Evaluating the Implementation of Automated Malaria Rapid Diagnostic Test Readers in Health Facilities in the Democratic Republic of Congo: Process, Challenges, and Lessons Learned

The WHO's Global Technical Strategy for malaria emphasizes the importance of reliable malaria surveillance systems to track disease burden and measure progress. A key indicator, the test positivity rate (TPR), largely depends on healthcare providers' adherence to rapid diagnostic test (RDT) results and their accurate reporting. To minimize healthcare providers' bias, this study explored the feasibility of using artificial intelligence (AI)-driven Deki Reader devices in the Democratic Republic of Congo. The devices were deployed in 144 health facilities across Haut Katanga, Kasai Central, and Sud Kivu provinces from January to December 2022. Healthcare providers performed malaria diagnostic tests using RDTs and reported the results through the routine system. In addition, they used the Deki Reader device, which automatically read, recorded, and transmitted the AI interpretation into a cloud database. The study compared TPRs from both sources to identify discrepancies. The study revealed the feasibility of using these devices but also identified several logistic and technical challenges. These included delays in device procurement due to COVID-19 pandemic and customs issues, emphasizing the need for better planning and coordination in future rollouts. Device malfunctions and the reliance on stable internet connectivity highlighted the importance of robust support systems and contingency plans. This study demonstrated both the benefits and challenges of implementing such digital health technologies in primary health facilities. Key considerations for successful deployment include careful planning, adequate training and supervision, and taking into account local infrastructure, especially internet connectivity.