Compounding diagnostic delays: a qualitative study of point‐of‐care testing in South Africa

Abstract

Abstractobjectives Successful point-of-care (POC) testing (completion of test-and-treat cycle in one patient encounter) has immense potential to reduce diagnostic and treatment delays, and improve patient and public health outcomes. We explored what tests are done and how in public/private, rural/urban hospitals and clinics in South Africa and whether they can ensure successful POC testing.methods This qualitative research study examined POC testing across major diseases in Cape Town, Durban and Eastern Cape. We conducted 101 semi-structured interviews and seven focus group discussions with doctors, nurses, community health workers, patients, laboratory technicians, policymakers, hospital managers and diagnostic manufacturers.results In South Africa, diagnostics are characterised by a centralised system. Most tests conducted on the spot can be made to work successfully as POC tests. The majority of public/private clinics and smaller hospitals send samples via couriers to centralised laboratories and retrieve results the same way, via internet, fax or phone. The main challenge to POC testing lies in transporting samples and results, while delays risk patient loss from diagnostic/treatment pathways. Strategies to deal with associated delays create new problems, such as artificially prolonged turnaround times, strains on human resources and quality of testing, compounding additional diagnostic and treatment delays.conclusions For POC testing to succeed, particular characteristics of diagnostic ecosystems and adaptations of professional practices to overcome associated challenges must be taken into account.

Implementation of Point-of-Care Diagnostics in Rural Primary Healthcare Clinics in South Africa: Perspectives of Key Stakeholders

“…Firstly, it is important to note that the research is set within a high HIV-prevalence region [9], with limited access to laboratory infrastructure [33]. Although the study has provided important information, which relates to contextual and organizational factors that can influence decision making during the implementation of POC diagnostics in rural and resource-limited settings, these findings may not be generalized to the implementation of POC diagnostic services in a developed setting or other resource-limited settings with different characteristics from rural KZN.…”

“…Although POC diagnostics are available for use in PHC clinics in South Africa, the majority of pathology tests are still carried out in laboratories [33]. Use of laboratory testing has been associated with artificially prolonged turnaround times, strain on human resources and quality of testing and compounding additional diagnostic and treatment delays [33].…”

“…Use of laboratory testing has been associated with artificially prolonged turnaround times, strain on human resources and quality of testing and compounding additional diagnostic and treatment delays [33]. South Africa accounts for 18% of global HIV infections, with approximately 6.7 million people infected [9].…”

Implementation of the Xpert MTB/RIF assay for tuberculosis in Mongolia: a qualitative exploration of barriers and enablers

“…Only few research studies, however, have investigated implementation issues from an organisational perspective (Creswell et al, 2014; Engel et al, 2015a; Durovni et al, 2014; Raizada et al, 2014; De Camargo Jr et al, 2015; Albert et al, 2016), two of which included qualitative tools designed specifically for the study to gather information on user experiences and challenges related to Xpert MTB/RIF implementation (Creswell et al, 2014; De Camargo Jr et al, 2015). Some of the identified challenges associated with Xpert MTB/RIF implementation in low-and middle income countries include lack of standardised guidance, piecemeal implementation of training, quality assurance, planning processes and equipment servicing and maintenance, issues with continuous power supply and difficulties recording and reporting test results using new technology (Creswell et al, 2014; De Camargo Jr et al, 2015; Albert et al, 2016).…”

Exploring the Case for a Global Alliance for Medical Diagnostics Initiative

“…While centralized laboratories play an important role in providing medical diagnostic services, they require significant laboratory infrastructure and trained personnel. As patient samples are transported from a network of health facilities in urban and rural settings to centralized laboratories, delays in testing may result in patient loss to follow-up or poor retention in care [1,2]. Decentralized PoC technologies might address the challenges associated with centralized laboratory testing, provided they are easy-to-use, cost effective, provide results within a reasonable time, and yield better patient outcomes [3].…”