Nelson Hannah, Song Jia Tong, Kinshella Mai-Lei Woo, Cochrane Jennifer, Mooder Karen, Hassani Kasra, Dittrick Michelle, Goldfarb David M
Experimental Medicine Graduate Program, University of British Columbia, Vancouver, British Columbia, Canada.
Department of Pathology and Laboratory Medicine, BC Children's and Women's Hospital & Health Centre, Vancouver, British Columbia, Canada.
PLoS One. 2025 May 13;20(5):e0321690. doi: 10.1371/journal.pone.0321690. eCollection 2025.
Community-based molecular diagnostic testing for infectious diseases can bring equitable healthcare to resource-limited settings without hospital-based laboratories. Low-complexity molecular testing devices allow for unprecedented sensitivity and specificity for infectious disease diagnostics outside of a dedicated laboratory, which may facilitate timely initiation of therapeutics and other public health interventions in rural, remote and/or marginalized communities.
To identify barriers and facilitators to the implementation of community-based molecular testing.
A systematic search was conducted on MEDLINE Ovid, EMBASE, Web of Science, Cumulative Index to Nursing and Allied Health, Google Scholar, and reference lists. Original research that includes implementation of molecular testing systems at the community-level or at rural/remote health facilities with frontline healthcare workers and reports barriers and facilitators to implementation were included. Studies were assessed by the Critical Appraisal Skills Programme Qualitative Checklist and underwent inductive thematic analysis. The review protocol was registered to Prospero prior to conducting the review (CRD42023397800).
A total of 6 studies were included in the review. We found three main themes present across all six included studies: infrastructure, usability, and staffing considerations. Infrastructure emerged as a critical determinant, with challenges ranging from physical space constraints to issues with reliable electricity and internet connectivity. The usability of testing devices, encompassing factors like ease of use and testing quality, also played a pivotal role. Staffing considerations, including workload, training, and attitudes, significantly influenced implementation outcomes.
Our review highlights the importance of addressing infrastructural challenges, ensuring usability of testing devices, and adequately supporting staff through training and workload management to realize the full potential of this new opportunity. Future implementation should consider these factors to successfully integrate molecular diagnostics into community-level healthcare delivery, particularly in rural and remote areas.
基于社区的传染病分子诊断检测可为没有医院实验室的资源有限地区带来公平的医疗服务。低复杂性分子检测设备在专用实验室之外进行传染病诊断时具有前所未有的灵敏度和特异性，这可能有助于在农村、偏远和/或边缘化社区及时启动治疗和其他公共卫生干预措施。
确定实施基于社区的分子检测的障碍和促进因素。
在MEDLINE Ovid、EMBASE、Web of Science、护理学与联合健康累积索引、谷歌学术以及参考文献列表中进行了系统检索。纳入了在社区层面或农村/偏远卫生设施中由一线医护人员实施分子检测系统并报告实施障碍和促进因素的原始研究。研究通过批判性评估技能计划定性检查表进行评估，并进行归纳主题分析。在进行综述之前，该综述方案已在Prospero上注册（CRD42023397800）。
该综述共纳入6项研究。我们在所有6项纳入研究中发现了三个主要主题：基础设施、可用性和人员配置考量。基础设施成为一个关键决定因素，面临的挑战从物理空间限制到可靠电力和互联网连接问题不等。检测设备的可用性，包括易用性和检测质量等因素，也发挥了关键作用。人员配置考量，包括工作量、培训和态度，对实施结果有重大影响。
我们的综述强调了解决基础设施挑战、确保检测设备可用性以及通过培训和工作量管理充分支持工作人员以实现这一新机遇全部潜力的重要性。未来的实施应考虑这些因素，以成功地将分子诊断纳入社区层面的医疗服务，特别是在农村和偏远地区。
