Duke Global Health Institute, Duke University, Durham, NC, USA.
Department of Epidemiology and Biostatistics, Moi University School of Public Health, College of Health Sciences, Eldoret, Kenya.
Malar J. 2018 May 18;17(1):206. doi: 10.1186/s12936-018-2358-6.
Malaria 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.
From 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.
At 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.
With 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.
疟疾快速诊断检测（RDT）是一种简单的、即时的医疗技术，可以改善疟疾的诊断和后续治疗。它们是一种越来越常见的诊断工具，但社区卫生工作者（CHW）对其使用仍存在一些担忧。这些担忧涉及感染预防措施、检测结果解释和治疗方案遵守方面的长期趋势。本研究评估了 CHW 在 12 个月的时间内是否保持了进行 RDT 的能力，以及这种能力是否因 CHW 的特定特征而有所不同。
2015 年 6 月至 9 月，CHW（n=271）接受了为期 3 天的经过验证的课程培训，以进行 RDT，并完成了基线评估。2016 年 6 月至 8 月，随机选择 105 名 CHW 进行随访评估，使用包含与安全、准确性和治疗相关的 20 个步骤的检查表；103 名 CHW 参加了随访评估。使用泊松回归检验随访时错误计数数据与泊松回归模型之间的关联，并使用广义估计方程比较各时间点的数据。
在基线和随访观察时，至少有 80%的 CHW 正确完成了 20 个步骤中的 17 个。50 岁或以上的 CHW 与基线和随访时的总错误和安全错误增加有关。在随访时，先前进行 RDT 的经验与错误较少有关。在正确完成所有检查表步骤和安全步骤方面，绩效并未在 12 个月内下降，而准确性步骤的绩效有所提高（平均错误比：0.51；95%CI 0.40-0.63）。与研究团队的解释相比，RDT 结果的视觉解释使 CHW 的敏感性达到 92.0%，特异性达到 97.3%。未发现调查的任何特征与 RDT 解释显著相关。
经过培训，大多数进行 RDT 的 CHW 在至少 12 个月内保持诊断检测能力。CHW 通常安全且准确地解释结果。年龄较小和先前有 RDT 经验与更好的检测性能相关。未来的研究应调查 CHW 特征影响 RDT 程序的模式。
