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

Abstract

Introduction: Key stakeholders’ involvement is crucial to the sustainability of quality point-of-care (POC) diagnostics services in low-and-middle income countries. The aim of this study was to explore key stakeholder perceptions on the implementation of POC diagnostics in rural primary healthcare (PHC) clinics in South Africa. Method: We conducted a qualitative study encompassing in-depth interviews with multiple key stakeholders of POC diagnostic services for rural and resource-limited PHC clinics. Interviews were digitally recorded and transcribed verbatim prior to thematic content analysis. Thematic content analysis was conducted using themes guided by the World Health Organisation (WHO) quality-ASSURED (Affordable, Sensitive, Specific, User friendly, Rapid and to enable treatment at first visit and Robust, Equipment free and Delivered to those who need it) criteria for POC diagnostic services in resource-limited settings. Results: 11 key stakeholders participated in the study. All stakeholders perceived the main advantage of POC diagnostics as enabling access to healthcare for rural patients. Stakeholders perceived the current POC diagnostic services to have an ability to meet patients’ needs, but recommended further improvement of the following areas: research on cost-effectiveness; improved quality management systems; development of affordable POC diagnostic and clinic-based monitoring and evaluation. Conclusions: Key stakeholders of POC diagnostics in rural PHC clinics in South Africa highlighted the need to assess affordability and ensure quality assurance of current services before adopting new POC diagnostics and scaling up current POC diagnostics.

Stakeholders’ Perspectives for the Development of a Point-of-Care Diagnostics Curriculum in Rural Primary Clinics in South Africa—Nominal Group Technique

“…The findings of this study support the wider literature in emphasizing that incompetency of health professionals, lack of CPD, training resources and time constraints remain as barriers to the provision of quality POC services in resource limited settings [3,4,22]. Furthermore, participants in a study conducted in a resource limited setting in India also highlighted high workloads, lack of willingness to participate in POC testing programs, missing support (including training) and pressure to meet targets as contributors to poor quality testing [23].…”

“…These studies also highlighted lack of support, training opportunities, high workloads and lack of staff involvement as challenges or priority arears to be addressed towards ensuring the provision of quality POC diagnostic services. Stakeholder engagements were further recommended for ensuring effectiveness of future diagnostics as well as for the true potential of POC testing to be realized [4,23].…”

“…Moreover, poor knowledge and adherence to quality assurance as well as HIV testing standards remain a challenge especially in resource limited areas [3]. This is a concern because quality assurance programs, which include regular calibration of instruments, participation to external quality assessment schemes, adherence to standard operating procedures and test operator competency as well as running of internal quality control samples on every test day have been shown to ensure accuracy of POC diagnostic testing [4,5]. Factors contributing to this problem include poor access to laboratory infrastructure, training resources and institutions due to clinics being situated in deep rural areas, time constraints and lack of motivation to engage in new interventions [3,6,7].…”

Experiential Learning Curriculum Delivery Approach for Quality Improvement in Resource Limited Settings: Mobile Learning for Point-of-Care Technologies

“…Examples of common POC technologies include the electronic medical record keeping (EMR), POC information technology and POC testing (Addondata, 2017). In this review our main focus is POC diagnostics in resource limited settings, where Paper-based assays such as lateral flow strips and dipsticks (Uni-GoldRecombigenHIVtest, DetermineHIV-1/2 Ag/Ab Combo and INSTI HIV-1 Rapid Antibody) are the most widely used (T. Mashamba-Thompson, Jama, Sartorius, Drain, & Thompson, 2017;Wang et al, 2016). These were shown to be the most widely used because of their simple working procedure and low cost (Wang et al, 2016).…”

Wireless colorimetric readout to enable resource-limited point-of-care

“…Currently insurmountable constraints in these settings, such as cost, infrastructure and trained staff, have limited the effective implementation of diagnostics at the POC, with the primary challenges lying in the accurate result readout and communication of results among clinics, hospitals and laboratories. [1][2][3] Additional problems highlighted by extensive literature regarding POC testing in South Africa [4][5][6][7][8][9][10][11] include the increased workload that POC devices introduce to clinics, as user training is required and test times may be lengthy. The maintenance of equipment and supply of consumables are also challenges to contend with, 10 along with data connectivity.…”