Evaluation of malaria rapid diagnostic test (RDT) use by community health workers: a longitudinal study in western Kenya
Abstract Background 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...
| Main Authors: | , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
BMC
2018-05-01
|
| Series: | Malaria Journal |
| Subjects: | |
| Online Access: | http://link.springer.com/article/10.1186/s12936-018-2358-6 |
| _version_ | 1819099676798877696 |
|---|---|
| author | Matthew R. Boyce Diana Menya Elizabeth L. Turner Jeremiah Laktabai Wendy Prudhomme-O’Meara |
| author_facet | Matthew R. Boyce Diana Menya Elizabeth L. Turner Jeremiah Laktabai Wendy Prudhomme-O’Meara |
| author_sort | Matthew R. Boyce |
| collection | DOAJ |
| description | Abstract Background 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. Methods 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. Results 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. Conclusions 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. |
| first_indexed | 2024-12-22T00:50:40Z |
| format | Article |
| id | doaj.art-220930a6f8c3472f9c631319d29006ba |
| institution | Directory Open Access Journal |
| issn | 1475-2875 |
| language | English |
| last_indexed | 2024-12-22T00:50:40Z |
| publishDate | 2018-05-01 |
| publisher | BMC |
| record_format | Article |
| series | Malaria Journal |
| spelling | doaj.art-220930a6f8c3472f9c631319d29006ba2022-12-21T18:44:27ZengBMCMalaria Journal1475-28752018-05-0117111110.1186/s12936-018-2358-6Evaluation of malaria rapid diagnostic test (RDT) use by community health workers: a longitudinal study in western KenyaMatthew R. Boyce0Diana Menya1Elizabeth L. Turner2Jeremiah Laktabai3Wendy Prudhomme-O’Meara4Duke Global Health Institute, Duke UniversityDepartment of Epidemiology and Biostatistics, Moi University School of Public Health, College of Health SciencesDuke Global Health Institute, Duke UniversityDepartment of Family Medicine, Moi University School of MedicineDuke Global Health Institute, Duke UniversityAbstract Background 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. Methods 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. Results 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. Conclusions 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.http://link.springer.com/article/10.1186/s12936-018-2358-6Community health workerMalariaRapid diagnostic testRDTKenyaSub-Saharan Africa |
| spellingShingle | Matthew R. Boyce Diana Menya Elizabeth L. Turner Jeremiah Laktabai Wendy Prudhomme-O’Meara Evaluation of malaria rapid diagnostic test (RDT) use by community health workers: a longitudinal study in western Kenya Malaria Journal Community health worker Malaria Rapid diagnostic test RDT Kenya Sub-Saharan Africa |
| title | Evaluation of malaria rapid diagnostic test (RDT) use by community health workers: a longitudinal study in western Kenya |
| title_full | Evaluation of malaria rapid diagnostic test (RDT) use by community health workers: a longitudinal study in western Kenya |
| title_fullStr | Evaluation of malaria rapid diagnostic test (RDT) use by community health workers: a longitudinal study in western Kenya |
| title_full_unstemmed | Evaluation of malaria rapid diagnostic test (RDT) use by community health workers: a longitudinal study in western Kenya |
| title_short | Evaluation of malaria rapid diagnostic test (RDT) use by community health workers: a longitudinal study in western Kenya |
| title_sort | evaluation of malaria rapid diagnostic test rdt use by community health workers a longitudinal study in western kenya |
| topic | Community health worker Malaria Rapid diagnostic test RDT Kenya Sub-Saharan Africa |
| url | http://link.springer.com/article/10.1186/s12936-018-2358-6 |
| work_keys_str_mv | AT matthewrboyce evaluationofmalariarapiddiagnostictestrdtusebycommunityhealthworkersalongitudinalstudyinwesternkenya AT dianamenya evaluationofmalariarapiddiagnostictestrdtusebycommunityhealthworkersalongitudinalstudyinwesternkenya AT elizabethlturner evaluationofmalariarapiddiagnostictestrdtusebycommunityhealthworkersalongitudinalstudyinwesternkenya AT jeremiahlaktabai evaluationofmalariarapiddiagnostictestrdtusebycommunityhealthworkersalongitudinalstudyinwesternkenya AT wendyprudhommeomeara evaluationofmalariarapiddiagnostictestrdtusebycommunityhealthworkersalongitudinalstudyinwesternkenya |