Barriers and Facilitators to Community Acceptability of Integrating Point-of-Care Testing to Screen for Sickle Cell Disease in Children in Primary Healthcare Settings in Rural Northern Ghana

Introduction: Sickle cell disease (SCD) remains a public health problem especially in sub-Saharan Africa including Ghana. While pilot initiatives in Africa have demonstrated that neonatal screening coupled with early intervention reduces SCD-related morbidity and mortality, only 50-70% of screen-positive babies have been successfully retrieved to benefit from these interventions. Further, systematic newborn screening for SCD as public health programs is lacking. To address this problem, innovation is needed to bridge the diagnostic gap and develop sustainable care programs through universal health coverage. Point-of-care testing (POCT) with high specificity and sensitivity for SCD screening can be more easily integrated into existing immunization programs in Africa and are more likely to improve retrieval rates. This study explored community perceptions and acceptability of integrating POCT to screen for SCD in newborns and children under 5 years of age in primary healthcare facilities in rural Kassena-Nankana Districts of Northern Ghana.

Method: This was an exploratory study using qualitative research approach where 10 focus group discussions and 20 in-depth interviews were conducted with community members and health workers between April and June 2022 covering major thematic areas such as community awareness and perceptions of SCD, their views on integrating POCT to screen for SCD, and barriers and facilitators of community acceptability and uptake of SCD screening in children under 5 years of age in primary care settings. The theoretical framework on acceptability of healthcare interventions validated by Sekhon et al. was adopted and used in this study. The interviews were recorded with participants' consent and transcribed verbatim after repeatedly listening to the recordings. Data was coded into themes using Nvivo 12 software before thematic analysis. The study was approved by the Institutional Review Board of the Navrongo Health Research Centre.

Results: Most participants (70.9 %) described SCD as serious and potentially life-threatening condition affecting children. Of 148 community members and health workers, 141 (95.2%) expressed positive views about the screening exercise, which could facilitate diagnosis of SCD in children for early management. However, discrimination, fear of being tested positive, stigmatization, negative health worker attitude linked with issues of maintaining confidentiality were reported by majority of participants as key factors that could negatively impact uptake of the screening exercise. Most participants suggested that health education (74.3 %), short duration of screening processes (74.3%), positive attitude of health workers (69.5%), and screening health workers not being biased (58.8%) as factors that could promote community acceptability.

Conclusion: A large majority (over 95%) of participants viewed screening of SCD in children as very important. However, views expressed by most participants suggest that health education, short duration of the screening process, and professionalism of health workers in keeping patients’ information confidential could improve community acceptability. These findings have informed the implementation design for using POCT to screen for SCD in children under 5 years of age in primary care settings in rural Northern Ghana.