Pai Nitika Pant, Wilkinson Samantha, Deli-Houssein Roni, Vijh Rohit, Vadnais Caroline, Behlim Tarannum, Steben Marc, Engel Nora, Wong Tom
Department of Medicine, McGill University; †Division of Clinical Epidemiology, Department of Medicine, McGill University Health Centre; ‡INSPQ, Montreal, Quebec, Canada; §Department of Health, Ethics & Society, Research School for Public Health and Primary Care, Maastricht University, Maastricht, The Netherlands; and ∥Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.
Point Care. 2015 Sep;14(3):81-87. doi: 10.1097/POC.0000000000000056.
Implementation of human immunodeficiency virus rapid and point-of-care tests (RDT/POCT) is understood to be impeded by many different factors that operate at 4 main levels-test devices, patients, providers, and health systems-yet a knowledge gap exists of how they act and interact to impede implementation. To fill this gap, and with a view to improving the quality of implementation, we conducted a systematic review.
Five databases were searched, 16,672 citations were retrieved, and data were abstracted on 132 studies by 2 reviewers.
Across 3 levels (ie, patients, providers, and health systems), a majority (59%, 112/190) of the 190 barriers were related to the integration of RDT/POCT, followed by test-device-related concern (ie, accuracy) at 41% (78/190). At the patient level, a lack of awareness about tests (15/54, 28%) and time taken to test (12/54, 22%) dominated. At the provider and health system levels, integration of RDT/POCT in clinical workflows (7/24, 29%) and within hospitals (21/34, 62%) prevailed. Accuracy (57/78, 73%) was dominant only at the device level.
Integration barriers dominated the findings followed by test accuracy. Although accuracy has improved during the years, an ideal implementation could be achieved by improving the integration of RDT/POCT within clinics, hospitals, and health systems, with clear protocols, training on quality assurance and control, clear communication, and linkage plans to improve health outcomes of patients. This finding is pertinent for a future envisioned implementation and global scale-up of RDT/POCT-based initiatives.
人们认为，人类免疫缺陷病毒快速检测和即时检测（RDT/POCT）的实施受到许多不同因素的阻碍，这些因素在四个主要层面发挥作用，即检测设备、患者、医疗服务提供者和卫生系统，但对于它们如何阻碍实施以及相互作用的了解存在差距。为填补这一差距，并着眼于提高实施质量，我们进行了一项系统评价。
检索了五个数据库，检索到16672条文献，由两名审阅者对132项研究的数据进行了提取。
在三个层面（即患者、医疗服务提供者和卫生系统），190个障碍中的大多数（59%，112/190）与RDT/POCT的整合有关，其次是与检测设备相关的问题（即准确性），占41%（78/190）。在患者层面，对检测缺乏了解（15/54，28%）和检测所需时间（12/54，22%）占主导。在医疗服务提供者和卫生系统层面，RDT/POCT在临床工作流程中的整合（7/24，29%）以及在医院内部的整合（21/34，62%）占主导。准确性（57/78，73%）仅在设备层面占主导。
整合障碍在研究结果中占主导，其次是检测准确性。尽管这些年来准确性有所提高，但通过改善RDT/POCT在诊所、医院和卫生系统中的整合，制定明确的方案、进行质量保证和控制培训、清晰的沟通以及改善患者健康结果的联动计划，可实现理想的实施。这一发现与未来设想的基于RDT/POCT的举措的实施和全球推广相关。
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