2 Module 16 Objectives By the end of this module, learners will: Explain why the malaria control program has elected to use RDTs in the country/districtDescribe a rapid diagnostic test (RDT)Name appropriate actions for RDT positive, negative and invalid resultsDescribe the steps in performing a malaria RDT
3 In Addition, Learners Will … Demonstrate the correct and appropriate skills for drawing blood safely and effectively with a finger prickState the universal precautionsCorrectly interpret different RDT outcomesDemonstrate the skills for performing RDT safely and effectively, using the job aid as a guideState appropriate treatment based on RDT results
4 Why Use RDTs?Most of the febrile illnesses share common signs and symptoms:FeverHeadacheWeaknessPositive RDT results help to confirm malaria and thereby differentiate it from other febrile illnessGiving anti-malarial drugs/artemisinin-based combination therapy (ACT) presumptively is expensive and might lead to drug resistance
5 Many Different RDT Products The World Health Organization and its partners have tested over 400 different types and brands of RDTRDTs are chosen by each country’s National Malaria Control Program (NMCP) based on factors like …Malaria prevalenceStable endemic, year-roundUnstable, epidemic, seasonalMalaria typePlasmodium falciparumPlasmodium vivax
6 Key Similarities among RDTs Most all RDTs have:A lancet to draw bloodA tube, pipette or straw to transfer bloodA cassette to deposit blood and display resultsA buffer solution to add to the blood
7 Overall Steps for CHWs/CDDs When training community health workers (CHWs)/community-directed distributors (CDDs), explain each step and provide an opportunity for them to:Determine if signs and symptoms suggest malariaDo RDTInterpret the testTake appropriate action(If RDT result is positive) treat appropriately, according to national standards(If RDT result is negative) seek further information, and either:Treat for other conditions like pneumonia or diarrheaRefer to the nearest health center, if severe(If RDT result is invalid) repeat test with a new cassette from a different batch
8 Prepare for Demonstration and Return Demonstration for CHWs/CDDs Assemble all needed materialsEnsure that the RDTs used for the demonstration match those approved by your NMCPMake sure supportive materials like gloves, sharps box, etc. are available
11 Check Product Expiry Date Show CDDs where to look for expiry (expiration) dateExplain that expired RDTs will not give correct resultPass around packets for CHWs to examine and find datesDiscuss importance of planning ahead so RDT stocks do not expire or expired ones are replaced quickly
12 Wear Gloves Why is it important to wear gloves when doing the test? To protect:CHWs from possible infection with blood-borne diseases, including HIV/AIDSPatients from possible infection with blood-borne diseases, including HIV/AIDS
13 Open the Test Packet and Remove the Contents As you remove each item, hold it up so that everyone can see itExplain how it is used
14 Review Blood Transfer Devices Once the packet is opened, the desiccant sachet serves no purpose and should be discardedIt may be harmful if swallowed, so it should be kept away from children
15 Examine the Test Cassette The square hole, labeled “A,” is where you add the bloodThe round hole, labeled “B,” is where you add the bufferThe rectangular hole is the results window where you read the test resultsThe results window is divided into two sections
16 How to Determine the Diagnosis The longer section near the letter “T” is where you determine the diagnosisIf a line appears in this section, it means the patient has malariaIf no line appears here, it means malaria was not detected in the patientRemember that the lines may be different for different brands/types of RDT—so be sure to explain what is currently approved by the NMCP
17 Look for Lines to Appear The smaller section near the letter “C” tells you whether the test is working correctlyA line must appear in this section for the test to be validIf no line appears here, the test is not working properly and the results are invalidIf no line appears here, you must discard the cassette and test the patient again using a new test packet that has not been previously opened
18 Label the Test Cassette for Proper Identification Every patient’s test cassette must be clearly labeled for proper identification
19 Clean to Prevent Infection Clean the chosen finger with an alcohol swabThis will help to prevent infection of the finger that could be caused by dirt
20 How to Draw BloodPrick the patient’s finger, preferably toward the side of the pulp (ball) of the fingerPricking the midline or tip is more painfulCheck to be sure the finger prick will produce enough bloodThen discard the lancet in the sharps container
21 Never set the lancet down before discarding it Follow Universal Precautions to Ensure Blood Safety When Using a LancetRemind learners that every time they use a lancet, they must take all of the following steps to ensure blood safety:Discard the lancet in an appropriate sharps container immediately after using itNever set the lancet down before discarding itNever discard the lancet in a non-sharps containerNever use a lancet on more than one person
22 Dispose of Used Materials Safely Ensure that used sharp objects like lancets and capillary tubes/test tubes are properly discarded immediately after useEven though it is called “sharps container,” we should dispose of all medical waste in it
23 How to Collect the Patient’s Blood On the next two slides, we show four blood collection devicesYou may show these devices to the CHWs, but give special attention to the device in the current RDT packet or kit
24 Examples of Blood-Collection Devices for RDT: Capillary Tube, Straw
25 Examples of Two More Blood-Collection Devices for RDT: Loop, Pipette
26 Deposit Blood from Collection Device on Cassette and Then Dispose of Blood-Collection Device Safely
27 Dispense the Buffer Reagent Appropriately Dispense the appropriate number of drops of the buffer reagent to the appropriate hole (round hole) of the cassetteRead out from packet insert the number of drops recommended for the type of RDT being used
28 Time the Test ProperlyMake sure the test stands for 15 minutes after adding the buffer, before reading the resultBe sure to read the RDT packet insert because some types call for longer times
29 Dispose of Used Materials Safely Take care to remove and discard your gloves safelyPlan a system for safe disposal of all RDT waste materialsDecide whether CHWs will dispose of items in the village or bring these items to the health center for disposal
30 How to Interpret the RDT Results Square hole(for blood)The square hole labeled “A” is where you add the bloodThe round hole labeled “B” is where you add the bufferThe rectangular hole is the results window where you read the test resultsThe smaller section near the letter “C” tells you whether the test is working correctly (it is also known as the control)Round hole(for buffer)Test window“C” control line“T2” test line“T1” test line
31 How to Interpret Results of RDTs Designed for More than One Type of Malaria Lines in “T1” and “T2” and a line in “C” means:The patient DOES have falciparum malaria monoinfection or a mixed infectionNO LINE in “T1” or “T2” but a line in ‘C’ means:CT1T2NegativeT1T2CPf or Mixed +In the graphic above, Pf = P. falciparum.The patient DOES NOT have either falciparum malaria or non-falciparum malaria
32 How to Interpret the RDT Results (continued) Line in “T1” or “T2” and NO LINE in “C” means:No line in “T1” or “T2” and NO LINE in “C” means:T2T1T2InvalidT1InvalidThe test is damaged.Results are INVALID.The test is damaged.Results are INVALID.
33 Review Different Possible Results A line in “T2” and a line in “C” means:T2T1Non-Pf +In the graphic above, Non-Pf = non-falciparum.The patient DOES have non-falciparummalaria (P. vivax, P. ovale, P. malariaeor a mixed infection of these).
34 Review Different Possible Results (continued) A line in “T1” and a line in “C”means:The test is POSITIVE even if the line in “T1” is very faint.T1T2T2T1Pf +The patient DOES have falciparum malaria.Pf +
35 RDT Interpretation Chart Control lineTest linesP. falciparum linePan-specific lineP. falciparum/pan-specific RDTe.g., detects P. falciparum-specific and other species (P. vivax, P. malariae, P. ovale)NEGATIVE/POSITIVE (P. falciparum only)POSITIVE (P. falciparum and other species)POSITIVE non-P. falciparum (i.e., other species)INVALID
37 Interpretations for Test Results 1‒10 P. falciparumNegativeInvalid (no control)Non-falciparum (P. vivax, P. ovale, P. malariae, or a mixed infection of these)Non-falciparum (P. vivax, P. ovale, P. malariae, or a mixed infection of these)NegativeP. falciparumP. falciparum or a mixed infection
38 How to Record Results 1‒10 on a Chart Positive ( + )Negative (-)InvalidPfPf or MixedNon-Pf1↔2345678910In the chart above, Pf = P. falciparum.
39 Demonstrate the RDT for Learners The facilitator will demonstrate the steps in performing an RDT for all to seeHe/she will ask questions of the learners as he/she performs the demonstration
40 Review and Questions Which RDT is currently used in your country? What are the main components of the test?How do we distinguish between a positive and negative test?How do we know if a result is invalid or unclear?What should we do with such results?How do we know what treatment is appropriate after conducting the RDT?
41 Learners Practice Performing an RDT Learners will form small groupsEach learner will have a chance to practice the RDTGroup members will give feedback after each person attempts the testMake copies of the checklist that follows for learners to observe each other
42 RDT Performance Checklist—Procedure 1 Task1. RDT preparation (four tasks)Assemble all materials required for the RDT testRead expiration dateUse test with earliest expiration dateAllow RDT to come to room temperature (if kept in cool storage)
43 RDT Performance Checklist—Procedure 2 Task2. Patient preparation (four tasks)Wash handsIdentify patient’s details and record patient’s name on the RDT cassetteExplain procedure to patient. Provide reassurance, as neededWear gloves
44 RDT Performance Checklist—Procedure 3 Task3. Blood collection + dispensing (five tasks)Select site for blood collection. Clean site with alcohol swab and allow it to dryPrick site firmly with sterile lancetDO NOT squeeze finger excessivelyCollect an adequate volume of bloodDispense blood in correct well
45 RDT Performance Checklist—Procedure 4 Task4. RDT procedure + reading results (four tasks)Dispense correct volume of bufferWait for correct time (according to manufacturer’s instructions)Verify internal test controlRead results correctly
46 RDT Checklist—Procedures 5, 6, 7 Task5. Recording results (two tasks)Record results correctly (including mixed infections if a combo test is used)Record date and time of reporting results6. Disposal of infectious material (two tasks)Dispose of used tests, and transfer devices and other contaminated material to plastic-lined binDispose of used lancet in a sharps container7. Deliver the results (one task)Explain to the patient the results and what they mean
47 RDT Performance Checklist After the small group practice sessions, bring the whole group back togetherAsk learners to talk about their experienceUsing the checklist findings, ask learners what steps were easy or difficult—and why
48 Summary: RDT ResultsIf RDT result is positive, treat according to national guidelinesIf RDT result is negative, seek further information and either:Treat for other conditions like pneumonia or diarrhea as seen in our modules, orRefer to the nearest health center, if severe (i.e., lethargic or unconscious)If RDT result is invalid, repeat test with a new cassette from a different batch
49 Summary: Safety and Precautions Employ universal precautions to ensure safety when handling blood:Always put on gloves before handling bloodAvoid contacting any wound with blood (Wounds must be appropriately covered before conducting the RDT test)Wash hands appropriately with soap before and after conducting the RDT testClean the finger to be pricked with an alcohol swab to prevent infectionNever use a lancet or any blood collection device (loop, capillary tube, straw or pipette) on more than one personDispose of all sharp objects appropriately (use a sharps box)Take care to remove and discard your gloves safely
50 Storing and Using RDTs in the Village In closing the session, ask CHWs/CDDs to discuss and plan the following:How can we store RDTs in a safe and cool place in the village?How can we safely dispose of sharps and medical waste from the RDTs in the village?How can we explain to patients who believe they have malaria, but their RDT is negative?What other concerns do you have?
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