"If one is not careful there is room for error": Potential sources of misdiagnosis in rapid HIV testing according to health facility staff in Zimbabwe

Morten Skovdal; Nadine Beckmann; Rufurwokuda Maswera; Constance Nyamukapa; Simon Gregson

"If one is not careful there is room for error": Potential sources of misdiagnosis in rapid HIV testing according to health facility staff in Zimbabwe

Morten Skovdal, Nadine Beckmann, Rufurwokuda Maswera, Constance Nyamukapa, Simon Gregson

Research output: Contribution to conference › Poster › peer-review

Abstract

Introduction - There is uncertainty associated with all medical testing and diagnosis. However, a growing number of studies highlight disconcerting levels of misdiagnosis in the scale-up of HIV rapid testing programmes. Evaluation studies point to user errors as potential sources of misdiagnosis, but what are the views and experiences of clinicians and primary counsellors who perform rapid HIV testing?

Methods - To generate a user-perspective of potential sources for misdiagnosis, this study draws on interviews with 28 health facility staff who perform rapid HIV tests on a daily basis. The testers were recruited from 11 health facilities across Zimbabwe, eight of which have above average rates of misdiagnosis. Interviews were translated, transcribed and thematically interrogated.

Findings - While most testers conceded that misdiagnosis can occur, it was considered an extremely rare event, and nearly half of the testers stated they had never heard of such an occurrence. Nonetheless, reflecting on their rapid HIV testing practices, potential sources of misdiagnosis included uncertainties associated with new testing algorithms and test kits; reading test results too quickly or too late; misreading of test results if the test produces faint or unclear lines; and failure to record and document test results accurately. The testers put a lot of trust in the standard operating procedures, and argued that enough quality controls are embedded within the procedures to circumvent misdiagnosis. Misdiagnosis was thus portrayed as a result of deviating from the procedures. The testers located deviance from standard operating procedures in the wider context of high workloads and growing demands for HIV testing, arguing that distractions, HIV test kit stock-outs, and changes in standard operating procedures occasionally made it difficult for testers to follow the procedures.

Conclusion – Rather than attributing misdiagnosis to malfunctioning test kits or complicated standard operating procedures, testers embraced the procedures and saw misdiagnosis largely as human error – failure to follow laid out procedures. Their recognition of how a resource-depleted work and HIV testing environment can contribute to misdiagnoses, highlight the need to adequately resource HIV rapid testing programmes.

Original language	English
Publication status	Published - Jul 2019
Event	AIDSIMPACT 2019 - Hilton Hotel Syon Park, London, United Kingdom Duration: 29 Jul 2019 → 31 Jul 2019 http://www.aidsimpact.com/

Conference

Conference	AIDSIMPACT 2019
Country/Territory	United Kingdom
City	London
Period	29/07/19 → 31/07/19
Internet address	http://www.aidsimpact.com/

Cite this

@conference{e1ebf471476b4604aee9928489219be1,

title = "{"}If one is not careful there is room for error{"}: Potential sources of misdiagnosis in rapid HIV testing according to health facility staff in Zimbabwe",

abstract = "Introduction - There is uncertainty associated with all medical testing and diagnosis. However, a growing number of studies highlight disconcerting levels of misdiagnosis in the scale-up of HIV rapid testing programmes. Evaluation studies point to user errors as potential sources of misdiagnosis, but what are the views and experiences of clinicians and primary counsellors who perform rapid HIV testing? Methods - To generate a user-perspective of potential sources for misdiagnosis, this study draws on interviews with 28 health facility staff who perform rapid HIV tests on a daily basis. The testers were recruited from 11 health facilities across Zimbabwe, eight of which have above average rates of misdiagnosis. Interviews were translated, transcribed and thematically interrogated. Findings - While most testers conceded that misdiagnosis can occur, it was considered an extremely rare event, and nearly half of the testers stated they had never heard of such an occurrence. Nonetheless, reflecting on their rapid HIV testing practices, potential sources of misdiagnosis included uncertainties associated with new testing algorithms and test kits; reading test results too quickly or too late; misreading of test results if the test produces faint or unclear lines; and failure to record and document test results accurately. The testers put a lot of trust in the standard operating procedures, and argued that enough quality controls are embedded within the procedures to circumvent misdiagnosis. Misdiagnosis was thus portrayed as a result of deviating from the procedures. The testers located deviance from standard operating procedures in the wider context of high workloads and growing demands for HIV testing, arguing that distractions, HIV test kit stock-outs, and changes in standard operating procedures occasionally made it difficult for testers to follow the procedures. Conclusion – Rather than attributing misdiagnosis to malfunctioning test kits or complicated standard operating procedures, testers embraced the procedures and saw misdiagnosis largely as human error – failure to follow laid out procedures. Their recognition of how a resource-depleted work and HIV testing environment can contribute to misdiagnoses, highlight the need to adequately resource HIV rapid testing programmes. ",

author = "Morten Skovdal and Nadine Beckmann and Rufurwokuda Maswera and Constance Nyamukapa and Simon Gregson",

year = "2019",

month = jul,

language = "English",

note = "AIDSIMPACT 2019 ; Conference date: 29-07-2019 Through 31-07-2019",

url = "http://www.aidsimpact.com/ ",

}

TY - CONF

T1 - "If one is not careful there is room for error": Potential sources of misdiagnosis in rapid HIV testing according to health facility staff in Zimbabwe

AU - Skovdal, Morten

AU - Beckmann, Nadine

AU - Maswera, Rufurwokuda

AU - Nyamukapa, Constance

AU - Gregson, Simon

PY - 2019/7

Y1 - 2019/7

N2 - Introduction - There is uncertainty associated with all medical testing and diagnosis. However, a growing number of studies highlight disconcerting levels of misdiagnosis in the scale-up of HIV rapid testing programmes. Evaluation studies point to user errors as potential sources of misdiagnosis, but what are the views and experiences of clinicians and primary counsellors who perform rapid HIV testing? Methods - To generate a user-perspective of potential sources for misdiagnosis, this study draws on interviews with 28 health facility staff who perform rapid HIV tests on a daily basis. The testers were recruited from 11 health facilities across Zimbabwe, eight of which have above average rates of misdiagnosis. Interviews were translated, transcribed and thematically interrogated. Findings - While most testers conceded that misdiagnosis can occur, it was considered an extremely rare event, and nearly half of the testers stated they had never heard of such an occurrence. Nonetheless, reflecting on their rapid HIV testing practices, potential sources of misdiagnosis included uncertainties associated with new testing algorithms and test kits; reading test results too quickly or too late; misreading of test results if the test produces faint or unclear lines; and failure to record and document test results accurately. The testers put a lot of trust in the standard operating procedures, and argued that enough quality controls are embedded within the procedures to circumvent misdiagnosis. Misdiagnosis was thus portrayed as a result of deviating from the procedures. The testers located deviance from standard operating procedures in the wider context of high workloads and growing demands for HIV testing, arguing that distractions, HIV test kit stock-outs, and changes in standard operating procedures occasionally made it difficult for testers to follow the procedures. Conclusion – Rather than attributing misdiagnosis to malfunctioning test kits or complicated standard operating procedures, testers embraced the procedures and saw misdiagnosis largely as human error – failure to follow laid out procedures. Their recognition of how a resource-depleted work and HIV testing environment can contribute to misdiagnoses, highlight the need to adequately resource HIV rapid testing programmes.

AB - Introduction - There is uncertainty associated with all medical testing and diagnosis. However, a growing number of studies highlight disconcerting levels of misdiagnosis in the scale-up of HIV rapid testing programmes. Evaluation studies point to user errors as potential sources of misdiagnosis, but what are the views and experiences of clinicians and primary counsellors who perform rapid HIV testing? Methods - To generate a user-perspective of potential sources for misdiagnosis, this study draws on interviews with 28 health facility staff who perform rapid HIV tests on a daily basis. The testers were recruited from 11 health facilities across Zimbabwe, eight of which have above average rates of misdiagnosis. Interviews were translated, transcribed and thematically interrogated. Findings - While most testers conceded that misdiagnosis can occur, it was considered an extremely rare event, and nearly half of the testers stated they had never heard of such an occurrence. Nonetheless, reflecting on their rapid HIV testing practices, potential sources of misdiagnosis included uncertainties associated with new testing algorithms and test kits; reading test results too quickly or too late; misreading of test results if the test produces faint or unclear lines; and failure to record and document test results accurately. The testers put a lot of trust in the standard operating procedures, and argued that enough quality controls are embedded within the procedures to circumvent misdiagnosis. Misdiagnosis was thus portrayed as a result of deviating from the procedures. The testers located deviance from standard operating procedures in the wider context of high workloads and growing demands for HIV testing, arguing that distractions, HIV test kit stock-outs, and changes in standard operating procedures occasionally made it difficult for testers to follow the procedures. Conclusion – Rather than attributing misdiagnosis to malfunctioning test kits or complicated standard operating procedures, testers embraced the procedures and saw misdiagnosis largely as human error – failure to follow laid out procedures. Their recognition of how a resource-depleted work and HIV testing environment can contribute to misdiagnoses, highlight the need to adequately resource HIV rapid testing programmes.

M3 - Poster

T2 - AIDSIMPACT 2019

Y2 - 29 July 2019 through 31 July 2019

ER -