Across the Asia Pacific region, the patient care journey for a dengue infection varies significantly depending on the structure of the local healthcare system [1]. The primary divide stems from whether care is delivered via a centralised model or a community-based model [1].
Delivering appropriate care for patients infected with the dengue virus is increasingly important as the pathogen becomes endemic in more places; nearly all countries in the Southeast Asia region are endemic [2, 3]. With nearly 15 million cases of this virus reported by the World Health Organisation (WHO) last year ā and hundreds of millions more cases suspected ā the dengue virus is pervasive and dangerous [2].
According to the WHO, 1.3 billion people in South East Asia live in areas where dengue is endemic [3]. About half of the entire global burden of dengue infections falls on this population. Between 2015 and 2019, the number of dengue cases in this region rose by 46% [3].
With so many people affected, inequalities in care delivery can have major consequences in public health. At the 2025 Advancing Diagnostics Roundtable convened by Vista Health at the sidelines of the Asia Dengue Summit, experts reported on pronounced differences in care pathways across the APAC region.
Where care is delivered
Optimal patient outcomes depend on two key factors: rapid diagnosis and early intervention [2]. Importantly, reliable diagnostic results can also inform public health efforts to control local mosquito populations, a key element in reducing outbreaks [2].
Across Asia, care pathways vary based on local healthcare models [1]. Many countries use a community-based approach to deliver diagnostic and patient care through local clinics, including [1]:
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- Indonesia (puskesmas)
- Malaysia (klinik kesihatan)
- The Philippines (barangays)
- Singapore (general practitioner clinics)
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In countries such as India and Thailand, care is more centralised, with limited access at the community level [1]. Of course, access also depends heavily on the cost of tests. India, Malaysia, and Thailand offer free or fully subsidised diagnostic services for dengue infections, while Indonesia, Singapore, the Philippines, and Vietnam provide partially subsidised diagnostic services [1]. In the Philippines, for instance, most diagnostics are out-of-pocket and not fully covered by insurance or PhilHealth ā a government insurance corporation aiming to provide universal health coverage for the nation [1].
A challenging diagnostic landscape
Differences have emerged in which types of tests are most commonly used in each of the APAC countries. For most of the region, rapid diagnostic tests (RDTs) for the NS1 antigen and IgG/IgM ELISA tests are commonly used in dengue diagnostics [1]. RDTs are typically utilised as the initial screening choice for immediate clinical management, largely due to their fast turn-around-time (TAT) [1]. Conversely, ELISA tests remain commonly used due to their superior accuracy and specificity over RDTs [1,4]. Sitting at the highest tier of complexity and cost, RT-PCR tests ā known for its high sensitivity and specificity ā are limited to surveillance and specialised cases, and are mostly available only in national reference laboratories or private hospitals in high-income countries [1,4].
Newer technologies, such as those based on isothermal PCR or on CRISPR workflows, are typically adopted only in higher-income countries, where they are generally seen in pilot/research studies. Countries such as Malaysia and Singapore tend to use ELISA tests for clinical decisions in teaching or public hospitals, while RT-PCR is used for severe cases in the ICU [1]. In the Philippines, RT-PCR tests are mainly limited to research or surveillance use, while ELISA tests are used in hospital facilities or national labs [1]. A consistent challenge across countries is that access to diagnostics is limited in rural areas [1].
Meanwhile, RDTs have become widely adopted in Indonesia, the Philippines, Singapore, and Thailand to pave the way for faster clinical decision-making [1]. In India, the use of RDTs is not recommended due to the variable sensitivity and specificity levels of these assays [1]. This issue has led to low clinician confidence in results from rapid tests across Asia, making it a common barrier to accessing these tests [1]. Consequently, experts opined that clinicians may underutilise rapid tests even when they are appropriate, or rely too heavily on alternative tools such as complete blood counts [1].
The high cost and longer turn-around-time (TAT) of advanced dengue tests, such as RT-PCR and ELISA assays, often lead to clinician hesitancy in ordering these tests [1]. While experts acknowledge that RT-PCR and ELISA assays offer superior accuracy and specificity over rapid tests [1, 4], the need for a shorter TAT makes RDTs often the preferred initial screening choice for immediate clinical management [1]. This trade-off between high accuracy on one hand and speed and affordability on the other could be important considerations, somewhat limiting adoption of the advanced dengue tests for high-volume routine use [1].
Room for improvement
With lab-based tests, results are often delayed due to manual reporting systems and a lack of laboratory automation [1]. This extends the time it takes to diagnose a patient and begin appropriate treatment [1]. Gaps in training have also emerged as a challenge; the lack of proper guidance or skilled personnel to interpret test results ā especially from rapid diagnostic tests ā is a significant barrier across many countries that can contribute to patient mismanagement [1].
Additionally, countries can maximise resource effectiveness by leveraging economies of scale through methods like tiered supply arrangements or bulk order procurement coordinated by the Ministry of Health [1]. Transparently sharing data on these successful procurement models could help drive competitive efficiency, hence making testing more affordable [1]. Moreover, test delivery can be further optimised through alternative financing structures, such as reagent rental agreements, or by seeking support from philanthropic organisations [1].
Overcoming these challenges will be important for delivering dengue diagnoses earlier and accelerating time to intervention, critical steps for reducing the risk of complications and for lowering fatality rates [1, 2]. Integrating diagnostic education into continuing medical education programmes and increasing formal training opportunities for test use and interpretation will be key steps in this process [1].
Note: Insights referenced from the 2025 Advancing Diagnostics Roundtable Report represent participating expertsā opinions.
References:
[1] Vista Health Pte Ltd (2025). Advancing diagnostics roundtable at the Asia Dengue Summit report. PowerPoint presentation, 15 June.
[2] World Health Organization (2025). Dengue (Fact sheet). Available at: https://www.who.int/news-room/fact-sheets/detail/dengue-and-severe-dengue (Accessed: 13 October 2025).
[3] World Health Organization (WHO), South-East Asia Regional Office (no date). Dengue and severe dengue. Available at: https://www.who.int/southeastasia/health-topics/dengue-and-severe-dengue (Accessed: 7 December 2025).
[4] World Health Organization (2025) Laboratory testing for dengue virus: interim guidance. Available at: https://www.who.int/publications/i/item/B09394.Ā Ā Ā
