Evaluation of point-of-care PCR deployment in community clinics during an Ebola outbreak in West Africa

Thesis Abstract

The deployment of point-of-care polymerase chain reaction (POC-PCR) in community clinics during the West Africa Ebola outbreak presents a critical intervention to curb transmission, reduce time-to-diagnosis, and preserve health system capacity in resource-limited settings. This study aims to evaluate the operational effectiveness, diagnostic accuracy, and socio-technical impact of POC-PCR adoption in frontline clinics under outbreak conditions. Specific objectives are to (i) determine diagnostic sensitivity and specificity of POC-PCR compared with centralized laboratory testing, (ii) assess turnaround times from presentation to result, treatment initiation, and patient disposition, (iii) examine healthcare worker adherence to testing protocols and their perceived ease of use, (iv) identify organizational and community-level determinants of implementation success, and (v) elucidate ethical, logistical, and equity implications of rapid diagnostics during an epidemic. A mixed-methods research design was employed. The quantitative strand recruited 12 community clinics across three affected districts, enrolling 1,200 symptomatic individuals who underwent simultaneous POC-PCR and conventional RT-PCR testing over a 6-month period. Diagnostic performance metrics (sensitivity, specificity, positive and negative predictive values) were calculated using RT-PCR as the reference standard, with 95% confidence intervals estimated via exact binomial methods. Turnaround times were analyzed using survival analysis techniques to account for censored observations. The qualitative strand involved semi-structured interviews with 36 clinicians, 12 laboratory technicians, and 8 health administrators, and 4 focus group discussions with community health volunteers, analyzed through thematic analysis guided by the Technology Acceptance Model (TAM) and the Diffusion of Innovations theory. Validity and reliability procedures included triangulation across data sources, member checking, and calculation of Cohen’s kappa for inter-rater reliability in coding. Ethical considerations encompassed informed consent, data confidentiality, and equitable access to testing, with approvals obtained from national ethics committees and local health authorities. Expected findings indicate that POC-PCR will demonstrate high diagnostic performance (pooled sensitivity ? 92% and specificity ? 97%), with a statistically significant reduction in median turnaround time from 24–48 hours to 2–4 hours, enabling earlier isolation and treatment initiation. The study anticipates that adherence to testing protocols will be robust when training is complemented by ongoing supervisory feedback, though challenges such as supply chain disruptions and device maintenance may limit sustained performance. Qualitative insights are expected to reveal that perceived usefulness, perceived ease of use, and perceived compatibility with clinic workflows influence adoption, while community trust and clear communication strategies determine participation and acceptance. The integration of quantitative and qualitative results will illuminate how organizational capabilities, infrastructure readiness, and workforce competency jointly shape the success of POC-PCR deployment in outbreak settings. The study contributes to knowledge by providing empirical evidence on the operational feasibility and effectiveness of POC-PCR in real-world epidemic conditions, offering a framework for rapid diagnostics integration in primary care settings within low-resource environments. It advances theory by applying TAM and Diffusion of Innovations to epidemic diagnostics, revealing how outbreak urgency interacts with user acceptance and systemic constraints. Policy implications include recommendations for scale-up strategies, procurement and maintenance planning, training curricula, data governance, and community engagement protocols to optimize diagnostic impact while mitigating ethical and equity concerns. Overall, the study concludes that strategically implemented POC-PCR in community clinics can substantially improve timely case identification and outbreak control, provided that robust training, supply chain resilience, device maintenance, and community engagement mechanisms are in place. It recommends standardized training, regular performance audits, multi-stakeholder coordination, and investment in durablePOC-PCR infrastructure to ensure sustained benefits beyond the immediate outbreak period.