Dispensary level pilot implementation of rapid diagnostic tests: An evaluation of RDT acceptance and usage by providers and patients - Tanzania, 2005
International Emergency and Refugee Health Branch, Centers for Disease Control and Prevention (CDC), Mail Stop F-60, 1600 Clifton Road NE, Atlanta, GA 30333, United States; National Centre in HIV Epidemiology and Clinical Research, University of New South Wales, Australia; Ifakara Health Research and Development Centre (IHRDC), Tanzania; Malaria Branch, CDC, United States
Background. Malaria rapid diagnostic tests (RDTs) may assist in diagnosis, improve prescribing practices and reduce potential drug resistance development. Without understanding operational issues or acceptance and usage by providers and patients, the costs of these tests may not be justified. Objectives. To evaluate the impact of RDTs on prescribing behaviours, assess prescribers' and patients' perceptions, and identify operational issues during implementation. Methods. Baseline data were collected at six Tanzanian public dispensaries. RDTs were implemented for eight weeks and data collected on frequency of RDT use, results, malaria diagnoses and the prescription of antimalarials. Patients referred for RDTs completed a standardised exit interview. Qualitative methods assessed attitudes toward and satisfaction with RDTs, perceptions about the test and operational issues related to implementation. Results. Of 595 patients at baseline, 200 (33%) were diagnosed clinically with malaria but had a negative RDT. Among the 2519 RDTs performed during implementation, 289 (11.5%) had a negative result and antimalarials prescribed. The proportion of "over-prescriptions" at baseline was 54.8% (198/365). At weeks four and eight this decreased to 16.1% (27/168) and 16.4% (42/256) respectively. A total of 355 patient or parent/caregiver and 21 prescriber individual interviews and 12 focus group discussions (FGDs) were conducted. Patients, caregivers and providers trusted RDT results, agreed that use of RDTs was feasible at dispensary level, and perceived that RDTs improved clinical diagnosis. Negative concerns included community suspicion and fear that RDTs were HIV tests, the need for additional supervision in interpreting the results, and increased work loads without added compensation. Conclusion. Overprescriptions decreased over the study period. There was a high degree of patient/caregiver and provider acceptance of and satisfaction with RDTs. Implementation should include community education, sufficient levels of training and supervision and consideration of the need for additional staff. © 2008 Williams et al; licensee BioMed Central Ltd.
antimalarial agent; ambulatory care; article; caregiver; clinical evaluation; diagnostic test; diagnostic value; health care personnel; health care utilization; human; Human immunodeficiency virus; information processing; interview; major clinical study; malaria; parental attitude; patient attitude; patient referral; perception; prescription; preventive health service; Tanzania; workload; attitude to health; health center; malaria; pilot study; psychological aspect; sensitivity and specificity; standard; statistics; Tanzania; Community Health Centers; Diagnostic Tests, Routine; Health Knowledge, Attitudes, Practice; Health Personnel; Humans; Malaria; Patient Acceptance of Health Care; Pilot Projects; Sensitivity and Specificity; Tanzania