Point of care tests in the diagnosis of chronic and allergic aspergillosis Chronic and allergic forms of aspergillosis are an increasingly recognised global health problem. They are caused by the fungus Aspergillus, a very common environmental mould. We breathe in fungus particles daily, but we are usually able to clear them from the lungs. In some cases though, the fungus can establish itself in the lung and cause disease. This usually happens in people with weak immune systems, such as after chemotherapy for cancer, but can also happen on a background of chronic lung disease, like previous tuberculosis (TB) or chronic obstructive lung disease (COPD). This disease is termed chronic pulmonary aspergillosis (CPA).  One in 5 people is expected to develop CPA after successful treatment of TB: this means that CPA affects 1.2 million people globally as a consequence of TB. The number of new TB cases in Indonesia exceeds 1 million per year, making Indonesia the country with the 2nd largest number of TB cases in the world. As TB and CPA may present with the same symptoms, CPA may be mistaken and treated as TB. If CPA is not diagnosed and treated, it can result in lung destruction, weight loss, cough and blood in the sputum. Treatment exists in the form of antifungal medication. It is difficult to diagnose CPA, as diagnosis relies on specialist laboratory tests not available in most low and middle-income countries. A point-of-care (POC) blood test, performed in clinic without the need to send the sample to a laboratory would make CPA much easier and cheaper to diagnose.   We plan to use a recently developed POC test that detects Aspergillus antibody in blood in patients who present with suspected but not confirmed TB in Indonesia, and to compare with a standard serological test. The results will be made known to the physicians who can then decide on best treatment. So we can assess the importance of the result, we will follow the patients for 12 months for signs of deterioration in their symptoms and chest X-Ray. We will also compare the outcomes in patients who were treated with antifungal medication for CPA. We hope we can prove that the POC test can be used to diagnose CPA in low and middle-income settings.  In high-income settings where TB is less common, such as the UK, CPA mainly affects patients with chronic respiratory disease like COPD or bronchiectasis. The diagnosis is made by bronchoscopy and testing of bronchoalveolar lavage fluid for Aspergillus; however, the tests are neither sensitive nor specific. Turn around time, even for specialised labs, may be long and cost is high. A POC test for diagnosis of Aspergillus from pulmonary secretions would speed up diagnosis in this setting too. We plan to compare two POC tests with the conventional methods for the diagnosis of CPA in patients having bronchoscopies. As the gold-standard, we will use a new technology to analyse the entire population of fungi in the lung (called the mycobiome).   Allergic bronchopulmonary aspergillosis (ABPA) complicates 1-4% of cases of asthma globally. It results in poor control of asthma, frequent admissions to hospital and use of long-term steroids which have several side effects. Diagnosis requires either an allergy skin test or blood test. Treatment with antifungals improves symptoms and leads to reduced steroid use. There are more than 13 million asthmatics in Indonesia, and more than 300 thousand with ABPA according to estimates; the majority would be unrecognised if testing is not undertaken. Due to lack of diagnostic facilities, this is the case in most low and middle-income countries. A POC blood test detecting sensitisation to Aspergillus would be ideal for quickly screening patients with poorly controlled asthma. We will screen patients with uncontrolled asthma in Indonesia with the POC test and compare with the standard-of-care blood test. This will help provide an estimate of the rate of ABPA in Indonesia for the first time, and validate the use of this POC test for use in the screening of ABPA. The Newton Fund builds research and innovation partnerships with developing countries across the world to promote the economic development and social welfare of the partner countries.