Point-of-Care Diagnostics for Improving Maternal Health in South Africa

Abstract

Improving maternal health is a global priority, particularly in high HIV-endemic, resource-limited settings. Failure to use health care facilities due to poor access is one of the main causes of maternal deaths in South Africa. “Point-of-care” (POC) diagnostics are an innovative healthcare approach to improve healthcare access and health outcomes in remote and resource-limited settings. In this review, POC testing is defined as a diagnostic test that is carried out near patients and leads to rapid clinical decisions. We review the current and emerging POC diagnostics for maternal health, with a specific focus on the World Health Organization (WHO) quality-ASSURED (Affordability, Sensitivity, Specificity, User friendly, Rapid and robust, Equipment free and Delivered) criteria for an ideal point-of-care test in resource-limited settings. The performance of POC diagnostics, barriers and challenges related to implementing POC diagnostics for maternal health in rural and resource-limited settings are reviewed. Innovative strategies for overcoming these barriers are recommended to achieve substantial progress on improving maternal health outcomes in these settings.

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

“…Despite this high communicable disease burden in South Africa, our review revealed that South Africa offers fewer POC tests for communicable diseases than the USA, which has a low disease burn [12]. Prompt access to these new POC tests is encouraged in high disease-burdened and resource-limited settings [13].…”

“…Successful implementation of POC diagnostics in resource-limited settings is based on its compliance with the 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 [12,13,18,19]. The entire process of POC diagnostics, from the pre-analytic through the analytic and post-analytic phases, has hidden reliability risks, which include false-positive and false-negative test results, which can lead to gross medical errors [20].…”

Assessment of the Impact of Rapid Point-of-Care CD4 Testing in Primary Healthcare Clinic Settings: A Survey Study of Client and Provider Perspectives

“…Although current programmes could be enhanced by the introduction of POC testing [41,42] to address some existing challenges [43], it has been suggested [44,45] that certain factors need to be considered before POC implementation: Clinic flows, diagnostic accuracy, staff training, quality control, and turnaround times. In South Africa, multiple strategies [46] have previously been used to overcome high patient burden and staff shortages [7] with respect to rapid HIV testing.…”

Improving the Accessibility and Efficiency of Point-of-Care Diagnostics Services in Low- and Middle-Income Countries: Lean and Agile Supply Chain Management

“…The benefits of improved accessibility to POC diagnostics services are significant. This review demonstrates the impacts of POC testing services such as enabling rapid diagnosis and informing prompt clinical decisions [ 4 , 6 , 11 , 12 , 14 , 16 , 17 , 20 , 21 , 25 , 26 , 27 , 77 , 78 , 79 ]. It also reveals that successful implementation of POC diagnostics services requires appropriate healthcare infrastructure, efficient supply chain management, quality systems management, enabling a policy framework and as well as geographical consideration during implementation [ 38 , 40 , 56 , 64 ].…”

“…POC testing can shorten the time of clinical decision-making about additional testing or therapy, as delays are no longer caused by transport and preparation of clinical samples, and biochemical test results are rapidly available at the point of care [ 8 ]. Studies have shown that POC testing improves medical outcome and lowers the costs of seeking healthcare services in resource-limited settings [ 8 , 9 , 10 , 11 ].…”