Change search
CiteExportLink to record
Permanent link

Direct link
Cite
Citation style
  • apa
  • harvard1
  • ieee
  • modern-language-association-8th-edition
  • vancouver
  • Other style
More styles
Language
  • de-DE
  • en-GB
  • en-US
  • fi-FI
  • nn-NO
  • nn-NB
  • sv-SE
  • Other locale
More languages
Output format
  • html
  • text
  • asciidoc
  • rtf
Health care workers' perceptions of point-of-care testing in a low-income country-A qualitative study in Southwestern Uganda
Show others and affiliations
2017 (English)In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 12, no 7, article id e0182005Article in journal (Refereed) Published
Abstract [en]

Background Point-of-care (POC) tests have become increasingly available and more widely used in recent years. They have been of particular importance to low-income settings, enabling them with clinical capacities that had previously been limited. POC testing programs hold a great potential for significant improvement in low-income health systems. However, as most POC tests are developed in high-income countries, disengagement between developers and end-users inhibit their full potential. This study explores perceptions of POC test end-users in a low-income setting, aiming to support the development of novel POC tests for low-income countries. Methods A qualitative study was conducted in Mbarara District, Southwestern Uganda, in October 2014. Fifty health care workers were included in seven focus groups, comprising midwives, laboratory technicians, clinical and medical officers, junior and senior nurses, and medical doctors. Discussions were audio-recorded and transcribed verbatim. Transcripts were coded through a data-driven approach for qualitative content analysis. Results Nineteen different POC tests were identified as currently being in use. While participants displayed being widely accustomed to and appreciative of the use of POC tests, they also assessed the use and characteristics of current tests as imperfect. An ideal POC test was characterized as being adapted to local conditions, thoughtfully implemented in the specific health system, and capable of improving the care of patients. Tests for specific medical conditions were requested. Opinions differed with regard to the ideal distribution of POC tests in the local health system. Conclusion POC tests are commonly used and greatly appreciated in this study setting. However, there are dissatisfactions with current POC tests and their use. To maximize benefit, stakeholders need to include end-user perspectives in the development and implementation of POC tests. Insights from this study will influence our ongoing efforts to develop POC tests that will be particularly usable in low-income settings.

Place, publisher, year, edition, pages
Public Library of Science , 2017. Vol. 12, no 7, article id e0182005
National Category
Health Care Service and Management, Health Policy and Services and Health Economy
Identifiers
URN: urn:nbn:se:kth:diva-212626DOI: 10.1371/journal.pone.0182005ISI: 000406575700113Scopus ID: 2-s2.0-85026480565OAI: oai:DiVA.org:kth-212626DiVA, id: diva2:1135749
Funder
Science for Life Laboratory - a national resource center for high-throughput molecular bioscienceSwedish Research Council, 2015-03217EU, European Research Council, 615458
Note

QC 20170824

Available from: 2017-08-24 Created: 2017-08-24 Last updated: 2018-05-03Bibliographically approved
In thesis
1. Development of array systems for molecular diagnostic assays
Open this publication in new window or tab >>Development of array systems for molecular diagnostic assays
2018 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

For molecular diagnostics, assays detecting biomarkers can be used to provide information to medical questions. Array formats such as microarrays and suspension bead arrays allow for multiplex assays, analyzing hundreds or thousands of analytes simultaneously in one single sample. There is a growing demand of multiplex assays, using panels of biomarkers, for the use in Point-of-Care (POC) diagnostic tests. These diagnostic tests require little or no equipment and relies on easy read-out systems. Lateral flow assays (LFAs) are well-known, paper-based POC assays, with advantageous features, which include performing the assay by capillary forces, stable reagents storage and naked-eye read-out. Vertical Flow Microarrays (VFMs) have previously been presented as an alternative to LFAs, circumventing downstream effects by vertically applying sample and reagents. In Paper I and II of this thesis, VFM arrays have been applied in the development of assays for molecular diagnosis, while Paper III explores Suspension Bead Array (SBA) format for biomarker discovery.

 

In Paper I, we have developed a DNA-VFM assay towards POC testing of Neisseria meningitidis, one of the major meningitis causing bacteria. Here, the target gene of N. meningitidis was amplified using Recombinase Polymerase Amplification (RPA). The amplified DNA was digested into ssDNA and hybridized to multiple VFM probes, for multiplex detection of different segments of the target gene. Optimization of the assay resulted in a Limit Of Detection (LOD) of 4.4 nM for amplification of synthetic DNA.

 

In Paper II, a VFM for reverse phase detection of IgE was developed. The assay was optimized using IgE spiked into IgE-negative serum, resulting in a LOD of 1.9 μg/mL. Optimized conditions were then used to screen a cohort of serum samples, including patients with rare primary immunodeficiency Hyper IgE syndrome and healthy controls. A comparative, traditional reverse phase assay was also performed on the same serum samples, showing comparable results to the reverse phase VFM.

 

In Paper III, a pediatric cohort from Plasmodium falciparum endemic Rwanda was analyzed using SBAs for proteins involved during various stages of malaria infection. Large, significant differences between cases and controls were found for 22 of the analyzed proteins. The majority of the candidate proteins presented validated previous work, nevertheless, several proteins were identified with no previously known link to malaria pathogenesis. Proteins discriminating between mild and severe malaria infection were also identified, showing minor separation between the two sample groups.

 

In Paper IV, a focus group discussion of using POC tests with Ugandan health care personnel was conducted. Health care personnel at different levels were interviewed about their perception of using POC tests in the health care system, including strengths and weaknesses. This study was designed to bridge some of the knowledge gap between the POC test developers and end-users.

Place, publisher, year, edition, pages
Stockholm: KTH Royal Institute of Technology, 2018. p. 71
Series
TRITA-CBH-FOU ; 2018:5
National Category
Medical Biotechnology
Research subject
Biotechnology
Identifiers
urn:nbn:se:kth:diva-227159 (URN)978-91-7729-717-8 (ISBN)
Public defence
2018-05-25, Gardaulan, Folkhälsomyndigheten, Nobels väg 18, Solna, 10:00 (English)
Opponent
Funder
EU, European Research Council, 615458
Note

QC 20180503

Available from: 2018-05-03 Created: 2018-05-03 Last updated: 2018-05-03Bibliographically approved

Open Access in DiVA

No full text in DiVA

Other links

Publisher's full textScopus

Authority records BETA

Reuterswärd, Philippa

Search in DiVA

By author/editor
Gantelius, JesperReuterswärd, PhilippaAndersson Svahn, Helene
By organisation
Proteomics and NanobiotechnologyScience for Life Laboratory, SciLifeLab
In the same journal
PLoS ONE
Health Care Service and Management, Health Policy and Services and Health Economy

Search outside of DiVA

GoogleGoogle Scholar

doi
urn-nbn

Altmetric score

doi
urn-nbn
Total: 13 hits
CiteExportLink to record
Permanent link

Direct link
Cite
Citation style
  • apa
  • harvard1
  • ieee
  • modern-language-association-8th-edition
  • vancouver
  • Other style
More styles
Language
  • de-DE
  • en-GB
  • en-US
  • fi-FI
  • nn-NO
  • nn-NB
  • sv-SE
  • Other locale
More languages
Output format
  • html
  • text
  • asciidoc
  • rtf