In places where rates of diseases that include malaria, HIV and tuberculosis are highest, the obstacles to tackling them begin with diagnosis. While the people most affected are likeliest to live on the edges of a city or in more remote rural areas, a recent edition of African Journal of Laboratory Medicine notes, most diagnostic testing continues to take place in centralized laboratories. The challenge that presents to timely diagnoses has led to a drive toward decentralized testing with diagnostic tools at the places where patients receive care. But in resource-limited settings, as a series of articles in the journal describe, where equipment failures, operator errors and shortages of necessary supplies can compromise the results of diagnostic tests, that can mean testing that is accessible, but not reliable.
The Quality Assurance in Point-of-Care Testing for HIV issue of the journal focuses on challenges and answers to ensuring the reliable accuracy of diagnostic tests in care settings. In addition to examinations of collaborations and technologies to support evaluations of testing sites, the issue looks at the challenges of nine countries facing a shifting diagnostic landscape to include monitoring treatment effectiveness through viral load monitoring and increased early infant HIV testing. Those include Mozambique, where in the 1990s HIV testing sites were few and far between, where today an estimated six million tests are performed at thousands of testing sites around the country annually, where early infant diagnostic tests are performed for about 60,000 children a year, and where viral load testing is now being expanded. There, the national health system includes a system to assess the quality of testing into plans to use point-of-care tests, but increasing numbers of sites and testing technologies are exceeding the system’s capacities. It also includes South Africa, where software, site monitoring, monthly reports and training on a provincial level are among the tools to assess the reliability of accurate HIV and tuberculosis testing.
The AJLM special issue notes that in settings where resources are limited and strained, ensuring the accuracy of testing performed in sites scattered across landscapes where resources are limited and strained can be costly. But, it also points out, expanding access to diagnostic tools means little without efforts to ascertain they are delivering actionable results.