Paper short abstract:

This paper examines how notions of ‘attuning-to-local-contexts’ are articulated in global innovation practices for TB and HIV point-of-care tests and to what effect. How do innovators perform/enact the translation of scientific and clinical knowledge and local settings into diagnostic technologies?

Paper long abstract:

Point of care (POC) tests promise to bring more diagnostic precision and rapidly available results at lower cost, with lower maintenance and user skills in settings without timely access to laboratory-based testing. The technology is presented as a way to overcome challenges that did not allow former technologies (laboratory-based testing) to function fully, by being more attuned to local contexts of use. STS scholars have long argued that healthcare technologies have to be adjusted to particular contexts of use to be effective. The aim of this paper is to examine how notions of 'attuning-to-local-contexts' are articulated in POC test innovation practices and to what effect for these processes. Adding to an emerging literature on the sociology of diagnostics and a recent STS interest in clinical translation, this paper asks how the translation of biomedical, clinical and engineering knowledge into diagnostics for the POC is performed and enacted. The analysis draws on semi-structured interviews with global health actors (diagnostic manufacturers, donors, civil society, industry consultants, international organisations, and researchers) involved in diagnostic development for tuberculosis and HIV. How do innovators of POC diagnostics incorporate local settings into the innovation process? How and what forms of expertise and knowledge are made accessible? What policy and regulatory approaches govern these practices? What are implications of these innovation and translation practices for meeting promises of what is considered a good POC test? The paper concludes by reflecting on opportunities for evaluation and intervention for STS scholars in how POC tests are developed and implemented.