Enhancing national cholera surveillance using rapid diagnostic tests (RDTs): A mixed methods evaluation

Area of Science:

• * Public Health
• * Infectious Disease Surveillance
• * Diagnostic Test Implementation

Background:

• * Cholera rapid diagnostic tests (RDTs) offer a cost-effective method to enhance understanding of cholera burden and guide prevention efforts.
• * The RDT Implementation Strategy and Evaluation (RISE) project piloted Gavi's Diagnostic Procurement Platform to supply cholera RDTs for national surveillance.
• * Implementation was evaluated in Nepal's Early Warning and Reporting System (EWARS) following RDT distribution in 2023.

Purpose of the Study:

• * To evaluate the implementation of cholera RDTs within Nepal's national surveillance system.
• * To identify facilitators and barriers to the effective use of RDTs in cholera surveillance.
• * To assess the impact of RDTs on reporting of acute gastroenteritis and cholera cases.

Main Methods:

• * Mixed-methods approach combining quantitative data from EWARS reports and REDCap surveys.
• * Qualitative data collection through semi-structured interviews with key personnel involved in cholera surveillance and response in Kathmandu.
• * Analysis of quantitative data on RDT utilization and reporting rates; thematic analysis of qualitative interview data.

Main Results:

• * Qualitative data revealed positive perceptions of RDTs regarding speed, ease of use, and suitability for resource-limited settings.
• * Key challenges identified include lack of awareness, insufficient training, and concerns about RDT quality, availability, and cost.
• * Quantitative findings indicated underreporting of acute gastroenteritis and cholera in EWARS, with only 2.6% of reported cases screened by RDT, alongside significant underutilization of RDTs.

Conclusions:

• * Cholera RDTs hold potential for improving surveillance but face significant implementation challenges related to lab capacity, reporting systems, and training.
• * Gaps in surveillance reporting were exacerbated by the complexity of integrating RDTs without adequate guidance and misconceptions about RDT validity.
• * Addressing these challenges at local and national levels is crucial for the successful scale-up of cholera RDTs in Nepal and other regions.