Rituals of care: Strategies adopted by HIV testers to avoid misdiagnosis in rapid HIV testing in Zimbabwe

摘要

A growing number of studies highlight high levels of misdiagnosis in thescale-up of HIV rapid testing programmes, which often remain invisible toindividual testers. Drawing on interviews with HIV testers andobservations in four health facilities in Zimbabwe, we show that testersnavigated the translation of the standardised, dis-embodied norms oflaboratory-based testing into the body work of point-of-care testingthrough ritualisation of laboratory-practices in their daily clinical work.Yet, this was interrupted through the challenging work conditions thetesters face. They ritualised careful procedures, forcing themselves tofocus even if queues were long, and making quality assuranceprocedures part of their daily routine. They actively tried to reduce theirworkloads and double-checked and discussed unexpected results,especially when a test result did not match their evaluation of clients’circumstances or clinical status. This helped not only to increaseconfidence in the authenticity of their diagnosis, but also to shareresponsibility for potential errors. Existing approaches to tackle theproblem of misdiagnosis through quality assurance (QA) proceduresmainly focus on adjusting individual testers’ performance and ensuringthat basic testing resources were present, thus falling short of creatinga work environment that is conducive to high quality testing.