UTI-Diag

The challenge

Urinary tract infections (UTIs) are caused by a range of pathogens and are extremely common, with globally more than  400 million UTI cases each year. The prevalence of UTIs has been increasing over the past two decades, particularly in low- and middle-income countries.

In low-resource settings, treatment is typically syndromic, or diagnosis is made primarily on clinical signs, which is incorrect in about a third of cases. This leads to high levels of antibiotic use, driving the spread of antimicrobial resistance. Disease recurrence is common, for example, occurring in 26-44% of women treated for UTIs. 

UTI symptoms are not specific to infections, so the first challenge in clinical care is to determine as quickly as possible whether a patient actually has an infection. Clinical management could also be improved by knowledge about the antibiotic resistance profile of a pathogen, enabling a suitable treatment to be selected.

The project

The UTI-Diag project is exploring whether new diagnostic and sampling technologies could be applied to UTI management in sub-Saharan Africa to enable more targeted antibiotic use and reduce the pressure driving the emergence and spread of antimicrobial resistance.

The project is focusing on four tools that could improve UTI detection and patient care:

• A simple sample collection and transport device, based on a card with disks for urine and blood samples, which can be sealed and sent by regular mail. This could be used by patients or clinicians.
• A lateral flow test (ULTRiPLEX), which detects two urinary proteins associated with UTIs, is to be used in initial triage to determine whether patients have infections.
• UTI-Diag, a battery-operated point-of-care device for molecular detection of antimicrobial resistance genes, to guide choice of antibiotic treatment.
• An adapted version of the AviroPocketClinic digital tool, which reports the results, aids clinical decision-making, and has built-in communications and training support modules.

The project is carrying out clinical validation studies of these tools at multiple sites in Cameroon and Senegal. Special efforts are being made to investigate their use in marginalised and hard-to-reach communities so that the results are as generalisable as possible. The performance of the tools is being compared with that of multiple other strategies and detection methods. Costing analyses are also being carried out.

Impact

The UTI-Diag project will provide data on one of the most common infections, which, in addition to leading to many deaths, has a major impact on quality of life, places high demands on health systems, and is increasingly difficult to treat due to antibiotic resistance. It will:

• Demonstrate whether the tools being tested, individually or collectively, can lead to more targeted treatment of UTIs.
• Show whether their use improves patient outcomes and leads to more rational use of antibiotics.
• Provide health authorities with information on the prevalence, spread and resistance patterns of infections.
• Generate data on the feasibility of the tools and their costs to inform national decision-making.

The project estimates that, with widespread use of the tools, treatment failures, hospital admissions, and healthcare costs could be reduced by more than 40%, and misdiagnosis could be reduced from around 33% to 5%. This would deliver significant benefits to patients, health systems and the long-term battle against AMR.