Temporal discrepancies in "rapid" HIV testing: explaining misdiagnoses at the point-of-care in Zimbabwe.
HIV testing
Point-of-care test
Rapid tests
Testing errors
Zimbabwe
Journal
BMC infectious diseases
ISSN: 1471-2334
Titre abrégé: BMC Infect Dis
Pays: England
ID NLM: 100968551
Informations de publication
Date de publication:
06 Jan 2023
06 Jan 2023
Historique:
received:
08
06
2022
accepted:
26
12
2022
entrez:
7
1
2023
pubmed:
8
1
2023
medline:
11
1
2023
Statut:
epublish
Résumé
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. 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. 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. 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.
Sections du résumé
BACKGROUND
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
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
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
CONCLUSIONS
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.
Identifiants
pubmed: 36609232
doi: 10.1186/s12879-022-07972-5
pii: 10.1186/s12879-022-07972-5
pmc: PMC9817402
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
9Subventions
Organisme : Bill and Melinda Gates Foundation
ID : OPP1131208
Organisme : Medical Research Council
ID : MR/R015600/1
Pays : United Kingdom
Informations de copyright
© 2023. The Author(s).
Références
J Clin Microbiol. 2007 Oct;45(10):3281-5
pubmed: 17699650
Glob Public Health. 2022 Oct 26;:1-14
pubmed: 36288538
Malar J. 2016 Feb 05;15:64
pubmed: 26850000
BMC Health Serv Res. 2010 Mar 22;10:73
pubmed: 20307310
PLoS One. 2013;8(3):e59906
pubmed: 23527284
J Int AIDS Soc. 2017 Aug 29;20(Suppl 6):21755
pubmed: 28872271
PLoS Med. 2012;9(9):e1001306
pubmed: 22973183
EBioMedicine. 2018 Nov;37:382-391
pubmed: 30509399
Med Anthropol. 2022 May-Jun;41(4):404-417
pubmed: 35412919
J Int AIDS Soc. 2017 Aug 29;20(Suppl 6):21753
pubmed: 28872274
J Int AIDS Soc. 2021 Apr;24(4):e25700
pubmed: 33882190
J Int AIDS Soc. 2017 Aug 29;20(Suppl 6):22190
pubmed: 28872270
J Int AIDS Soc. 2017 Aug 29;20(Suppl 6):21758
pubmed: 28872277
PLoS One. 2020 Aug 13;15(8):e0237239
pubmed: 32790692
Tanzan Health Res Bull. 2007 May;9(2):110-4
pubmed: 17722413
BMC Med. 2014 Sep 08;12:173
pubmed: 25197773
J Int AIDS Soc. 2017 Aug 29;20(Suppl 6):21780
pubmed: 28872272