Equivocal diagnostics

Making a ‘good’ point-of-care test for elimination in global health

Datos Bibliográficos

ID11923453
AutoresA Street (0000-0001-7874-0234, University of Edinburgh, Edinburgh, UK, autor de correspondencia), Elizabeth M Taylor (0000-0003-0261-9141, University of Edinburgh), Emma Michelle Taylor (University of Edinburgh, Edinburgh, UK)
Año2024
Volumen54
Número6
Páginas836-858
Fecha de publicación2024-04-23
Peer ReviewedSí
Open AccessSí
TipoARTICLE
RevistaSocial Studies of Science (JOURNAL)
Identificadores de la revistaISSN: 0306-3127 • E-ISSN: 1460-3659
EditorialSAGE Publishing (PUBLISHER • US)
DOI10.1177/03063127241246727
PMID38654559
OpenAlexW4395078318
IdiomaEN
Citas recibidas1
Referencias citadas64

What is a diagnostic test for? We might assume the answer to this question is straightforward. A good test would help identify what disease someone suffers from, assist health providers to determine the correct course of treatment and/or enable public health authorities to know and intervene in health at the level of the population. In this article, we show that what a specific diagnostic test is for, the value it holds for different actors, and what makes it good, or not, is often far from settled. We tell the story of the development and design of a rapid antibody test for onchocerciasis, or river blindness, tracking multiple iterations of the device through three configurational moments in the framing of onchocerciasis disease and reshaping of the global health innovation ecosystem. Efforts to build that ecosystem for diagnostics are often premised on the notion that public health needs for diagnostics are pre-given and stable; the challenge is seen to be how to incentivize investment and find a customer base for diagnostics in under-resourced settings. By contrast, we show that for any disease, diagnostic needs are both multiple and constantly in flux, and are unlikely to be met by a single, stand-alone product. In the case of the onchocerciasis Ov-16 rapid test, the failure to recognize and address the multiplicity and instability of diagnostic needs in the innovation process resulted in the development of a rapid point of care test that might be manufactured, procured and used, but is unloved by public health experts and commercial manufacturers alike. The equivocal value of the onchocerciasis rapid test, we suggest, reveals the inadequacy of the current global health innovation ecosystem for developing diagnostic 'goods

Biology · Epistemology · Pathology · Point (geometry · Point of care · Point-of-care testing · Sociology · Test (biology · Disaster Response and Management · Ethics in Clinical Research · Mathematics · Medicine · Philosophy · Psychology · Viral Infections and Outbreaks Research