Introduction of syphilis point-of-care tests, from pilot study to national programme implementation in Zambia: A qualitative study of healthcare workers' perspectives on testing, training and quality assurance

ANSBRO, É.M., GILL, M.M., REYNOLDS, J., SHELLEY, K.D., STRASSER, S., SRIPIPATANA, T., NCUBE, A.T., MUMBA, G.T., TERRIS-PRESTHOLT, F., PEELING, R.W. and MABEY, D. (2015). Introduction of syphilis point-of-care tests, from pilot study to national programme implementation in Zambia: A qualitative study of healthcare workers' perspectives on testing, training and quality assurance. PLoS ONE, 10 (6), e0127728.

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Abstract

Syphilis affects 1.4 million pregnant women globally each year. Maternal syphilis causes congenital syphilis in over half of affected pregnancies, leading to early foetal loss, pregnancy complications, stillbirth and neonatal death. Syphilis is under-diagnosed in pregnant women. Point-of-care rapid syphilis tests (RST) allow for same-day treatment and address logistical barriers to testing encountered with standard Rapid Plasma Reagin testing. Recent literature emphasises successful introduction of new health technologies requires healthcare worker (HCW) acceptance, effective training, quality monitoring and robust health systems. Following a successful pilot, the Zambian Ministry of Health (MoH) adopted RST into policy, integrating them into prevention of mother-to-child transmission of HIV clinics in four underserved Zambian districts. We compare HCW experiences, including challenges encountered in scaling up from a highly supported NGO-led pilot to a large-scale MoH-led national programme. Questionnaires were administered through structured interviews of 16 HCWs in two pilot districts and 24 HCWs in two different rollout districts. Supplementary data were gathered via stakeholder interviews, clinic registers and supervisory visits. Using a conceptual framework adapted from health technology literature, we explored RST acceptance and usability. Quantitative data were analysed using descriptive statistics. Key themes in qualitative data were explored using template analysis. Overall, HCWs accepted RST as learnable, suitable, effective tools to improve antenatal services, which were usable in diverse clinical settings. Changes in training, supervision and quality monitoring models between pilot and rollout may have influenced rollout HCW acceptance and compromised testing quality. While quality monitoring was integrated into national policy and training, implementation was limited during rollout despite financial support and mentorship. We illustrate that new health technology pilot research can rapidly translate into policy change and scale-up. However, training, supervision and quality assurance models should be reviewed and strengthened as rollout of the Zambian RST programme continues. © 2015, Public Library of Science. All rights reserved. This is an open access article, free of all copyright, and may be freely reproduced, distributed, transmitted, modified, built upon, or otherwise used by anyone for any lawful purpose. The work is made available under the Creative Commons CC0 public domain dedication.

Item Type:	Article
Uncontrolled Keywords:	Attitude of Health Personnel; Health Personnel; Health Plan Implementation; Humans; Pilot Projects; Point-of-Care Systems; Practice Guidelines as Topic; Qualitative Research; Quality Assurance, Health Care; Syphilis; Zambia; Humans; Syphilis; Pilot Projects; Attitude of Health Personnel; Qualitative Research; Health Personnel; Health Plan Implementation; Point-of-Care Systems; Quality Assurance, Health Care; Zambia; Practice Guidelines as Topic; MD Multidisciplinary; General Science & Technology
Identification Number:	https://doi.org/10.1371/journal.pone.0127728
Page Range:	e0127728
SWORD Depositor:	Symplectic Elements
Depositing User:	Symplectic Elements
Date Deposited:	21 Jan 2019 10:45
Last Modified:	18 Mar 2021 06:51
URI:	https://shura.shu.ac.uk/id/eprint/23377

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