Abstract
BackgroundThe World Health Organization (WHO) called for new clinical diagnostic for settings with limited access to laboratory services. Access to diagnostic testing may not be uniform in rural settings, which may result in poor access to essential healthcare services. The aim of this study is to determine the availability, current usage, and need for point-of-care (POC) diagnostic tests among rural primary healthcare (PHC) clinics in South Africa’s KwaZulu-Natal (KZN) province.MethodsWe used the KZN’s Department of Health (DoH) clinic classification to identify the 232 rural PHC clinics in KZN, South Africa. We then randomly sampled 100 of 232 rural PHC clinics. Selected health clinics were surveyed between April to August 2015 to obtain clinic-level data for health-worker volume and to determine the accessibility, availability, usage and need for POC tests. Professional healthcare workers responsible for POC testing at each clinic were interviewed to assess the awareness of POC testing. Data were survey weighted and analysed using Stata 13.ResultsAmong 100 rural clinics, the average number of patients seen per week was 2865 ± 2231 (range 374–11,731). The average number of POC tests available and in use was 6.3 (CI: 6.2–6.5) out of a potential of 51 tests. The following POC tests were universally available in all rural clinics: urine total protein, urine leukocytes, urine nitrate, urine pregnancy, HIV antibody and blood glucose test. The average number of desired POC diagnostic tests reported by the clinical staff was estimated at 15 (CI: 13–17) per clinic. The most requested POC tests reported were serum creatinine (37%), CD4 count (37%), cholesterol (32%), tuberculosis (31%), and HIV viral load (23%).ConclusionSeveral POC tests are widely available and in use at rural PHC clinics in South Africa’s KZN province. However, healthcare workers have requested additional POC tests to improve detection and management of priority disease conditions.Trial registrationClinical Trials.gov Identifier: NCT02692274
Highlights
The World Health Organization (WHO) called for new clinical diagnostic for settings with limited access to laboratory services
Using the primary healthcare (PHC) average daily patient census data reported by District Health Information Software (DHIS), a proportionate stratification of 100 primary sampling units (PSU) across the four strata was utilised Each stratum consisted of 25 facilities randomly selected by probability proportional to size (PPS)
We developed a POC diagnostics survey questionnaire with guidance from Howick et al 2014 survey tool and the World Organization of Family Doctors (WONCA) special interest group for global POC testing online survey [32, 33], we conducted a pilot test of the survey in five rural PHC clinics in KZN, and adjusted the survey tool based on feedback from respondents
Summary
The World Health Organization (WHO) called for new clinical diagnostic for settings with limited access to laboratory services. Point-of-care (POC) tests have been proven to be effective for strengthening health systems by providing rapid results to improve timely initiation of suitable therapy, facilitate linkages to care, and improve health outcomes [4, 13,14,15,16,17,18,19]. These tests are intended to assist clinical staff in performing diagnostic testing at the clinical point-of-care [20,21,22,23]. The introduction of POC diagnostics in remote and resource-limited settings has been proven to help improve healthcare access and patient outcomes [24, 25]
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