{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,12]],"date-time":"2025-10-12T02:47:47Z","timestamp":1760237267203,"version":"build-2065373602"},"reference-count":60,"publisher":"MDPI AG","issue":"2","license":[{"start":{"date-parts":[[2020,4,1]],"date-time":"2020-04-01T00:00:00Z","timestamp":1585699200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Canadian Institutes for Health Research","award":["DPH-88226"],"award-info":[{"award-number":["DPH-88226"]}]},{"DOI":"10.13039\/501100000862","name":"Sir Halley Stewart Trust","doi-asserted-by":"publisher","award":["none"],"award-info":[{"award-number":["none"]}],"id":[{"id":"10.13039\/501100000862","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100000781","name":"European Research Council","doi-asserted-by":"publisher","award":["295845"],"award-info":[{"award-number":["295845"]}],"id":[{"id":"10.13039\/501100000781","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100010663","name":"H2020 European Research Council","doi-asserted-by":"publisher","award":["715450"],"award-info":[{"award-number":["715450"]}],"id":[{"id":"10.13039\/100010663","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["TropicalMed"],"abstract":"<jats:p>To successfully eliminate human African trypanosomiasis (HAT), healthcare workers (HCWs) must maintain their diagnostic acuity to identify cases as the disease becomes rarer. HAT experts refer to this concept as a \u2018reflex\u2019 which incorporates the idea that diagnostic expertise, particularly skills involved in recognising which patients should be tested, comes from embodied knowledge, accrued through practice. We investigated diagnostic pathways in the detection of 32 symptomatic HAT patients in South Sudan and found that this \u2018reflex\u2019 was not confined to HCWs. Indeed, lay people suggested patients test for HAT in more than half of cases using similar practices to HCWs, highlighting the importance of the expertise present in disease-affected communities. Three typologies of diagnostic practice characterised patients\u2019 detection: \u2018syndromic suspicion\u2019, which closely resembled the idea of an expert diagnostic reflex, as well as \u2018pragmatic testing\u2019 and \u2018serendipitous detection\u2019, which depended on diagnostic expertise embedded in hospital and lay social structures when HAT-specific suspicion was ambivalent or even absent. As we approach elimination, health systems should embrace both expert and non-expert forms of diagnostic practice that can lead to detection. Supporting multidimensional access to HAT tests will be vital for HCWs and lay people to practice diagnosis and develop their expertise.<\/jats:p>","DOI":"10.3390\/tropicalmed5020052","type":"journal-article","created":{"date-parts":[[2020,4,2]],"date-time":"2020-04-02T11:57:14Z","timestamp":1585828634000},"page":"52","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Understanding the Role of the Diagnostic \u2018Reflex\u2019 in the Elimination of Human African Trypanosomiasis"],"prefix":"10.3390","volume":"5","author":[{"given":"Jennifer J.","family":"Palmer","sequence":"first","affiliation":[{"name":"Department of Global Health &amp; Development, London School of Hygiene &amp; Tropical Medicine, 15\u201317 Tavistock Place, London WC1H 9SH, UK"},{"name":"Centre of African Studies, University of Edinburgh, 15a George Square, Edinburgh EH8 9LD, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Caroline","family":"Jones","sequence":"additional","affiliation":[{"name":"Kemri-Wellcome Trust Research Programme, P.O. Box 230, Kilifi 80108, Kenya"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Elizeous I.","family":"Surur","sequence":"additional","affiliation":[{"name":"Independent consultant, Juba, South Sudan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ann H.","family":"Kelly","sequence":"additional","affiliation":[{"name":"Department of Global Health &amp; Social Medicine, King\u2019s College London, 30 Aldwych, London WC2B 4BG, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2020,4,1]]},"reference":[{"key":"ref_1","unstructured":"WHO (2016). Report of the Second WHO Stakeholders Meeting on Gambiense Human African Trypanosomiasis Elimination, Geneva, Switzerland, 21\u201323 March 2016, World Health Organisation."},{"key":"ref_2","doi-asserted-by":"crossref","unstructured":"Steverding, D. (2008). The history of African trypanosomiasis. 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