for analysis, resulting in a turn-around-time of at least one week.
As an open mobile healthcare platform, the MBS-Lab offers various opportunities for field deployable technologies (e.g. molecular detection platform with multiplexing/syndromic panel testing, lateral flow, sequencing etc.). Moreover, this platform generates high-quality data that can be turned into new insights and knowledge (disease intelligence) and offers great potential for the development of disease surveillance software and epidemiological tools for integrated public health surveillance.
It offers rapidly deployable, connected and state-of-the-art technology for effective field diagnostics capabilities. With extensive training and knowledge sharing, this experience perfectly illustrates that by investing in local capacity building efforts that moreover engage the communities and establish the necessary trust before the crisis hits, a country will be able to take local ownership of potential future outbreak responses and to address regional laboratory testing needs in an autonomous way.