Paper short abstract:

Juxtaposing routine Hepatitis C diagnostic testing in clinical settings with more decentralized testing drives, I explore competing enactments of "good diagnostics" in-practice. Discussing varying downstream results (intended or not), I also reflect on challenges for making such explorations matter.

Paper long abstract:

New pharmaceuticals have induced a therapeutic revolution for Hepatitis C virus (HCV) infections, promising to cure this intractable liver disease in over 90% of cases. With the purported solution to HCV looming large, "finding the missing millions" (WHA 2018) of unknowingly infected individuals has become a leading premise for global public health. To this end, HCV-testing is taking center-stage as biotech companies vie for top spot of recommended diagnostic test. Against this backdrop, I leverage ethnographic engagements in Austria and STS-insights into the enactment of bodies, health, and diagnoses (Mol 2002; Mol, Moser & Pols 2010; Yates-Doerr 2017) to explore the mundane practices of HCV diagnostic testing. Juxtaposing routine diagnostics in clinical settings with more decentralized testing drives, I attend to the instructive slippage between high-sensitivity laboratory testing and broad-impact screening efforts and ask how each of these enacts varying forms of "good diagnostics." While maximizing diagnostic certainty is the clear clinical target, the use of rapid tests in screening drives involves constant tinkering and myriad instances of uncertainty. However, as I will argue, this comparison does not easily translate into deficiencies of the latter. The uncertainty inherent in broad-impact screening routinely overflows, producing novel spaces for exchange-as-care and for rendering bodies sensitive to the risks of HCV. Ultimately, these purportedly competing forms of "good diagnostics" depend on one another while their results (intended or not) vary. I finish by reflecting on the practical challenges for STS-researchers to resist either-or choices and fashion ways to make different enactments matter.