Integrating innovations: a qualitative analysis of referral non-completion among rapid diagnostic test-positive patients in Uganda’s human African trypanosomiasis elimination programme

Abstract

Age, gender and ethnicity of the patient [25], patient perceptions of severity and treatability of symptoms [31], and knowledge of treatment requirements [32, 33] may also influence referral completion. [...]unattractive aspects of the culture of care at receiving facilities produced by long waiting times, dismissive or harsh treatment by health workers, language barriers and recurrent drug stock-outs can dissuade patients from completing referral [34, 35]. [...]this study has drawn attention to the human cost of imperfect test specificities in a context of low disease prevalence. [...]that so few patients in our sample left microscopy facilities with an alternative diagnosis or treatment for their ongoing symptoms raises an important discrepancy between meeting the objectives of an elimination programme and meeting individual patients’ needs. 3 In 2014 the number of facilities receiving RDTs was reduced to 125 based on the distribution of identified cases but increased to 149 in 2015 to include more private clinics and facilities close to refugee camps and the South Sudanese border. 4 LAMP is more sensitive than microscopy and more specific than RDTs but needs to be performed by technicians with a very high level of training in well-equipped facilities. Because these sophisticated molecular diagnostics are yet to be ‘field applicable’ in the routine diagnosis of sleeping sickness at the primary health-care level, the direct benefit to patients remains limited [59]. [...]thank-you to all the coordinators and supervisors of the ISSEP, Ministry of Health staff and research participants who contributed time and data to provide us with a complete picture of the challenges they face completing referral in this setting.