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“We usually see a lot of delay in terms of coming for or seeking care”: an expert consultation on COVID testing and care pathways in seven low- and middle-income countries

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dc.contributor.author Bonnet, Gabrielle
dc.contributor.author Bimba, John
dc.contributor.author Chavula, Chancy
dc.contributor.author Chifamba, Harunavamwe N.
dc.contributor.author Divala, Titus
dc.contributor.author Lescano Guevara, Andres Guillermo
dc.contributor.author Majam, Mohammed
dc.contributor.author Mbo, Danjuma
dc.contributor.author Suwantika, Auliya A.
dc.contributor.author Tovar, Marco A.
dc.contributor.author Yadav, Pragya
dc.contributor.author Corbett, Elisabeth L.
dc.contributor.author Vassall, Anna
dc.contributor.author Jit, Mark
dc.coverage.spatial India
dc.coverage.spatial Indonesia
dc.coverage.spatial Malawi
dc.coverage.spatial Nigeria
dc.coverage.spatial Perú
dc.coverage.spatial Sudáfrica
dc.coverage.spatial Zimbabwe
dc.date.accessioned 2023-12-07T22:33:23Z
dc.date.available 2023-12-07T22:33:23Z
dc.date.issued 2023
dc.identifier.uri https://hdl.handle.net/20.500.12866/14698
dc.description.abstract Background: Rapid diagnostic testing may support improved treatment of COVID patients. Understanding COVID testing and care pathways is important for assessing the impact and cost-effectiveness of testing in the real world, yet there is limited information on these pathways in low-and-middle income countries (LMICs). We therefore undertook an expert consultation to better understand testing policies and practices, clinical screening, the profile of patients seeking testing or care, linkage to care after testing, treatment, lessons learnt and expected changes in 2023. Methods: We organized a qualitative consultation with ten experts from seven LMICs (India, Indonesia, Malawi, Nigeria, Peru, South Africa, and Zimbabwe) identified through purposive sampling. We conducted structured interviews during six regional consultations, and undertook a thematic analysis of responses. Results: Participants reported that, after initial efforts to scale-up testing, the policy priority given to COVID testing has declined. Comorbidities putting patients at heightened risk (e.g., diabetes) mainly relied on self-identification. The decision to test following clinical screening was highly context-/location-specific, often dictated by local epidemiology and test availability. When rapid diagnostic tests were available, public sector healthcare providers tended to rely on them for diagnosis (alongside PCR for Asian/Latin American participants), while private sector providers predominantly used polymerase chain reaction (PCR) tests. Positive test results were generally taken at ‘face value’ by clinicians, although negative tests with a high index of suspicion may be confirmed with PCR. However, even with a positive result, patients were not always linked to care in a timely manner because of reluctance to receiving care or delays in returning to care centres upon clinical deterioration. Countries often lacked multiple components of the range of therapeutics advised in WHO guidelines: notably so for oral antivirals designed for high-risk mild patients. Severely ill patients mostly received corticosteroids and, in higher-resourced settings, tocilizumab. Conclusions: Testing does not always prompt enhanced care, due to reluctance on the part of patients and limited therapeutic availability within clinical settings. Any analysis of the impact or cost-effectiveness of testing policies post pandemic needs to either consider investment in optimal treatment pathways or constrain estimates of benefits based on actual practice. en_US
dc.language.iso eng
dc.publisher BioMed Central
dc.relation.ispartofseries BMC Health Services Research
dc.rights info:eu-repo/semantics/restrictedAccess
dc.rights.uri https://creativecommons.org/licenses/by-nc-nd/4.0/deed.es
dc.subject COVID-19 en_US
dc.subject Testing en_US
dc.subject Rapid diagnostic tests en_US
dc.subject Self-testing en_US
dc.subject Care pathways en_US
dc.subject Care-seeking en_US
dc.subject.mesh COVID-19
dc.subject.mesh Prueba de COVID-19
dc.subject.mesh Prueba de Diagnóstico Rápido
dc.subject.mesh Autoevaluación
dc.subject.mesh Vías Clínicas
dc.subject.mesh Aceptación de la Atención de Salud
dc.title “We usually see a lot of delay in terms of coming for or seeking care”: an expert consultation on COVID testing and care pathways in seven low- and middle-income countries en_US
dc.type info:eu-repo/semantics/article
dc.identifier.doi https://doi.org/10.1186/s12913-023-10305-0
dc.subject.ocde https://purl.org/pe-repo/ocde/ford#3.03.02
dc.relation.issn 1472-6963


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