How task-shifting of laboratory testing can improve the diagnosis process

Published May 14th, 2019

Given the limited number of trained healthcare workers in many low- and middle-income countries and the intense demands on their time, it is critical to find ways to task-shift responsibilities where possible. Task-shifting, defined as a process of delegation whereby specific tasks are moved, where appropriate, to health workers with shorter training and fewer qualifications, has helped with the rapid scale-up of HIV treatment programs and may be useful for scaling up diagnostics programs as well. Task-shifting could also theoretically include delegation to community workers. The advent of new and simpler diagnostic tests such as point-of-care (POC) testing for HIV, tuberculosis (TB), and other diseases has made it possible for staff without a laboratory background to operate tests, but it is crucial to ensure that POC tests are just as accurate as when operated by laboratory staff.

CHAI’s Laboratory Services Team (LST) and Applied Analytics Team (AAT) supported a systematic review together with the World Health Organization (WHO) to synthesize information from settings where laboratory task-shifting has been implemented. Forty-two relevant studies were identified. Measures of diagnostic accuracy and errors were compared when non-laboratory staff ran the tests compared to laboratory staff, and the acceptability of testing was assessed. This review found that the results of POC testing by non-laboratory staff was comparable to testing on the same devices by laboratory staff. As stated in the conclusion of the study, “The benefits of task shifting of testing may outweigh any possible harms as task shifting allows for increased decentralization, access of specific diagnostics, and faster result delivery.”

This study resulted in a WHO best practice statement regarding task-shifting. Read more about the study here.