Lay testing cadres and point-of-care diagnostic tests for HIV and other diseases: An essential combination in health service delivery

Ndlovu, Zibusiso; Ellman, Tom

doi:10.1371/journal.pmed.1003867

Cited by 3 publications

(2 citation statements)

References 24 publications

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“…Nurses and/or midwives have accurately used qualitative viral load assays (that use the GeneXpert and m-PIMA platforms) for early infant diagnosis of HIV, 26,27 and there is increasing interest in task-shifting point-of-care HIV diagnostics to nonlaboratory staff in low-and middle- income countries. [28][29][30] As these assays require plasma, venous blood samples had to be centrifuged by nurses in the study clinic. This required specific training and may not be feasible for nurses in many settings, which could limit use at the clinical point-of-care.…”

Section: Nurse Testingmentioning

confidence: 99%

Diagnostic Accuracy of the Rapid Xpert HIV-1 Viral Load XC, Xpert HIV-1 Viral Load, & m-PIMA HIV-1/2 Viral Load in South African Clinics

Dorward

Naidoo

Moodley

et al. 2022

JAIDS Journal of Acquired Immune Deficiency Syndromes

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Section: Nurse Testingmentioning

confidence: 99%

Diagnostic Accuracy of the Rapid Xpert HIV-1 Viral Load XC, Xpert HIV-1 Viral Load, & m-PIMA HIV-1/2 Viral Load in South African Clinics

Dorward

Naidoo

Moodley

et al. 2022

JAIDS Journal of Acquired Immune Deficiency Syndromes

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“…Reliance on the centralized laboratory infrastructure required for PCR can also deter patients from getting tested, particularly if they have to travel to health facilities to access diagnostic services. Evidence from other disease response, such as HIV, has highlighted the importance of decentralized diagnosis through the use of point-of-care technologies, in order to improve outcomes [ 10 ].…”

Section: Introductionmentioning

confidence: 99%

Monitored Implementation of COVID-19 Rapid Antigen Screening at Taxi Ranks in Johannesburg, South Africa

et al. 2022

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Digital tools can support community-based decentralized testing initiatives to broaden access to COVID-19 diagnosis, especially in high-transmission settings. This operational study investigated the use of antigen-detecting rapid diagnostic tests (Ag-RDTs) for COVID-19 combined with an end-to-end digital health solution, in three taxi ranks in Johannesburg, South Africa. Members of the public were eligible if they were aged ≥18 years, could read, and had a cellphone. Over 15,000 participants, enrolled between June and September 2021, were screened for COVID-19 risk factors. A digital risk questionnaire identified 2061 (13%) participants as moderate risk and 2987 (19%) as high risk, based on symptoms and/or recent exposure to a known case. Of this group referred for testing, 3997 (79%) received Ag-RDTs, with positivity rates of 5.1% in the “high-risk” group and 0.8% in the “moderate-risk” group. A subset of 569 randomly selected participants received additional PCR testing. Sensitivity of the Ag-RDT in this setting was 40% (95% CI: 30.3%, 50.3%); most false negatives had high cycle threshold values (>25), hence low viral loads. Over 80% of participants who tested positive completed a 2-week phone-based follow-up questionnaire. Overall, the digital tool combined with Ag-RDTs enhanced community-based decentralized COVID-19 testing service delivery, reporting and follow-up.

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Enhancing tuberculosis (TB) diagnosis among hospitalized patients in KwaZulu-Natal, South Africa: a before-and-after study of a lay health worker-driven intervention

Bulti,

Dumicho,

Shigayeva

et al. 2024

Preprint

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Background Tuberculosis (TB) among hospitalized patients is underdiagnosed. This study assessed systematic TB-screening, followed by an enhanced TB-diagnostic package for hospitalized patientsimplemented by trained lay health workers in KwaZulu-Natal, South Africa. Methods In this before-and-after study we included patients ≥ 18 years. The intervention consisted of systematic clinical screening for TB, HIV and diabetes mellitus by lay health workers and provision of an enhanced TB-diagnostic package including sputum Xpert MTB/Rif Ultra, urine lateral-flow lipoarabinomannan assay (LF-LAM), chest x-ray, and sputum culture. We compared TB case findings with people hospitalized one year preceding the intervention. Results In the pre-intervention phase, 5217 people were hospitalized. Among 4913 (94.2%) people not on TB treatment, 367 (7.5%) were diagnosed with TB. In the intervention phase, 4015 eligible people were hospitalized. Among 3734 (93.0%) people not on TB treatment, 560 (15.0%) were diagnosed with TB. The proportion of patients diagnosed with TB was higher in the intervention phase (15.0% vs. 7.5%, p < 0.001). Overall in-hospital mortality was lower in the intervention phase [166/3734(4.5%) vs. 336/4913(6.8%), p < 0.001]. Conclusion Lay health worker-led implementation of systematic TB-screening, coupled with provision of an enhanced TB-diagnostic package significantly improved TB case detection and mortality among hospitalized adults.

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Lay testing cadres and point-of-care diagnostic tests for HIV and other diseases: An essential combination in health service delivery

Cited by 3 publications

References 24 publications

Diagnostic Accuracy of the Rapid Xpert HIV-1 Viral Load XC, Xpert HIV-1 Viral Load, & m-PIMA HIV-1/2 Viral Load in South African Clinics

Diagnostic Accuracy of the Rapid Xpert HIV-1 Viral Load XC, Xpert HIV-1 Viral Load, & m-PIMA HIV-1/2 Viral Load in South African Clinics

Monitored Implementation of COVID-19 Rapid Antigen Screening at Taxi Ranks in Johannesburg, South Africa

Enhancing tuberculosis (TB) diagnosis among hospitalized patients in KwaZulu-Natal, South Africa: a before-and-after study of a lay health worker-driven intervention

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