疟疾快速诊断试纸条在消除疟疾阶段应用的可行性研究——基于江苏省的一项定性研究

目的:发现和总结消除疟疾阶段基层医疗卫生机构应用疟疾快速诊断试纸条(Rapid Diagnostic Test, RDT)的经验与问题,探讨在基层推广使用RDT的可行性,为改进疟疾诊断工作体系、适应疟疾消除阶段工作要求提供实证依据和政策建议。方法:在江苏省选取4个设区市作为研究现场调查点,在市、县、乡镇三个层面邀请医疗机构临床医师、检验人员、疾控机构疟疾防治人员及疟疾曾患病例共计36名研究对象,开展面对面半结构式关键知情人访谈和焦点小组访谈。结果:试点阶段江苏省基层疟疾防治人员对于RDT持谨慎欢迎态度,缺乏配套培训体系和RDT定位的不明晰是导致上述人员在实际工作中遭遇困惑和挑战的主要原因。临床医师对于疟疾诊治工作的态度和对于疟疾诊断技术的认知主要取决于其实际接诊疟疾病例经验和所在地区出国务工人员数量,不同地区间差异较大。结论:在基层医疗机构有开展RDT的需求和可能性,但需进一步加强对疟疾防治人员的培训和对临床医生的相关知识宣传。

Feasibility study on Rapid Diagnostic Test application and practice of malaria in the eradication phase: A qualitative research conducted in Jiangsu province

Objective:To discover and summarize the problems and useful practices in the current primary-level application of Rapid Diagnostic Test (RDT) of malariain the eradicationphase,and explore the feasibility of overall introduction of RDT in primary-level medical institutions.There in after, empirical evidence and policy suggestions are provided for the improvement of primary-level malaria diagnosis systemto better meet the working requirements in the malaria eradication phase. Methods:We selected four districts as theresearch sites from which 36 respondents were invited from city, county and township level.All of the respondents invited to receive face-to-face semi-structural key informants'' interviews included hospital physicians, hospital lab professionals, CDC malaria prevention and control professionals, and previous malaria patients. The interviewing system was focused on group interviews.Results:In the current stage, the primary-level malaria control professionals cautiously welcomed the RDT technology application. The lack of complete and specific training system and unclear RDT technological orientation were the two main reasons for the confusions and challenges faced by the above-mentioned professionals in the practical work at the primary-level. The primary-level hospital physicians'' attitude towards malaria diagnosis and treatment, and their awareness of related technologies highly depended on their actual experience of receiving malaria cases and the number of residents coming back from their foreign working places (especially Sub-Saharan Africa) within their hospitals'' service areas as well, which also differs across different regions. Conclusions:From the actual need of healthcare professionals and malaria patients, it is necessary and feasible to introduce RDT in primary-level medical institutions, but on the condition that further strengthening of the training on malaria prevention and control, and essential education on the existing knowledge are provided.