Implementation science evaluation of malaria rapid diagnostic test rollout in Uganda: fidelity, adaptation and health-system readiness

Malaria rapid diagnostic tests (mRDTs) have been deployed across Uganda's health system as a cornerstone of test-and-treat policy, yet their programmatic value depends less on the accuracy of the devices than on how faithfully and adaptively they are used within routine clinical and community workflows. Drawing on the DHS Program indicator 'Current users most recent supply or information from a government health center' (FP_SRCM_W_GHC) across 36 African countries and 150 country-survey observations from 1990 to 2025, the analysis situates Uganda's mRDT implementation within the wider pattern of public-sector health-service contact that conditions diagnostic uptake. The sample mean of the indicator was 25.261 (SD 18.895), with country values ranging from 1.50 in Morocco to 51.89 in Zambia. The framework specifies how fidelity dimensions (adherence to test-and-treat algorithms, documentation, and referral), adaptation types (task-shifting, community delivery, and supply-chain modification), and readiness domains (commodity security, workforce competency, supervision, and data systems) interact to produce or erode diagnostic effectiveness. Implementation fidelity should be treated as a system property rather than a provider attribute, and that adaptation without fidelity monitoring risks converting a high-specificity diagnostic into a low-value ritual. The contribution is a testable, discipline-grounded evaluation architecture for mRDT rollout that can be operationalised with routine health-management information and periodic facility surveys.