Impact of implementation of rapid syndromic molecular diagnostics on self-reported clinical and public health practice: a qualitative study in small island health services

ABSTRACT Objective This evaluation aimed to assess the impact of implementing Biofire© filmarray rapid syndromic molecular diagnostics systems in UK Overseas Territories, which are small jurisdictions with historically limited microbiological diagnostic capacity. The diagnostic systems were installed to improve patient management and public health response. Methods We conducted a qualitative evaluation. Data were gathered through semi-structured interviews and a focus group with clinicians, laboratory staff, and Chief Medical Officers. Results The interviewees’ reported substantial improvements in diagnostic capabilities. Interviewees shared that implementation reduced test turnaround times to 1-24 hours compared to several days to weeks pre-implementation, enabling faster and more accurate clinical management and improving clinician and patient satisfaction. Reduced reliance on off-island reference laboratories and patient medical evacuations was reported, contributing to potential cost savings and increased health system resilience. Respondents found rapid diagnostics to be useful in the context of communicable disease outbreaks. However, high test cartridge costs, supply and logistics issues, and lack of or low utilisation of protocols were noted challenges. Conclusion The implementation of this rapid automated syndromic molecular diagnostics technology markedly enhanced diagnostic capacity in territories included in this evaluation, particularly for respiratory, bloodstream, and gastrointestinal infections. This advancement accelerated diagnosis, was seen to improve patient management and antimicrobial stewardship. Despite these benefits, challenges remain. Further research is needed to assess the long-term impact on clinical practice, health outcomes, and cost-effectiveness, particularly in the unique contexts of small islands.