Understanding the Role of the Diagnostic ‘Reflex’ in the Elimination of Human African Trypanosomiasis

Palmer, Jennifer; Jones, Caroline; Surur, Elizeous I.; Kelly, Ann H.

doi:10.3390/tropicalmed5020052

Cited by 7 publications

(6 citation statements)

References 43 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In the case of human African trypanosomiasis (HAT), anthropologists found that a diagnostic reflex among healthcare workers is stronger when they are in the habit of testing and have time and space to consider symptoms and that this reflex also exists among communities and patients. A diagnostic reflex can be trained in times of elimination by treating detection of events as important learning opportunities and ensuring multidimensional access to diagnostics across the health system [ 40 ]. These data show that in order to make new technologies such as the biosensor accessible, malaria needs to be made and kept visible.…”

Section: Discussionmentioning

confidence: 99%

Implementing radical cure diagnostics for malaria: user perspectives on G6PD testing in Bangladesh

Engel

Ghergu

Matin

et al. 2021

Malar J

View full text Add to dashboard Cite

Background The radical cure of Plasmodium vivax requires treatment with an 8-aminoquinoline drug, such as primaquine and tafenoquine, to eradicate liver hypnozoite stages, which can reactivate to cause relapsing infections. Safe treatment regimens require prior screening of patients for glucose-6-phosphate dehydrogenase (G6PD) deficiency to avoid potential life-threatening drug induced haemolysis. Testing is rarely available in malaria endemic countries, but will be needed to support routine use of radical cure. This study investigates end-user perspectives in Bangladesh on the introduction of a quantitative G6PD test (SD Biosensor STANDARD™ G6PD analyser) to support malaria elimination. Methods The perspectives of users on the SD Biosensor test were analysed using semi-structured interviews and focus group discussions with health care providers and malaria programme officers in Bangladesh. Key emerging themes regarding the feasibility of introducing this test into routine practice, including perceived barriers, were analysed. Results In total 63 participants were interviewed. Participants emphasized the life-saving potential of the biosensor, but raised concerns including the impact of limited staff time, high workload and some technical aspects of the device. Participants highlighted that there are both too few and too many P. vivax patients to implement G6PD testing owing to challenges of funding, workload and complex testing infrastructure. Implementing the biosensor would require flexibility and improvisation to deal with remote sites, overcoming a low index of suspicion and mutual interplay of declining patient numbers and reluctance to test. This approach would generate new forms of evidence to justify introduction in policy and carefully consider questions of deployment given declining patient numbers. Conclusions The results of the study show that, in an elimination context, the importance of malaria needs to be maintained for both policy makers and the affected communities, in this case by ensuring P. vivax, PQ treatment, and G6PD deficiency remain visible. Availability of new technologies, such as the biosensor, will fuel ongoing debates about priorities for allocating resources that must be adapted to a constantly evolving target. Technical and logistical concerns regarding the biosensor should be addressed by future product designs, adequate training, strengthened supply chains, and careful planning of communication, advocacy and staff interactions at all health system levels.

show abstract

Section: Discussionmentioning

confidence: 99%

Implementing radical cure diagnostics for malaria: user perspectives on G6PD testing in Bangladesh

Engel

Ghergu

Matin

et al. 2021

Malar J

View full text Add to dashboard Cite

show abstract

“…In the case of human African trypanosomiasis (HAT), anthropologists found that a diagnostic re ex among healthcare workers is stronger when they are in the habit of testing and have time and space to consider symptoms and that this re ex also exists among communities and patients. A diagnostic re ex can be trained in times of elimination by treating detection of events as important learning opportunities and ensuring multidimensional access to diagnostics (28). These data show that in order to make new technologies such as the biosensor accessible, malaria needs to be made and kept visible.…”

Section: Discussionmentioning

confidence: 99%

Implementing Radical Cure Diagnostics for Malaria: User Perspectives on G6PD Testing in Bangladesh

Engel

Ghergu

Matin

et al. 2020

Preprint

View full text Add to dashboard Cite

Background: The radical cure of Plasmodium vivax requires treatment with an 8-aminoquinoline drug, such as primaquine and tafenoquine, to clear the liver of parasites which can reactivate to cause relapsing infections. Safe treatment regimens require prior screening of patients for glucose-6-phosphate dehydrogenase (G6PD) deficiency to avoid potential life-threatening drug induced hemolysis. Testing is rarely available in malaria endemic countries, but will be needed to support routine use of radical cure. This study investigates end-user perspectives in Bangladesh on the introduction of a quantitative G6PD test (SD Biosensor STANDARD™ G6PD analyser) to support malaria elimination.Methods: The perspectives of users on the SD Biosensor test were analysed using semi-structured interviews and focus group discussions with health care providers and malaria programme officers in Bangladesh. Key emerging themes regarding the feasibility of introducing this test into routine practice, including perceived barriers, were analysed.Results: In total 63 participants were interviewed. Participants emphasized the life-saving potential of the biosensor, but raised concerns including the impact of limited staff time, high workload and some technical aspects of the device. Participants highlighted that there are both too few and too many P. vivax patients to implement G6PD testing owing to challenges of funding, workload and complex testing infrastructure. Implementing the biosensor would require flexibility and improvisation to deal with remote sites, overcoming a low index of suspicion and mutual interplay of declining patient numbers and reluctance to test. This approach would generate new forms of evidence to justify introduction in policy and carefully consider questions of deployment given declining patient numbers. Conclusions: The results of the study show that, in an elimination context, the importance of malaria needs to be maintained for both policy makers and the affected communities, in this case by ensuring P. vivax, PQ treatment, and G6PD deficiency remain visible. Availability of new technologies, such as the biosensor, will fuel ongoing debates about priorities for allocating resources that must be adapted to a constantly evolving target. Technical and logistical concerns regarding the biosensor should be addressed by future product designs, adequate training, strengthened supply chains, and careful planning of communication, advocacy and staff interactions at all health system levels.

show abstract

“…While following the script was emphasised by all testers as the most important way to avoid misdiagnoses, our observations showed that testers also frequently used embodied knowledgeor at least their syndromic familiarity with HIV (Palmer et al, 2020) to evaluate the likelihood that a test result was trustworthy. Testers were aware that this practice went against the principles they had learned in their training, where the need for an unbiased, 'open mind' was emphasised.…”

Section: Embodied Knowledgementioning

confidence: 86%

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

View full text Add to dashboard Cite

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.

show abstract

Understanding the Role of the Diagnostic ‘Reflex’ in the Elimination of Human African Trypanosomiasis

Cited by 7 publications

References 43 publications

Implementing radical cure diagnostics for malaria: user perspectives on G6PD testing in Bangladesh

Implementing radical cure diagnostics for malaria: user perspectives on G6PD testing in Bangladesh

Implementing Radical Cure Diagnostics for Malaria: User Perspectives on G6PD Testing in Bangladesh

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

Contact Info

Product

Resources

About