Paper short abstract:

This paper discusses how developers and implementers of TB and HIV diagnostics align their technologies to the point-of-care and how uncertainty, global standards, and scarce resources cause frictions with the continuous nature of alignment work, impacting access and utilization of technologies.

Paper long abstract:

Social science literature has criticized simplified ideas of technology transfer underlying much technology design for global health. Healthcare technologies should be attuned to particular contexts-of-use to be effective. This paper uses the development of point-of-care (POC) diagnostics - promised to be designed to fit users outside laboratories or in resource constrained settings- to study what developers and implementers do to align diagnostic technologies to the POC. Fieldwork among global health actors involved in diagnostic development including manufacturers, donors, industry consultants, international organisations, policymakers, regulators and researchers is combined with fieldwork among users of diagnostics in India, including decision-makers, NGOs, program officers, laboratory technicians and nurses. Adding to STS theory of alignment, doability and user interaction, several points are put forward: The setting and user to which developers and implementers of global health diagnostics align are multiple, varied, emerging, keep shifting and go well beyond the imagined characteristics of a local user setting. They include multiple -engaged and imagined- user settings, but also those of developers, of global intermediaries, competitors, and diseases/bugs. The results reveal how a shifting complexity of actors, settings, scales and moments in time is invoked and made to collaborate. This alignment work is continuous and has consequences for access and utilization of the technology. Alignment work is characterized by uncertainty as to what is to be aligned, at the same time as standardizing elements, politics and scarce resources cause frictions with the continuous nature of (re-)aligning and over what constitutes a well-aligned diagnostic and for whom.