Objective:

To analyze factors influencing the adoption and long-term use of rapid diagnostic tests (RDTs) for febrile illnesses in sub-Saharan Africa.

Approach:

• Systematic Review: The review analyzed 48 publications from 33 countries, including 37 primary studies and 11 systematic reviews.

Key Findings:

• Identified 436 implementation factors: 321 barriers and 115 facilitators grouped into 35 themes.
• Common barriers included stockouts of test kits, poor integration into workflows, insufficient training, increased workload, and lack of confidence in test results.
• Challenges with single-disease testing programs were noted, particularly with malaria RDTs leading to limited diagnostic options.
• Facilitators for RDT uptake included simple test design, rapid turnaround times, regular training, reliable supply chains, and early testing in patient journeys.
• Organizational factors such as stockouts, maintenance issues, and unclear responsibilities were critical for sustained use.

Interpretation:

Successful diagnostic implementation requires attention to workflow, training, infrastructure, supply management, and clinical integration.

Limitations:

• Lack of evidence on sustaining RDT programs after initial rollout.
• Most studies focused on adoption rather than long-term use.

Conclusion:

Future fever-management strategies may benefit from integrated diagnostic approaches addressing multiple causes of fever.

Sources:

• Nature Communications