부산대학교 도서관

Point-of-care tests (POCTs) have become technological solutions for many global health challenges. This meta-ethnography examines what in-depth qualitative research reveals about the "social lives" of POCTs from, highlighting key social considerations for policymakers, funders, developers and users in the design, development and deployment of POCTs. We screened qualitative research examining POCTs in low- and middle-income countries (LMICs) and selected 13 papers for synthesis. Findings illuminate five value-based logics-technological autonomy, care, scalability, rapidity and certainty-shaping global health innovation ecosystems and their entanglement with health systems. Our meta-ethnography suggests POCTs never achieve the technological autonomy often anticipated during design and development processes. Instead, they are both embedded in and constitutive of the dynamic relationships that make up health systems in practice. POCTs are often imagined as caring commodities; however, in use, notions of care inscribed in these devices are constantly negotiated and transformed in relation to multiple understandings of care. POCTs promise to standardize care across scale, yet our analysis indicates non-standard processes, diagnoses and treatment pathways as essential to "fluid technologies" rather than dangerous aberrations. The rapidity of POCTs is constructed and negotiated within multiple distinct temporal registers and POCTs operate as temporal objects that can either speed up or slow down experiences of diagnosis and innovation. Finally, while often valued as epistemic tools that can dispel diagnostic uncertainty, these papers demonstrate that POCTs contribute to new forms of uncertainty. Together, these papers point to knowledge practices as multiple, and POCTs as contributing to, rather than reducing, multiplicity. The values embedded in POCTs are fluid and contested, with important implications for the kind of care these tools can deliver. These findings can contribute to more reflexive approaches to global health innovation, which take into account limitations of established global health logics, and recognise the socio-technical complexity of health systems.
(© The Author(s) 2024. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine.)