The (In)visibility of Misdiagnosis in Point-of-Care HIV Testing in Zimbabwe

Skovdal, Morten; Beckmann, Nadine; Maswera, Rufurwokuda; Nyamukapa, Constance; Gregson, Simon

doi:10.1080/01459740.2022.2054715

Cited by 2 publications

(4 citation statements)

References 21 publications

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“…When they in roundabout, and often coincidental ways discover a misdiagnosis, it is attributed to mislabeling and poor compliance with the test strategy [18], all 'crisispoints' that this paper show have temporal root causes.…”

Section: Discussionmentioning

confidence: 84%

“…Moreover, what further challenges their efforts is a general invisibility of misdiagnosis. As we discuss elsewhere [18], rapid HIV testers have no real way of ascertaining the accuracy of their test results.…”

Section: Discussionmentioning

confidence: 99%

“…The instructions are ordinarily in a poster format and include a photo for each step. Although these scripted steps are the focus of this article, they form part of a broader set of procedures that precede and follow, including steps related to storage, hygiene, and quality assurance, testing strategies [14,18], pre-and post-counselling.…”

Section: The Temporalities Of Scripted Rapid Hiv Testingmentioning

confidence: 99%

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Temporal discrepancies in “rapid” HIV testing: explaining misdiagnoses at the point-of-care in Zimbabwe

et al. 2023

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Background Rapid diagnostic tests have revolutionized the HIV response in low resource and high HIV prevalence settings. However, disconcerting levels of misdiagnosis at the point-of-care call for research into their root causes. As rapid HIV tests are technologies that cross borders and have inscribed within them assumptions about the context of implementation, we set out to explore the (mis)match between intended and actual HIV testing practices in Zimbabwe. Methods We examined actual HIV testing practices through participant observations in four health facilities and interviews with 28 rapid HIV testers. As time was identified as a key sphere of influence in thematic analyses of the qualitative data, a further layer of analysis juxtaposed intended (as scripted in operating procedures) and actual HIV testing practices from a temporal perspective. Results We uncover substantial discrepancies between the temporal flows assumed and inscribed into rapid HIV test kits (their intended use) and those presented by the high frequency testing and low resource and staffing realities of healthcare settings in Zimbabwe. Aside from pointing to temporal root causes of misdiagnosis, such as the premature reading of test results, our findings indicate that the rapidity of rapid diagnostic technologies is contingent on a slow, steady, and controlled environment. This not only adds a different dimension to the meaning of “rapid” HIV testing, but suggests that errors are embedded in the design of the diagnostic tests and testing strategies from the outset, by inscribing unrealistic assumptions about the context within which they used. Conclusion Temporal analyses can usefully uncover difficulties in attuning rapid diagnostic test technologies to local contexts. Such insight can help explain potential misdiagnosis ‘crisis points’ in point-of-care testing, and the need for public health initiatives to identify and challenge the underlying temporal root causes of misdiagnosis.

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Section: Discussionmentioning

confidence: 84%

Section: Discussionmentioning

confidence: 99%

Section: The Temporalities Of Scripted Rapid Hiv Testingmentioning

confidence: 99%

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Temporal discrepancies in “rapid” HIV testing: explaining misdiagnoses at the point-of-care in Zimbabwe

et al. 2023

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“…This process is guided by a different set of values and inevitably introduces a 'messiness' brought about by the interaction with clients' bodies and lives into the standardised procedures required by the testing script. The clinicians and primary counsellors who perform rapid HIV testing generally lack opportunities to authenticate their test results, thus rendering cases of misdiagnosis largely invisible (Skovdal et al, 2022). In the face of such uncertainty, this paper asks how point-of-care testers make sense of the conflicting demands posed by laboratory-based scripts and values in the context of their clinical work.…”

Section: Introductionmentioning

confidence: 99%

Rituals of care: Strategies adopted by HIV testers to avoid misdiagnosis in rapid HIV testing in Zimbabwe

Beckmann

Skovdal

Maswera

et al. 2022

Global Public Health

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A growing number of studies highlight high levels of misdiagnosis in the scale-up of HIV rapid testing programmes, which often remain invisible to individual testers. Drawing on interviews with HIV testers and observations in four health facilities in Zimbabwe, we show that testers navigated the translation of the standardised, dis-embodied norms of laboratory-based testing into the body work of point-of-care testing through ritualisation of laboratory-practices in their daily clinical work. Yet, this was interrupted through the challenging work conditions the testers face. They ritualised careful procedures, forcing themselves to focus even if queues were long, and making quality assurance procedures part of their daily routine. They actively tried to reduce their workloads and double-checked and discussed unexpected results, especially when a test result did not match their evaluation of clients' circumstances or clinical status. This helped not only to increase confidence in the authenticity of their diagnosis, but also to share responsibility for potential errors. Existing approaches to tackle the problem of misdiagnosis through quality assurance (QA) procedures mainly focus on adjusting individual testers' performance and ensuring that basic testing resources were present, thus falling short of creating a work environment that is conducive to high quality testing.

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The (In)visibility of Misdiagnosis in Point-of-Care HIV Testing in Zimbabwe

Cited by 2 publications

References 21 publications

Temporal discrepancies in “rapid” HIV testing: explaining misdiagnoses at the point-of-care in Zimbabwe

Temporal discrepancies in “rapid” HIV testing: explaining misdiagnoses at the point-of-care in Zimbabwe

Rituals of care: Strategies adopted by HIV testers to avoid misdiagnosis in rapid HIV testing in Zimbabwe

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