Abstract
BackgroundMalaria rapid diagnostic tests (RDTs) are a simple, point-of-care technology that can improve the diagnosis and subsequent treatment of malaria. They are an increasingly common diagnostic tool, but concerns remain about their use by community health workers (CHWs). These concerns regard the long-term trends relating to infection prevention measures, the interpretation of test results and adherence to treatment protocols. This study assessed whether CHWs maintained their competency at conducting RDTs over a 12-month timeframe, and if this competency varied with specific CHW characteristics.MethodsFrom June to September, 2015, CHWs (n = 271) were trained to conduct RDTs using a 3-day validated curriculum and a baseline assessment was completed. Between June and August, 2016, CHWs (n = 105) were randomly selected and recruited for follow-up assessments using a 20-step checklist that classified steps as relating to safety, accuracy, and treatment; 103 CHWs participated in follow-up assessments. Poisson regressions were used to test for associations between error count data at follow-up and Poisson regression models fit using generalized estimating equations were used to compare data across time-points.ResultsAt both baseline and follow-up observations, at least 80% of CHWs correctly completed 17 of the 20 steps. CHWs being 50 years of age or older was associated with increased total errors and safety errors at baseline and follow-up. At follow-up, prior experience conducting RDTs was associated with fewer errors. Performance, as it related to the correct completion of all checklist steps and safety steps, did not decline over the 12 months and performance of accuracy steps improved (mean error ratio: 0.51; 95% CI 0.40–0.63). Visual interpretation of RDT results yielded a CHW sensitivity of 92.0% and a specificity of 97.3% when compared to interpretation by the research team. None of the characteristics investigated was found to be significantly associated with RDT interpretation.ConclusionsWith training, most CHWs performing RDTs maintain diagnostic testing competency over at least 12 months. CHWs generally perform RDTs safely and accurately interpret results. Younger age and prior experiences with RDTs were associated with better testing performance. Future research should investigate the mode by which CHW characteristics impact RDT procedures.
Highlights
Malaria rapid diagnostic tests (RDTs) are a simple, point-of-care technology that can improve the diag‐ nosis and subsequent treatment of malaria
Half (51.5%) had prior experience working as a community health worker (CHW), one-third (32.2%) had received prior training in malaria case management and several (17.5%) had prior experiences with malaria RDTs
This work demonstrates that with proper training, most CHWs maintain their competency at conducting RDTs and interpreting subsequent results over a 12-month timeframe
Summary
Malaria rapid diagnostic tests (RDTs) are a simple, point-of-care technology that can improve the diag‐ nosis and subsequent treatment of malaria. They are an increasingly common diagnostic tool, but concerns remain about their use by community health workers (CHWs). In 2010, the World Health Organization revised their recommendations to require parasitological confirmation of malaria infection prior to treatment, known as the ‘testand-treat’ strategy [3] This change was precipitated by a declining prevalence of malaria in sub-Saharan Africa [4–6], evidence suggesting that malaria only causes a proportion of all febrile illness in malaria-endemic regions [7–9], concerns surrounding anti-malarial drug resistance [10, 11], and improvements in diagnostic technologies [12, 13]. The confirmation of parasitological infection is important for the management of nonmalaria febrile illnesses [2]
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