Testing Out of Facilities: A Questionnaire on Diagnostic Testing in Non-Traditional Settings

A new paradigm currently being considered is the testing of patients outside of the status quo traditional health systems. Testing patients outside of the hospital or clinic setting may have beneficial effects in the diagnosis and treatment of diseases and conditions. Tests administered in these settings may additionally create an incentive for people to seek more formal health care post diagnosis. Self-testing and self-sampling may provide a meaningful way for patients to test these diseases or conditions outside of traditional health settings.

Self-Tests

Self-testing is a process in which an individual collects his or her own sample, performs a diagnostic test on the sample and then interprets the results.

Self-Sampling

Self-sampling or self-collection occurs when an individual takes their own sample outside of a clinic setting and sends it to a clinic or laboratory for testing.

A new paradigm currently being considered is the testing of patients outside of the status quo traditional health systems. Testing patients outside of the hospital or clinic setting may have beneficial effects in the diagnosis and treatment of diseases and conditions. Tests administered in these settings may additionally create an incentive for people to seek more formal health care post diagnosis. Self-testing and self-sampling may provide a meaningful way for patients to test these diseases or conditions outside of traditional health settings.

Self-Tests

Self-testing is a process in which an individual collects his or her own sample, performs a diagnostic test on the sample and then interprets the results.

Self-Sampling

Self-sampling or self-collection occurs when an individual takes their own sample outside of a clinic setting and sends it to a clinic or laboratory for testing.

Motive of the Questionnaire

The motive of the questionnaire is to gather information to get evidence for which diseases or conditions will self-testing or self-sampling be the most impactful. An increasing number of studies and national policies support the use of self-testing and self-sampling for diseases such as HIV, yet our present objective is to explore the possibility of applying the use of these methods beyond HIV.

FIND’s goal is to gather information based on the following factors to gain insight on the diseases or conditions for which self-testing and self-sampling will be useful in terms of patient care and improving health outcomes:

Prioritization: Our first goal is to acquire information on what factors make self-testing and self- sampling a priority, as well as which diseases or conditions should be prioritized when developing these diagnostic methods.

Feasibility: Our second goal is to assess the degree to which self-testing and self-sampling can be administered easily: for which diseases or conditions are these methods most appropriate and among which target populations.

Efficacy: Our third goal is to evaluate whether self-tests and self-sampling can produce the desired diagnostic results.

Acceptability: Our fourth goal is to understand the extent to which self-tests or self-sampling will be tolerated or accepted amongst individuals and to identify critical enablers to successful introduction of self-testing and self-sampling tools.

Patient Demand: Our final goal is to document the current under met demand for self-testing and self-sampling disaggregated by disease or condition and target population.

Motive of the Questionnaire

The motive of the questionnaire is to gather information to get evidence for which diseases or conditions will self-testing or self-sampling be the most impactful. An increasing number of studies and national policies support the use of self-testing and self-sampling for diseases such as HIV, yet our present objective is to explore the possibility of applying the use of these methods beyond HIV.

FIND’s goal is to gather information based on the following factors to gain insight on the diseases or conditions for which self-testing and self-sampling will be useful in terms of patient care and improving health outcomes:

Prioritization: Our first goal is to acquire information on what factors make self-testing and self- sampling a priority, as well as which diseases or conditions should be prioritized when developing these diagnostic methods.

Feasibility: Our second goal is to assess the degree to which self-testing and self-sampling can be administered easily: for which diseases or conditions are these methods most appropriate and among which target populations.

Efficacy: Our third goal is to evaluate whether self-tests and self-sampling can produce the desired diagnostic results.

Acceptability: Our fourth goal is to understand the extent to which self-tests or self-sampling will be tolerated or accepted amongst individuals and to identify critical enablers to successful introduction of self-testing and self-sampling tools.

Patient Demand: Our final goal is to document the current under met demand for self-testing and self-sampling disaggregated by disease or condition and target population.

In your opinion, what criteria will have to prioritize self testing and self-sampling?
Convenience—Individuals can obtain and administer self-tests and self-sampling without difficulty
Stigmatization—Administration of self-tests and self-sampling tools in private environments to protect individuals from the stigma that may be tied to specific diseases or conditions
Re-testing—Individuals must regularly retest or resample their conditions
Affordability—Tools are inexpensive for individuals with the potential to be reimbursed by health insurance companies
Which do you believe are benefits of self-testing and self-sampling outside of clinics? (Select all that apply)
Less Stigma
Patient Empowerment
Feasibility
Alignment with Universal Health Care
Increased access to diagnostic testing
Other
If other, please specify or else skip the question.
Which do you believe are risks of self-testing and self-sampling outside of clinics? (Select all that apply)
Coercion or Violence
Misdiagnosis
Costs borne by the patients and not the health care systems
Regulatory Barriers—Lack of national health policies that support self-testing or self-sampling
Other
If other, please specify or else skip the question.
Self-testing and Self-Sampling Across Diseases and Conditions: Disease, Conditions and Syndrome Prioritization
 
 
Research involving the application of self-tests and self-sampling tools to certain diseases and conditions continues to evolve. More tools are being developed with the hopes of increasing access to diagnostics closer to the patient. Decisions about which diseases and conditions should be prioritized for self-testing and self-sampling involve numerous factors, such as the scientific feasibility of self-testing technologies for a particular disease, public health need and costs.
Self-testing and Self-Sampling Across Diseases and Conditions: Disease, Conditions and Syndrome Prioritization
 
 
Research involving the application of self-tests and self-sampling tools to certain diseases and conditions continues to evolve. More tools are being developed with the hopes of increasing access to diagnostics closer to the patient. Decisions about which diseases and conditions should be prioritized for self-testing and self-sampling involve numerous factors, such as the scientific feasibility of self-testing technologies for a particular disease, public health need and costs.
Which diseases or conditions do you feel self-testing and self-sampling would be most impactful? Please rank each of the following items in order of importance with #1 being the most important object to #12 being the least important object.
Diseases/Conditions: Please take care to answer per disease once.
1
2
3
4
5
6
7
8
9
10
11
12
Do you have any additional diseases or conditions that you believe should be prioritized for self-testing and self-sampling? If not, please skip the question.
Self-Testing and Self-Sampling: A Syndromic Approach
 
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Many syndromes are mapped to multiple diseases and conditions. Self-testing and self-sampling may help in the diagnosis of conditions that may result in certain symptoms, such as fever. This then may provide an impetus for individuals to pursue further care in more specialized health settings.

Self-Testing and Self-Sampling: A Syndromic Approach
 
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Many syndromes are mapped to multiple diseases and conditions. Self-testing and self-sampling may help in the diagnosis of conditions that may result in certain symptoms, such as fever. This then may provide an impetus for individuals to pursue further care in more specialized health settings.

Are there any syndromes you believe should be prioritized for self-testing and self-sampling? Please rank each of the following items in order of importance with #1 being the most important object to #5 being the least important object. Likert Scale 1: not at all impactful, 3 neutral, 5 very impactful.
Acute Chest Pain
1
2
3
4
5
Vaginal or Urethral Discharge
1
2
3
4
5
Skin Rashes or Inflammation
1
2
3
4
5
Fever
1
2
3
4
5
Diarrhea
1
2
3
4
5
Are there any additional syndromes that you believe should be prioritized for self-testing? If not, please skip the question.
Suitability of Self-Testing and Self-Sampling

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Self-testing and self-sampling are beneficial yet not all conditions should be tested through these methods. Some conditions may be better tested primarily by specialized health professionals due to the high risks that may accompany misdiagnosis.

Suitability of Self-Testing and Self-Sampling

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Self-testing and self-sampling are beneficial yet not all conditions should be tested through these methods. Some conditions may be better tested primarily by specialized health professionals due to the high risks that may accompany misdiagnosis.

Are there diseases that would not be amenable to self-testing or self-sampling? If yes, please list the disease(s) or else skip the question.
Target Groups for Self-Testing and Self-Sampling
 

A factor which may contribute to large diagnostic gaps is the lack of access to proper health care amongst some populations. Furthermore, factors such as stigmatization can dissuade certain groups from reaching out to health care professionals for the testing of some diseases and conditions.

Target Groups for Self-Testing and Self-Sampling
 

A factor which may contribute to large diagnostic gaps is the lack of access to proper health care amongst some populations. Furthermore, factors such as stigmatization can dissuade certain groups from reaching out to health care professionals for the testing of some diseases and conditions.

Are there any specific groups that you believe may benefit from self-testing?
Key populations or others who face stigma at clinics
Isolated or remote communities
People with disabilities or others who may have trouble getting to clinics with labs
Marginalized groups that otherwise face barriers to clinic-based testing
Other
If other, please specify or else skip the question.
What conditions are required to increase uptake of self-testing among vulnerable and at risk populations?
Which populations do you feel there is high patient demand?
Settings
 
 
The settings in which self-testing or self-sampling are administered is essential in the development of diagnostic tests using these methods. Though both diagnostic tests should ideally be home-based, an availability of self-testing or self-sampling in other non-traditional settings may be beneficial in improving access to diagnostics amongst populations.
Settings
 
 
The settings in which self-testing or self-sampling are administered is essential in the development of diagnostic tests using these methods. Though both diagnostic tests should ideally be home-based, an availability of self-testing or self-sampling in other non-traditional settings may be beneficial in improving access to diagnostics amongst populations.
In which settings do you think self-testing and self-sampling would be feasible?
Community Health Centers
Pharmacies
Social gathering places: Supermarkets. Shopping Centers, Churches, Bars
Workplace Settings
School Settings
Health Fairs
Home-based settings (tests done within the home)
Door to Door Peer Assisted Testing
Other
If other, please specify or else skip the question.
In which geographic locations do you believe self-testing and self-sampling would be most impactful?
Rural or hard to reach areas by transport
Locations where clinics have limited labs
Other
If other, please specify or else skip the question.
In some context and settings self-testing and self-sampling may be more difficult or not appropriate. What settings do you believe these diagnostic tests would be inappropriate?
Sampling

 

Self-testing and self-sampling both involve a person collecting his or her own samples when administering the diagnostic tests. Finding a proper sample which is sensitive to diagnostic tests, easy to collect and acceptable amongst populations is important in the development of self- testing and self-sampling diagnostic tools.

Sampling

 

Self-testing and self-sampling both involve a person collecting his or her own samples when administering the diagnostic tests. Finding a proper sample which is sensitive to diagnostic tests, easy to collect and acceptable amongst populations is important in the development of self- testing and self-sampling diagnostic tools.

Which type of samples collected do you feel will be most acceptable for self-testing and self-sampling?
Fingerstick Blood
Urine
Skin
Genital Swabs
Oral Fluid
Hair
Other
If other, please specify or else skip the question.
Future Directions
 
 
With technological advancements and the increase of access to industrial devices globally, what will the future of self-testing and self-sampling look like within LMICs?
Future Directions
 
 
With technological advancements and the increase of access to industrial devices globally, what will the future of self-testing and self-sampling look like within LMICs?
Wearable Health Devices are increasingly helping individuals to better monitor their health status. Which diseases or conditions do you think will highly benefit from these devices?
Digital health is the convergence of digital technologies with healthcare to enhance the efficiency of healthcare delivery. Which diseases or conditions do you think will benefit from these technological tools?
Survey Respondent Information
Name
Disease or Condition of Interest
Email Address
Phone (Optional)
Skype (Optional)
Organization
Website (Optional)
Reference
Survey Respondent Information: Gender
Male
Female
Survey Respondent Information: Geographical Location
African Region
Region of the Americas
South-East Asia Region
European Region
Western Pacific Region
Eastern Mediterranean Region
Survey Respondent Information: Profession
Clinician
Lab Technician
Pharmacist
Community Health Worker
Activist
Other
If other, please specify or else skip the question.
Survey Respondent Information: Affiliations
University
Government Agency
Private Sector Health Provider
Civil Advocacy Group
Other
If other, please specify or else skip the question.
What is your previous experience with diagnostic testing in general and testing outside of clinics in particular?
None
Low
Moderate
High
If you would like to participate further in our external scoping for lay-testing how would you like to be approached?
Email
Phone
In-Person Meeting
Other (please specify)
Thank you very much for your participation in the following questionnaire:
 
This information will be used as part of a landscaping process to assess the feasibility of self-testing and self- sampling tools for diagnosis and management. A report will be generated from the questionnaire responses and will be accessible following the closing of the questionnaire.
 
The closing date of the survey is October 30, 2019. We encourage you to share the questionnaire with others in your field.
 
Questionnaire Link: http://www.poll-maker.com/QM66YOG
Thank you very much for your participation in the following questionnaire:
 
This information will be used as part of a landscaping process to assess the feasibility of self-testing and self- sampling tools for diagnosis and management. A report will be generated from the questionnaire responses and will be accessible following the closing of the questionnaire.
 
The closing date of the survey is October 30, 2019. We encourage you to share the questionnaire with others in your field.
 
Questionnaire Link: http://www.poll-maker.com/QM66YOG
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