COVID-19 diagnosis for remote Indonesia

Full title: Validating GeneXpert platform for SARS-COV-2 diagnosis for remote sites in Eastern Indonesia

Funder: University of Oxford

Principal Investigator: Kevin Baird

Location of activity: Indonesia

Control of the expanding COVID-19 epidemic in Indonesia requires access to SARS-CoV-2 diagnostics – currently just 526 tests/1,000,000 vs. 2,681, 3,264, and >30K for Vietnam, Thailand, and Singapore. Indonesia’s islands have limited access to rtPCR laboratories. The extent of SARS-CoV-2 spread, particularly in impoverished eastern Indonesia, thus remains unknown. The limited availability of supplies, combined with extraordinary cost, difficulty of transport, and enormous backlogs at referral laboratories preclude timely diagnostics for COVID-19 across most of eastern Indonesia.

We aim to leverage existing networks of GeneXpert (Cephid,USA) platforms (MDR TB) diagnosis in eastern Indonesia to remedy nearly non-existent COVID-19 diagnostic services. FDA-approved COVID-19 cartridges are available from Cepheid at LMIC-discount of $19.80/test. We further aim to validate saliva in that platform, thereby simplifying sample collection and logistics. We envision enabling access to SARS-CoV-2 diagnosis at a fraction of the cost and rendered within 1hr, employing available GeneXpert instruments and logistics. We will demonstrate the accuracy and practicality of GeneXpert COVID-19 diagnoses by leveraging our expertise, experience and networks on the remote island of Sumba in eastern Indonesia. We will employ two existing GeneXpert instruments and laboratory facilities at the new government referral hospital for western Sumba.

Aims and objectives

  1. Validate diagnosis of SARS-CoV-2 by analysis of fresh and dried saliva in GeneXpert among 300 patients seeking treatment for febrile illness at Karitas Hospital.
  2. Describe prevalence of SARS-CoV-2 among patients seeking treatment for febrile illness at Karitas Hospital.
  3. Validate the practical diagnosis of SARS-CoV-2 by analysis of 300 saliva specimens on filter paper collected at remote clinics and sent to Karitas Hospital.
  4. Describe prevalence of SARS-CoV-2 among patients seeking treatment for febrile illness at health posts in remote Kodi subdistrict on Sumba.