|Research Area:||Global Health|
|Scientific Themes:||Tropical Medicine & Global Health|
|Keywords:||antimicrobial resistance, community and ethics|
Rachel Greer is a UK trained GP currently working in Chiangrai, Thailand with
Mahidol-Oxford Tropical Medicine Research Unit.
Interests include community medicine, targeting antibiotics and using research to help vulnerable people groups.
Current studies include:
- The impact of C-reactive protein testing on antibiotic prescription in febrile patients attending primary care in low-resource settings
- REACH (Resilience, Empowerment & Advocacy in Women’s and Children’s Health Research)
- The risk factors and outcomes of community-acquired Acinetobacter bacteraemia in Thailand
|Professor Yoel Lubell||Tropical Medicine||Oxford University, Bangkok||Thailand|
|Professor Phaik Yeong Cheah||Tropical Medicine||Oxford University, Bangkok||Thailand|
|Dr Direk Limmathurotsakul||Tropical Medicine||Oxford University, Bangkok||Thailand|
|Associate Professor Maureen Kelley||Ethox Centre in the Nuffield Department of Population Health||University of Oxford||United Kingdom|
New and affordable point-of-care testing (POCT) solutions are hoped to guide antibiotic prescription and to help limit antimicrobial resistance (AMR)-especially in low- and middle-income countries where resource constraints often prevent extensive diagnostic testing. Anthropological and sociological research has illuminated the role and impact of rapid point-of-care malaria testing. This paper expands our knowledge about the social implications of non-malarial POCT, using the case study of a C-reactive-protein point-of-care testing (CRP POCT) clinical trial with febrile patients at primary-care-level health centres in Chiang Rai province, northern Thailand. We investigate the social role of CRP POCT through its interactions with (a) the healthcare workers who use it, (b) the patients whose routine care is affected by the test, and (c) the existing patient-health system linkages that might resonate or interfere with CRP POCT. We conduct a thematic analysis of data from 58 purposively sampled pre- and post-intervention patients and healthcare workers in August 2016 and May 2017. We find widespread positive attitudes towards the test among patients and healthcare workers. Patients' views are influenced by an understanding of CRP POCT as a comprehensive blood test that provides specific diagnosis and that corresponds to notions of good care. Healthcare workers use the test to support their negotiations with patients but also to legitimise ethical decisions in an increasingly restrictive antibiotic policy environment. We hypothesise that CRP POCT could entail greater patient adherence to recommended antibiotic treatment, but it could also encourage riskier health behaviour and entail potentially adverse equity implications for patients across generations and socioeconomic strata. Our empirical findings inform the clinical literature on increasingly propagated point-of-care biomarker tests to guide antibiotic prescriptions, and we contribute to the anthropological and sociological literature through a novel conceptualisation of the patient-health system interface as an activity space into which biomarker testing is introduced.