A Survey on Use of Rapid Tests and Tuberculosis Diagnostic Practices by Primary Health Care Providers in South Africa: Implications for the Development of New Point-of-Care Tests.
BACKGROUND
Effective infectious disease control requires early diagnosis and treatment initiation. Point-of-care testing offers rapid turn-around-times, facilitating same day clinical management decisions. To maximize the benefits of such POC testing programs, we need to understand how rapid tests are used in everyday clinical practice.


METHODS
In this cross-sectional survey study, 400 primary healthcare providers in two cities in South Africa were interviewed on their use of rapid tests in general, and tuberculosis diagnostic practices, between September 2012 and June 2013. Public healthcare facilities were selected using probability-sampling techniques and private healthcare providers were randomly selected from the Health Professional Council of South Africa list. To ascertain differences between the two healthcare sectors 2-sample z-tests were used to compare sample proportions.


RESULTS
The numbers of providers interviewed were equally distributed between the public (n = 200) and private sector (n = 200). The most frequently reported tests in the private sector include blood pressure (99.5%), glucose finger prick (89.5%) and urine dipstick (38.5%); and in the public sector were pregnancy (100%), urine dipstick (100%), blood pressure (100%), glucose finger prick (99%) and HIV rapid test (98%). The majority of TB testing occurs in the public sector, where significantly more providers prefer Xpert MTB/RIF assay, the designated clinical TB diagnostic tool by the national TB program, as compared to the private sector (87% versus 71%, p-value >0.0001). Challenges with regard to TB diagnosis included the long laboratory turn-around-time, difficulty in obtaining sputum samples and lost results. All providers indicated that a new POC test for TB should be rapid and cheap, have good sensitivity and specificity, ease of sample acquisition, detect drug-resistance and work in HIV-infected persons.


CONCLUSIONS
The existing centralized laboratory services, poor quality assurance, and lack of staff capacity deter the use of more rapid tests at POC. Further research into the practices and choices of these providers is necessary to aid the development of new POC tests.
Lung Infection and Immunity Unit, Division of pulmonology and UCT lung Institute, Department of Medicine, University of Cape Town, Anzio Road, Cape Town, South Africa.
Malika
M
Davids
Lung Infection and Immunity Unit, Division of pulmonology and UCT lung Institute, Department of Medicine, University of Cape Town, Anzio Road, Cape Town, South Africa.
Keertan
K
Dheda
Division of Clinical Epidemiology, Department of Medicine, McGill University and McGill University Health Centre, V Building, Royal Victoria Hospital, 687 Pine Avenue West, Montreal, H3A1A1, Canada.
Nitika
N
Pant Pai
Lung Infection and Immunity Unit, Division of pulmonology and UCT lung Institute, Department of Medicine, University of Cape Town, Anzio Road, Cape Town, South Africa.
Dolphina
D
Cogill
McGill International TB Centre, Department of Epidemiology & Biostatistics, McGill University, 1020 Pine Ave West, Montreal, QC H3A 1A2, Canada.
Madhukar
M
Pai
Department of Health, Ethics & Society, Research School for Public Health and Primary Care, Maastricht University, Postbus 616, NL - 6200 MD, Maastricht, The Netherlands.
Nora
N
Engel
D000066491:Clinical Decision-Making; D003430:Cross-Sectional Studies; D042241:Early Diagnosis; D019538:Health Care Surveys; D006282:Health Personnel; D006801:Humans; D009169:Mycobacterium tuberculosis; D019095:Point-of-Care Systems; D011320:Primary Health Care / Q000379:methods; D017149:Private Sector; D017150:Public Sector; D013019:South Africa / Q000453:epidemiology; D014376:Tuberculosis / Q000175:diagnosis* / Q000453:epidemiology*