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.
