7 Barriers to Point of Care Testing in India and South Africa
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of couriers, and damaged samples), but also due to poor sample quality, lost results,
misspelled names, excess workload in laboratories, and break down of computer
systems. In anticipation of these delays, doctors and nurses would tell patients to
come back even later, would drive results out to clinics by themselves, or fetch
results in laboratories. These strategies artificially prolong diagnostic turnaround
times and put a strain on scarce available human resources (Engel et al. 2015a).
Counselors and nurses who conduct HIV rapid tests (lateral flow assays using
blood samples generated by a finger prick) in clinics, outreach settings, and communities need to maintain relationships to other providers to help each other in
overcoming stockouts of test kits and reagents and manage high workloads. This
could mean that counselors and nurses would share the number of people who came
for testing or that hospital doctors would drive test kits to remote clinics based on
a good relationship with the nurse working in that clinic (Engel et al. 2017). Irregular supply of test kits, frequently changing test kit brands with slightly different
steps to perform (for instance time to result, amount of buffer added), or efforts
to accommodate impatient clients mean that providers described different ways of
using the test kits (for instance, how long they waited before reading results of the
testing strip). These adaptations in practices and differences in how HIV rapid tests
were conducted have unclear implications for outcomes of testing and mean that
some providers mistrusted each other’s quality of diagnostic work, leading to replication of testing and additional delays (Engel et al. 2017). Some providers suggested
to establish comprehensive quality control measures, systems of maintenance, and
ensure continuous (re)-training for every new rapid test kit that counselors and nurses
use. While some wished more testing could be done at POC to guide on the spot
treatment decisions or at doorsteps in communities to reduce fear of social stigma
when accessing clinics, others emphasized to instead prioritize improving referral
systems to centralized laboratories, staff training, and infrastructure strengthening.
Clients who seek an HIV test actively manage their diagnostic processes including
attempts to control where they receive testing (by choosing testing sites that fit
considerations of cost, distance, or avoidance of social stigma), how and which results
they are able to obtain. This could sometimes mean to present with a wrong identity
to be eligible for testing at a different site or to access a different diagnostic device (in
this case, POC CD4 testing, an HIV monitoring test that was only available in selected
sites to newly diagnosed clients). These strategies burden an already overstretched
public health system by using additional testing resources and creating difficulties
with follow-up and tracing. However, they also show how patients actively turn the
test into a tool to achieve another goal (in this case to access another testing device)
(Engel et al. 2017).
81
of couriers, and damaged samples), but also due to poor sample quality, lost results,
misspelled names, excess workload in laboratories, and break down of computer
systems. In anticipation of these delays, doctors and nurses would tell patients to
come back even later, would drive results out to clinics by themselves, or fetch
results in laboratories. These strategies artificially prolong diagnostic turnaround
times and put a strain on scarce available human resources (Engel et al. 2015a).
Counselors and nurses who conduct HIV rapid tests (lateral flow assays using
blood samples generated by a finger prick) in clinics, outreach settings, and communities need to maintain relationships to other providers to help each other in
overcoming stockouts of test kits and reagents and manage high workloads. This
could mean that counselors and nurses would share the number of people who came
for testing or that hospital doctors would drive test kits to remote clinics based on
a good relationship with the nurse working in that clinic (Engel et al. 2017). Irregular supply of test kits, frequently changing test kit brands with slightly different
steps to perform (for instance time to result, amount of buffer added), or efforts
to accommodate impatient clients mean that providers described different ways of
using the test kits (for instance, how long they waited before reading results of the
testing strip). These adaptations in practices and differences in how HIV rapid tests
were conducted have unclear implications for outcomes of testing and mean that
some providers mistrusted each other’s quality of diagnostic work, leading to replication of testing and additional delays (Engel et al. 2017). Some providers suggested
to establish comprehensive quality control measures, systems of maintenance, and
ensure continuous (re)-training for every new rapid test kit that counselors and nurses
use. While some wished more testing could be done at POC to guide on the spot
treatment decisions or at doorsteps in communities to reduce fear of social stigma
when accessing clinics, others emphasized to instead prioritize improving referral
systems to centralized laboratories, staff training, and infrastructure strengthening.
Clients who seek an HIV test actively manage their diagnostic processes including
attempts to control where they receive testing (by choosing testing sites that fit
considerations of cost, distance, or avoidance of social stigma), how and which results
they are able to obtain. This could sometimes mean to present with a wrong identity
to be eligible for testing at a different site or to access a different diagnostic device (in
this case, POC CD4 testing, an HIV monitoring test that was only available in selected
sites to newly diagnosed clients). These strategies burden an already overstretched
public health system by using additional testing resources and creating difficulties
with follow-up and tracing. However, they also show how patients actively turn the
test into a tool to achieve another goal (in this case to access another testing device)
(Engel et al. 2017).