Baumgartner Erin T, Williams Kendra N, Rai Emee, Rosser Erica N, Marasini Rudra P, Dahal Sagar, Shakya Anu, Lynch Julia, Karki Kshitij, Bajracharya Deepak C, Sack David A, Debes Amanda K
Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, United States of America.
G.T.A. Foundation, Kathmandu, Nepal.
PLoS Negl Trop Dis. 2025 May 6;19(5):e0013019. doi: 10.1371/journal.pntd.0013019. eCollection 2025 May.
Cholera rapid diagnostic tests (RDTs) can strengthen existing surveillance systems by offering a cost-effective screening method that improves understanding of cholera burden allowing for targeted prevention and control efforts. The RDT Implementation Strategy and Evaluation (RISE) project is the pilot study for Gavi's innovative Diagnostic Procurement Platform which provides cholera RDTs to enhance national surveillance. Implementation of cholera RDTs was evaluated following their distribution in 2023 to facilities within Nepal's Early Warning and Reporting System (EWARS). Quantitative data was collected through EWARS surveillance reports, national-level and individual-level REDCap surveys from select facilities in Kathmandu. Key-informant interviews were also conducted in Kathmandu with personnel involved in cholera surveillance and response. Interviews were conducted using a semi-structured interview guide and analyzed according to inductively identified themes. Qualitative findings indicated generally positive perceptions of cholera RDTs, highlighting their speed and ease of use, and suitability for deployment in under-resourced areas by unskilled personnel. However, a lack of awareness of the RDTs, limited training, and concerns about the RDTs' quality, availability, and costs were challenges raised consistently. Quantitative findings revealed underreporting of acute gastroenteritis (AGE) and cholera in EWARS and an underutilization of the cholera RDTs, with only 2.6% of reported AGE cases screened using an RDT. This field evaluation demonstrated that RDTs can have an important role in cholera surveillance but highlighted significant challenges with cholera lab capacity, reporting, and training. Both the qualitative and quantitative findings showed gaps in surveillance reporting, which were exacerbated by the complexity of adding RDTs without strong guidance as well as beliefs about the RDTs' poor validity. These misconceptions and challenges need to be addressed at the local and national level to successfully scale-up cholera RDTs in Nepal and beyond.
霍乱快速诊断检测（RDTs）可以通过提供一种具有成本效益的筛查方法来加强现有的监测系统，这种方法有助于更好地了解霍乱负担，从而进行有针对性的预防和控制工作。RDT实施策略与评估（RISE）项目是全球疫苗免疫联盟（Gavi）创新诊断采购平台的试点研究，该平台提供霍乱RDTs以加强国家监测。2023年，霍乱RDTs在尼泊尔早期预警与报告系统（EWARS）的设施中分发后，对其实施情况进行了评估。通过EWARS监测报告、加德满都选定设施的国家级和个人级REDCap调查收集了定量数据。还在加德满都对参与霍乱监测和应对的人员进行了关键信息访谈。访谈使用半结构化访谈指南进行，并根据归纳确定的主题进行分析。定性研究结果表明，人们对霍乱RDTs总体上持积极看法，强调其速度快、使用方便，以及适合由非专业人员在资源匮乏地区部署。然而，对RDTs缺乏认识、培训有限，以及对RDTs的质量、可用性和成本的担忧是一直存在的挑战。定量研究结果显示，EWARS中急性胃肠炎（AGE）和霍乱的报告不足，且霍乱RDTs未得到充分利用，只有2.6%的报告AGE病例使用RDT进行了筛查。这项现场评估表明，RDTs在霍乱监测中可以发挥重要作用，但也凸显了霍乱实验室能力、报告和培训方面的重大挑战。定性和定量研究结果都显示了监测报告方面的差距，在没有强有力指导的情况下增加RDTs的复杂性以及对RDTs有效性差的看法加剧了这些差距。这些误解和挑战需要在地方和国家层面得到解决，以便在尼泊尔及其他地区成功扩大霍乱RDTs的使用。
