User perspectives, challenges and opportunities in the implementation of protein-to-creatinine dipstick test for proteinuria detection in Ghana: A mixed methods study

Objective To assess the appropriateness, acceptability and feasibility of implementing the Test-it PrCr Urinalysis Dipstick Test (LifeAssay Diagnostics, South Africa) in referral hospitals in Ghana. Participants 96 healthcare professionals were trained on the protein-to-creatinine (PrCr) test, which was integrated into protocols alongside standard-of-care tests between November 2021 and April 2022. Test users completed questionnaires post training. Three focus group discussions (FGDs) and seven key informant interviews were conducted to evaluate test procedure comprehension, insights into training effectiveness, usability/user confidence, perceptions, attitudes towards the test and barriers and facilitators of use. Results High product usability, user confidence and satisfaction were reported. Staff perceived the test as easy to use and similar to current products. Misinterpretations of test results were less likely for strong results. Facilitators of use included effective trainings, sensitisation of the product and key stakeholder endorsement. Challenges impacting implementation feasibility included the short shelf life of test strips (3 months) after opening cannisters, the added complexity of the ratiometric result interpretation and the test's lack of other parameters that are included in current products (eg, glucose, nitrate), limiting its broader clinical utility for antenatal care screening. All FGD participants agreed that the use of the PrCr test would not change current practices/protocols for dipstick use. Conclusion Although the Test-It PrCr test is easy to use and well accepted, key product attributes limit its implementation feasibility in this setting. It may be more appropriate for monitoring high-risk women in this context.