- Lack of access to testing plays a major role in the underdiagnosis of infectious and noncommunicable diseases, leading to higher morbidity and mortality.
- Point-of-care (POC) tests can offer rapid results, allowing for timely initiation of therapy. However, mere availability of POC tests in health facilities does not ensure utilization. Conducting POC tests has been shown to be a burden on highly trained frontline healthcare workers (HCWs; clinicians and nurses), who often have a broader scope of responsibilities and are critically scarce in many settings.
- The continual emergence of easy-to-use POC tests has not been accompanied by investment in a cadre of health workers to support their delivery, especially at decentralized health facilities where patients initially seek healthcare support.
- Historically, implementation of task shifting for POC tests has proven difficult due to lack of integration into national human resource structures and fiscal plans and lack of explicit national policies promoting task shifting, together with resistance from laboratory professionals.
- We propose that the scope of work for existing lay health worker (LHW) cadres could be broadened/remodeled to include POC tests for HIV services including for advanced HIV disease and other priority diseases, especially in primary healthcare or lower level facilities without laboratories. Policy makers and national program managers could ensure that this is part of broader national health workforce policies.
- Concerns of professional and/or regulatory bodies must be addressed, and these bodies (medical and laboratory councils) can guide national policy on which POC tests can be task shifted to less laboratory-trained cadres, and they could also lead in the development of a framework of education and supervision to ensure sustainability and maintenance of professional standards.
- Lay testing initiatives can scale up access to the multitude of available essential POC tests, for maximal impact of disease testing, closer to where people live. This can improve global health and accelerate progress toward universal health coverage.
URL: Lay testing cadres and point-of-care diagnostic tests for HIV and other diseases: An essential combination in health service delivery