Point-of-Care Testing for Infectious Diseases: Diversity, Complexity, and Barriers in Low- And Middle-Income Countries

Enthusiasm and hope are increasing around point-of-care (POC) diagnostics for diseases of global health importance. The mere availability of rapid or simple tests does not automatically ensure their adoption or scale-up. A range of barriers prevent the successful use of POC testing—economic, regulatory, and policy-related, as well as user/provider perceptions and cultural barriers. Technology as such does not define a POC test. Rather, it is the successful use at the POC that defines a diagnostic process as POC testing. Thus, the focus must be on POC testing programs, rather than POC technologies. We discuss a framework that envisions POC testing as a spectrum of technologies (simplest to more sophisticated), users (lay persons to highly trained), and settings (homes, communities, clinics, peripheral laboratories, and hospitals). A deeper appreciation of this diversity in target product profiles, and likely barriers in each setting, might help test developers and public health managers to identify the most impactful product and delivery model.