CDI Module 16: RDT Training
©Jhpiego Corporation
The Johns Hopkins University
A Training Program on CommunityDirected Intervention (CDI) to Improve
Access to Essential Health Services
Module 16 Objectives
By the end of this module, learners will:
 Explain why the malaria control program has elected
to use RDTs in the country/district
 Describe a rapid diagnostic test (RDT)
 Name appropriate actions for RDT positive, negative
and invalid results
 Describe the steps in performing a malaria RDT
2
In Addition, Learners Will …
 Demonstrate the correct and appropriate skills for
drawing blood safely and effectively with a finger
prick
 State the universal precautions
 Correctly interpret different RDT outcomes
 Demonstrate the skills for performing RDT safely
and effectively, using the job aid as a guide
 State appropriate treatment based on RDT results
3
Why Use RDTs?
 Most of the febrile illnesses share common signs
and symptoms:
 Fever
 Headache
 Weakness
 Positive RDT results help to confirm malaria and
thereby differentiate it from other febrile illness
 Giving anti-malarial drugs/artemisinin-based
combination therapy (ACT) presumptively is
expensive and might lead to drug resistance
4
Many Different RDT Products
 The World Health
Organization and its
partners have tested
over 400 different types
and brands of RDT
 RDTs are chosen by
each country’s National
Malaria Control
Program (NMCP)
based on factors like …
 Malaria prevalence
 Stable endemic, year-
round
 Unstable, epidemic,
seasonal
 Malaria type
 Plasmodium
falciparum
 Plasmodium vivax
5
Key Similarities among RDTs
Most all RDTs have:
 A lancet to draw
blood
 A tube, pipette or
straw to transfer
blood
 A cassette to deposit
blood and display
results
 A buffer solution to
add to the blood
6
Overall Steps for CHWs/CDDs
When training community health workers (CHWs)/
community-directed distributors (CDDs), explain each step
and provide an opportunity for them to:
1. Determine if signs and symptoms suggest malaria
2. Do RDT
3. Interpret the test
4. Take appropriate action
 (If RDT result is positive) treat appropriately, according to
national standards
 (If RDT result is negative) seek further information, and either:
– Treat for other conditions like pneumonia or diarrhea
– Refer to the nearest health center, if severe
 (If RDT result is invalid) repeat test with a new cassette from a
different batch
7
Prepare for Demonstration and Return
Demonstration for CHWs/CDDs
 Assemble all needed
materials
 Ensure that the RDTs
used for the
demonstration match
those approved by
your NMCP
 Make sure supportive
materials like gloves,
sharps box, etc. are
available
8
Gather Materials Needed
9
Gather Additional Materials Needed

Biohazard safety box
10
Check Product Expiry Date
 Show CDDs where to look for
expiry (expiration) date
 Explain that expired RDTs will
not give correct result
 Pass around packets for
CHWs to examine and find
dates
 Discuss importance of
planning ahead so RDT
stocks do not expire or
expired ones are replaced
quickly
11
Wear Gloves
 Why is it important to
wear gloves when
doing the test?
 To protect:
 CHWs from possible
infection with bloodborne diseases,
including HIV/AIDS
 Patients from possible
infection with bloodborne diseases,
including HIV/AIDS
12
Open the Test Packet and Remove the Contents
 As you remove each
item, hold it up so that
everyone can see it
 Explain how it is used
13
Review Blood Transfer Devices
 Once the packet is
opened, the desiccant
sachet serves no
purpose and should
be discarded
 It may be harmful if
swallowed, so it
should be kept away
from children
14
Examine the Test Cassette
 The square hole,
labeled “A,” is where
you add the blood
 The round hole, labeled
“B,” is where you add
the buffer
 The rectangular hole is
the results window
where you read the test
results
 The results window is
divided into two
sections
15
How to Determine the Diagnosis
 The longer section near the letter “T” is where
you determine the diagnosis
 If a line appears in this section, it means the
patient has malaria
 If no line appears here, it means malaria was not
detected in the patient
 Remember that the lines may be different for
different brands/types of RDT—so be sure to
explain what is currently approved by the NMCP
16
Look for Lines to Appear
 The smaller section near the letter “C” tells you
whether the test is working correctly
 A line must appear in this section for the test to
be valid
 If no line appears here, the test is not working
properly and the results are invalid
 If no line appears here, you must discard the
cassette and test the patient again using a new
test packet that has not been previously
opened
17
Label the Test Cassette
for Proper Identification
Every patient’s test
cassette must be clearly
labeled for proper
identification
18
Clean to Prevent Infection
 Clean the chosen
finger with an alcohol
swab
 This will help to
prevent infection of
the finger that could
be caused by dirt
19
How to Draw Blood
 Prick the patient’s
finger, preferably
toward the side of the
pulp (ball) of the finger
 Pricking the midline or
tip is more painful
 Check to be sure the
finger prick will produce
enough blood
 Then discard the lancet
in the sharps container
20
Follow Universal Precautions to
Ensure Blood Safety When Using a Lancet
Remind learners that every time they use a lancet,
they must take all of the following steps to ensure
blood safety:
 Discard the lancet in an appropriate sharps
container immediately after using it
 Never set the lancet down before discarding it
 Never discard the lancet in a non-sharps
container
 Never use a lancet on more than one person
21
Dispose of Used Materials Safely
 Ensure that used
sharp objects like
lancets and capillary
tubes/test tubes are
properly discarded
immediately after use
 Even though it is
called “sharps
container,” we should
dispose of all medical
waste in it
22
How to Collect the Patient’s Blood
 On the next two
slides, we show four
blood collection
devices
 You may show these
devices to the CHWs,
but give special
attention to the device
in the current RDT
packet or kit
23
Examples of Blood-Collection Devices
for RDT: Capillary Tube, Straw
24
Examples of Two More
Blood-Collection Devices for RDT: Loop, Pipette
Loop:
25
Deposit Blood from Collection Device on Cassette and
Then Dispose of Blood-Collection Device Safely
26
Dispense the Buffer Reagent Appropriately
 Dispense the
appropriate number of
drops of the buffer
reagent to the
appropriate hole (round
hole) of the cassette
 Read out from packet
insert the number of
drops recommended for
the type of RDT being
used
27
Time the Test Properly
 Make sure the test
stands for 15 minutes
after adding the
buffer, before reading
the result
 Be sure to read the
RDT packet insert
because some types
call for longer times
28
Dispose of Used Materials Safely
 Take care to remove
and discard your gloves
safely
 Plan a system for safe
disposal of all RDT
waste materials
 Decide whether CHWs
will dispose of items in
the village or bring
these items to the
health center for
disposal
29
How to Interpret the RDT Results
Square hole
(for blood)
Round hole
Test window
(for buffer)
“C” control
line
“T2” test line
 The square hole labeled
“A” is where you add the
blood
 The round hole labeled “B”
is where you add the
buffer
 The rectangular hole is the
results window where you
read the test results
 The smaller section near
the letter “C” tells you
whether the test is working
correctly (it is also known
as the control)
“T1” test line
30
How to Interpret Results of RDTs Designed for
More than One Type of Malaria
Lines in “T1” and “T2”
and a line in “C” means:
C
T1
T2
NO LINE in “T1” or “T2”
but a line in ‘C’ means:
C
T1
T2
Pf or Mixed +
Negative
The patient DOES have
falciparum malaria
monoinfection or a mixed
infection
The patient DOES NOT
have either falciparum
malaria or non-falciparum
malaria
31
How to Interpret the RDT Results
(continued)
Line in “T1” or “T2”
and NO LINE in “C”
means:
T1
T2
Invalid
 The test is damaged.
 Results are INVALID.
No line in “T1” or “T2” and
NO LINE in “C” means:
T1
T2
Invalid
 The test is damaged.
 Results are INVALID.
32
Review Different Possible Results
A line in “T2” and a line in “C”
means:
T1
T2
Non-Pf +
The patient DOES have non-falciparum
malaria (P. vivax, P. ovale, P. malariae
or a mixed infection of these).
33
Review Different Possible Results
(continued)
A line in “T1” and a line in “C”
means: T1
T2
Pf +
The patient DOES have
falciparum malaria.
The test is POSITIVE
even if the line in “T1” is
very faint.
T1
T2
Pf +
34
RDT Interpretation Chart
Control line
Test lines
P. falciparum line
P. falciparum/panspecific RDT
e.g., detects P. falciparum-specific and other species (P. vivax, P.
malariae, P. ovale)
NEGATIVE
/
POSITIVE (P.
falciparum only)
/
/
/
/
POSITIVE (P.
falciparum and
other species)
POSITIVE non-P.
falciparum (i.e.,
other species)
/
/
INVALID
/
INVALID
/
/
INVALID
INVALID
Pan-specific line
/
/
35
Can You Interpret These Tests?
36
Interpretations for Test Results 1‒10
1.
2.
3.
4.
P. falciparum
Negative
Invalid (no control)
Non-falciparum (P.
vivax, P. ovale, P.
malariae, or a mixed
infection of these)
5. P. falciparum
6. Non-falciparum (P.
vivax, P. ovale, P.
malariae, or a mixed
infection of these)
7. Negative
8. P. falciparum
9. P. falciparum
10.P. falciparum or a
mixed infection
37
How to Record Results 1‒10 on a Chart
Positive ( + )
Pf
1
Pf or
Mixed
Negative (-)
Non-Pf
↔
2
↔
3
↔
4
5
↔
↔
6
↔
7
↔
8
↔
9
↔
10
Invalid
↔
38
Demonstrate the RDT for Learners
 The facilitator will
demonstrate the steps
in performing an RDT
for all to see
 He/she will ask
questions of the
learners as he/she
performs the
demonstration
39
Review and Questions
 Which RDT is currently used in your country?
 What are the main components of the test?
 How do we distinguish between a positive and
negative test?
 How do we know if a result is invalid or
unclear?
 What should we do with such results?
 How do we know what treatment is appropriate
after conducting the RDT?
40
Learners Practice Performing an RDT
 Learners will form small
groups
 Each learner will have a
chance to practice the
RDT
 Group members will
give feedback after
each person attempts
the test
 Make copies of the
checklist that follows for
learners to observe
each other
41
RDT Performance Checklist—Procedure 1
Procedure
1. RDT preparation (four
tasks)
Task
• Assemble all materials
required for the RDT test
• Read expiration date
• Use test with earliest
expiration date
• Allow RDT to come to room
temperature (if kept in cool
storage)
42
RDT Performance Checklist—Procedure 2
Procedure
2. Patient preparation (four
tasks)
Task
• Wash hands
• Identify patient’s details
and record patient’s name
on the RDT cassette
• Explain procedure to
patient. Provide
reassurance, as needed
• Wear gloves
43
RDT Performance Checklist—Procedure 3
Procedure
3. Blood collection +
dispensing (five tasks)
Task
• Select site for blood collection.
Clean site with alcohol swab
and allow it to dry
• Prick site firmly with sterile
lancet
• DO NOT squeeze finger
excessively
• Collect an adequate volume of
blood
• Dispense blood in correct well
44
RDT Performance Checklist—Procedure 4
Procedure
4. RDT procedure + reading
results (four tasks)
Task
• Dispense correct volume
of buffer
• Wait for correct time
(according to
manufacturer’s
instructions)
• Verify internal test control
• Read results correctly
45
RDT Checklist—Procedures 5, 6, 7
Procedure
5. Recording results
(two tasks)
•
•
6. Disposal of infectious •
material (two tasks)
•
7. Deliver the results
(one task)
•
Task
Record results correctly (including
mixed infections if a combo test is
used)
Record date and time of reporting
results
Dispose of used tests, and
transfer devices and other
contaminated material to plasticlined bin
Dispose of used lancet in a sharps
container
Explain to the patient the results
and what they mean
46
RDT Performance Checklist
 After the small group
practice sessions,
bring the whole group
back together
 Ask learners to talk
about their
experience
 Using the checklist
findings, ask learners
what steps were easy
or difficult—and why
47
Summary: RDT Results
 If RDT result is positive, treat according to
national guidelines
 If RDT result is negative, seek further
information and either:
 Treat for other conditions like pneumonia or diarrhea
as seen in our modules, or
 Refer to the nearest health center, if severe (i.e.,
lethargic or unconscious)
 If RDT result is invalid, repeat test with a new
cassette from a different batch
48
Summary: Safety and Precautions
 Employ universal precautions to ensure safety when
handling blood:
 Always put on gloves before handling blood
 Avoid contacting any wound with blood (Wounds must be





appropriately covered before conducting the RDT test)
Wash hands appropriately with soap before and after
conducting the RDT test
Clean the finger to be pricked with an alcohol swab to
prevent infection
Never use a lancet or any blood collection device (loop,
capillary tube, straw or pipette) on more than one person
Dispose of all sharp objects appropriately (use a sharps
box)
Take care to remove and discard your gloves safely
49
Storing and Using RDTs in the Village
In closing the session, ask CHWs/CDDs to discuss
and plan the following:
1. How can we store RDTs in a safe and cool
place in the village?
2. How can we safely dispose of sharps and
medical waste from the RDTs in the village?
3. How can we explain to patients who believe
they have malaria, but their RDT is negative?
4. What other concerns do you have?
50