Sebastian Fuller: Implications of new technologies in healthcare

I'm Sebastian Fuller and I am a senior researcher at the Health Systems Collaborative.

I'm a social scientist, I have a background in community-based behavioural health research, and now I work on understanding the implications of new technologies in healthcare as part of my health systems research.

I have a history of working with industry and other collaborators in clinical services as well as community services, so all different kinds of stakeholders, specifically around the development and implementation and evaluation of new diagnostics for sexually transmitted infections or STIs. I do a number of different projects that are looking specifically at that. Two of the projects that I'm working with involve my collaboration with the World Health Organization. I've worked with them to develop a protocol for the implementation of new diagnostics into sexual health services around the world. One is in Malta, I'm working with the Ministry for Health there, and they are looking at expanding their reproductive and sexual health services, especially looking at the provision of diagnostics, including point-of-care diagnostics in general practice, surgeries, in order to serve their growing migrant population. I'm working with the Ministry there and also with clinics and other healthcare providers and some NGOs to understand how we can best implement that programme of expansion, as well as looking at how it can be evaluated, to understand if it should be further expanded beyond the two or three centres that we're starting with.

The other project that I'm working with is with a DPhil student in Zambia, and she is looking at the expansion of sexual and reproductive healthcare services across Zambia, and whether or not diagnostics for STIs might play a key role in that expansion of services to really widen the provision across the nation or with key special interest groups.

Some of the questions that we have to answer are, one is about the clinical impact of point-of-care tests for STIs, and that's really looking at the implications of using these rapid tests and expanding diagnostics more generally. A key consideration there is antimicrobial resistance, especially around gonorrhoea infections. Then the second aspect of my work, that's a really big question in the field, is around the implementation of these tests and how to be able to do that sustainably and at scale and trying to really square the circle around being able to create a programme of implementation that works across different contexts, but is still localizable enough to make sense within each of these local contexts.

The work that I do makes a difference to patients because it is looking at expanding services.  Right now, a lot of the sexual health services and STIs testing that happens is done not with diagnostics. What they do is what's called syndromic treatment, and syndromic treatment means that we look for the clinical signs and symptoms of an infection. Many STIs are not actually symptomatic, so about half of them are people that are infected, don't have any symptoms, and then those that do have symptoms often these STIs have similar symptoms. It can be very difficult to know what to treat them with, because each of these infections needs to be treated differently. It's about providing the right treatment for the right infection at the right time for patients.

There's a lot of reasons why we need to expand these services. I think, especially with the growing threat of antibiotic resistance, it's important that we really understand what role diagnostics can play in the fight against antimicrobial resistance, for example gonorrhoea infections, in the field of sexually transmitted infections. There's a lot that we need to know too about the implementation of new technologies in healthcare and specifically around diagnostics that aren't known, and so ideas such as how to be able to implement things in which context, what that means within the local context, how to bring about change is really understudied and also under-reported. So that's a really big question mark that we have in our field, and I think it deserves more focus and attention.

This interview was recorded in July 2024.