The feasibility of novel point-of-care diagnostics for febrile illnesses at health centres in Southeast Asia: a mixed-methods study

Abstract

Background The decline of malaria in Southeast Asia means other causes of fever are increasingly relevant, but often undiagnosed. The objective of this study was to assess the feasibility of point-of-care tests to diagnose acute febrile illnesses in primary care settings. Methods A mixed-methods study was conducted at nine rural health centres in western Cambodia. Workshops introduced health workers to the STANDARD(TM) Q Dengue Duo, STANDARD(TM) Q Malaria/CRP Duo and a multiplex biosensor detecting antibodies and/or antigens of eight pathogens. Sixteen structured observation checklists assessed users’ performances and nine focus group discussions explored their opinions. Results All three point-of-care tests were performed well under assessment, but sample collection was difficult for the dengue test. Respondents expressed that the diagnostics were useful and could be integrated into routine clinical care, but were not as convenient to perform as standard malaria rapid tests. Health workers recommended that the most valued point-of-care tests would directly inform clinical management (e.g. a decision to refer a patient or to provide/withhold antibiotics). Conclusions Deployment of new point-of-care tests to health centres could be feasible and acceptable if they are user-friendly, selected for locally circulating pathogens and are accompanied by disease-specific education and simple management algorithms.

Expanding the roles of community health workers to sustain programmes during malaria elimination: a meeting report on operational research in Southeast Asia

“…An operational study showed the potential of VMWs in executing additional roles, particularly in acquiring new knowledge and techniques about disease diagnosis and primary management. Although VMWs were able to use rapid diagnostic kits, the practical difficulty in using the dengue test was identified early on and may have important implications [ 24 ]. While any new techniques would inevitably require adequate and repeated training and supervision, some of the roles and responsibilities are difficult to implement and thus require careful consideration for the future [ 38 ].…”

“…Multiplexed biosensors were designed to test malaria (four Plasmodium species, using pLDH and HRP2), dengue virus, zika virus, chikungunya virus, leptospirosis, Rickettsia typhi , Burkholderia pseudomallei , and Orientia tsutsugamushi . [ 24 ]. The full report on the deployment of novel RDTs is under preparation (Visser et al 2023).…”

“…Work Package B aimed to explore the feasibility of point-of-care tests to diagnose acute febrile illnesses in primary care settings. As a part of the study, workshops and focus group discussions were held at nine health centres to explore the practicalities related to multiplexed biosensors, malaria/CRP, and dengue antigen–antibody tests [ 24 ]. In Battambang, some barriers to deploying the new diagnostics were reported.…”

“…There was dissatisfaction from patients regarding the blood volume required for the dengue test (110 µl vs 15 µl for malaria/CRP), which was seen by some patients as potentially harmful and may affect the future acceptability of the test. Overall, dengue tests were not found to be convenient in comparison to malaria RDTs by the health centre staff [ 24 ]. In summary, the majority of VMWs could perform RDTs appropriately and follow management algorithms.…”

Comparing the roles of community health workers for malaria control and elimination in Cambodia and Tanzania

“…We reflect on our engagement with CHWs related to malaria on how their roles and contributions could be optimised for malaria control and elimination. 15–18 Table 1 provides an overview comparing the CHW network in Cambodia with Tanzania ( table 1 ).…”