Antimicrobial resistance diagnostic use accelerator – Behavioural determinants of point-of-care diagnostic uptake, and adherence to prescription

Background: Targeting both diagnostic capacity and behaviours has the potential for decreasing unnecessary antibiotic prescriptions in acute febrile patients, thereby improving patient health outcomes, supporting actions against AntiMicrobial Resistance (AMR) and contributing to Universal Health Coverage (UHC). Methods and materials: The clinical study of the ‘AMR Diagnostic Use Accelerator’ based at 9 sites in 6 LMICs comprises a qualitative behavioural component to answer the question: “What are the behavioural determinants of the uptake of diagnostic algorithms, PoC tests and associated prescribing practices, by healthcare workers and adherence to antibiotic prescriptions by patients presenting with acute fever and respiratory tract infections at outpatient clinics in LMICs.” A baseline qualitative study is being conducted to understand the contextual factors and behavioural determinants towards adherence to prescriptions. The findings will form part of the clinical intervention arm consisting of diagnostic algorithms, PoC tests, prescribing decision trees, clinic process flow, training and communication on adherence to prescription. This is compared with a control of current practice. Results: Data collection includes adherence to prescription by study participants, future intentions regarding antibiotics in clinic visits, and the effects of communication intervention on patients. The information we are gathering will inform a training and communication package which will be rolled out during the clinical intervention. Conclusion: Further research will investigate the long-term effects of behavioural determinants for healthcare workers who will use the clinical algorithms, new PoC rapid diagnostic tests and associated prescribing practices. Using the COM-B (Capacity, Opportunity and Motivation) and TDF (Theoretical Domains Framework) models, findings on behavioural determinants will be used to develop recommendations for behaviour change interventions to address the key areas of uptake of PoC diagnostic tests, algorithms, associated prescribing practices, and adherence to prescriptions by patients.