title: Compounding diagnostic delays: a qualitative study of point-of-care testing in South Africa.
abstract: OBJECTIVE
  Successful point-of-care (POC) testing (completion of test-and-treat cycle in one patient encounter) has immense potential to reduce diagnostic and treatment delays, and improve patient and public health outcomes. We explored what tests are done and how in public/private, rural/urban hospitals and clinics in South Africa and whether they can ensure successful POC testing.
  
  
  METHODS
  This qualitative research study examined POC testing across major diseases in Cape Town, Durban and Eastern Cape. We conducted 101 semi-structured interviews and seven focus group discussions with doctors, nurses, community health workers, patients, laboratory technicians, policymakers, hospital managers and diagnostic manufacturers.
  
  
  RESULTS
  In South Africa, diagnostics are characterised by a centralised system. Most tests conducted on the spot can be made to work successfully as POC tests. The majority of public/private clinics and smaller hospitals send samples via couriers to centralised laboratories and retrieve results the same way, via internet, fax or phone. The main challenge to POC testing lies in transporting samples and results, while delays risk patient loss from diagnostic/treatment pathways. Strategies to deal with associated delays create new problems, such as artificially prolonged turnaround times, strains on human resources and quality of testing, compounding additional diagnostic and treatment delays.
  
  
  CONCLUSIONS
  For POC testing to succeed, particular characteristics of diagnostic ecosystems and adaptations of professional practices to overcome associated challenges must be taken into account.
authors.affiliation: Department of Health, Ethics & Society, Research School for Public Health and Primary Care, Maastricht University, Maastricht, The Netherlands.
authors.forename: Nora
authors.initials: N
authors.lastname: Engel
authors.forename: Malika
authors.initials: M
authors.lastname: Davids
authors.forename: Nadine
authors.initials: N
authors.lastname: Blankvoort
authors.forename: Nitika Pant
authors.initials: NP
authors.lastname: Pai
authors.forename: Keertan
authors.initials: K
authors.lastname: Dheda
authors.forename: Madhukar
authors.initials: M
authors.lastname: Pai
mesh_terms: D000554:Ambulatory Care Facilities; D057210:Delayed Diagnosis; D003920:Diabetes Mellitus / Q000175:diagnosis; D017144:Focus Groups; D006282:Health Personnel; D006761:Hospitals; D006801:Humans; D006973:Hypertension / Q000175:diagnosis; D007239:Infections / Q000175:diagnosis; D007407:Interviews as Topic; D019095:Point-of-Care Systems; D036301:Qualitative Research; D013019:South Africa; D013048:Specimen Handling; D014186:Transportation
keywords: Afrique du Sud; South Africa; Sudáfrica; cualitativo; diagnostic delay; point-of-care testing; pruebas de diagnóstico inmediato; qualitatif; qualitative; retard de diagnostic; retraso diagnóstico; tests sur le lieu des soins