7 Barriers to Point of Care Testing in India and South Africa
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human resources. The onus is on the patient to ensure completion of test and treat
cycles. If a patient’s initiative is not supported in these journeys, chances are high that
he/she opts out. Constructive counseling by providers about various aspects of diagnostic tests and processes is necessary but not sufficient. Functioning relationships
between providers are equally important (Engel et al. 2015b).
While the system in South Africa does not foresee such an active role for patients
in ensuring a POC continuum, it still relies on a patients’ ability to return to clinics on
another day for either results (in the case of laboratory-based testing) or for followup testing and counseling sessions in the case of HIV. The examples of HIV testing
showed that HIV patients also need to actively manage diagnostic processes to make
testing fit their personal circumstances and make testing worthwhile for themselves
(Engel et al. 2017).
These profound differences between the diagnostic setup, offer very different conditions for POC testing. Although the promises that have been attached to POC testing
easily lend themselves to view testing technologies as silver bullets, it matters how
diagnostic processes are organized and made to work at POC. The results reveal how
the material dimensions of diagnosis, such as the test platform, reagents, and supplies,
the actors involved, their relations and the sociocultural context in which testing and
diagnosis are happening are invariably interlinked (Engel et al. 2015b). This means
that simply focusing on one element, for instance, improving infrastructure or test
platforms or relationships, is not sufficient. Those aspects need to be studied and
tackled together. The contrasting results from India and South Africa further highlight that the settings and the tests have their own histories, assumptions, practices,
and understandings inscribed in them. This means that by implementing tests successfully, both the setting, including its organization of the workflow, workforce,
its infrastructure, interaction with patients, and standards, and the tests are being
shaped and need to be adapted. Tools and (user) practices are being co-constructed
(Oudshoorn and Pinch 2003). Implementing diagnostic tests is thus a dynamic and
ongoing process that requires continuous observation, analysis, reflection, iterations,
and adaptations of tests and (user)-practices and -settings.
Such insights need to be taken into account when designing POC testing programs
and technologies. Test developers, decision-makers, and funders need to account for
these ground realities. They need to identify and involve users and various stakeholders in design, evaluation, and implementation processes. However, current global
diagnostic design and development practices, research, regulation, and evaluation
capacities do not do justice to the dynamic nature of these processes of making
diagnostic tests work at POC.
Based on these insights, practitioners, donors, and test developers should make
sure to
• Study diagnostic practices at POC and how devices are integrated into workflow
and patient pathways before, during and after design and implementation of new
products;
83
human resources. The onus is on the patient to ensure completion of test and treat
cycles. If a patient’s initiative is not supported in these journeys, chances are high that
he/she opts out. Constructive counseling by providers about various aspects of diagnostic tests and processes is necessary but not sufficient. Functioning relationships
between providers are equally important (Engel et al. 2015b).
While the system in South Africa does not foresee such an active role for patients
in ensuring a POC continuum, it still relies on a patients’ ability to return to clinics on
another day for either results (in the case of laboratory-based testing) or for followup testing and counseling sessions in the case of HIV. The examples of HIV testing
showed that HIV patients also need to actively manage diagnostic processes to make
testing fit their personal circumstances and make testing worthwhile for themselves
(Engel et al. 2017).
These profound differences between the diagnostic setup, offer very different conditions for POC testing. Although the promises that have been attached to POC testing
easily lend themselves to view testing technologies as silver bullets, it matters how
diagnostic processes are organized and made to work at POC. The results reveal how
the material dimensions of diagnosis, such as the test platform, reagents, and supplies,
the actors involved, their relations and the sociocultural context in which testing and
diagnosis are happening are invariably interlinked (Engel et al. 2015b). This means
that simply focusing on one element, for instance, improving infrastructure or test
platforms or relationships, is not sufficient. Those aspects need to be studied and
tackled together. The contrasting results from India and South Africa further highlight that the settings and the tests have their own histories, assumptions, practices,
and understandings inscribed in them. This means that by implementing tests successfully, both the setting, including its organization of the workflow, workforce,
its infrastructure, interaction with patients, and standards, and the tests are being
shaped and need to be adapted. Tools and (user) practices are being co-constructed
(Oudshoorn and Pinch 2003). Implementing diagnostic tests is thus a dynamic and
ongoing process that requires continuous observation, analysis, reflection, iterations,
and adaptations of tests and (user)-practices and -settings.
Such insights need to be taken into account when designing POC testing programs
and technologies. Test developers, decision-makers, and funders need to account for
these ground realities. They need to identify and involve users and various stakeholders in design, evaluation, and implementation processes. However, current global
diagnostic design and development practices, research, regulation, and evaluation
capacities do not do justice to the dynamic nature of these processes of making
diagnostic tests work at POC.
Based on these insights, practitioners, donors, and test developers should make
sure to
• Study diagnostic practices at POC and how devices are integrated into workflow
and patient pathways before, during and after design and implementation of new
products;