It is a good idea to transition to implementing the POC test on a wider scale fairly soon after the pilot so that the experience from the pilot can be directly applied. The pilot will have explored all the important aspects of introducing a new test (policy aspects, advocacy and communications, engagement with stakeholders, test selection, testing algorithms, treatment, procurement and supply chain management, referral pathways, training, quality management, project management, monitoring and evaluation). The most important factors influencing scale-up will be the support and commitment of stakeholders.

Key questions to ask when planning for scale-up include:

Respond to a recognised need Have a clear definition of the program objectives & expected health benefits
Identify the population that will benefit from screening Promote equity and access to screening for the entire target population
Have scientific evidence of screening program effectiveness Ensure the overall benefits of screening outweigh the harm
Be cost-effective overall Use cost-effective measures to encourage high coverage
Ensure informed choice, confidentiality and respect for autonomy Have evidence-based guidelines & policies for assessment, diagnosis and support for people with a positive test result
Clearly define the screening pathway & screening interval Have a referral system for management of any abnormalities found and for providing information about normal screening tests
Have adequate facilities available for having tests and interpreting them Have adequate facilities for follow-up assessment, diagnosis, management and treatment
Integrate education, testing, clinical services and program management Ensure availability of the organisation, infrastructure, facilities and workforce needed to deliver the screening program
Plan evaluation from the outset and ensure that program data are maintained so that evaluation & monitoring of the program can be performed regularly Have an organised quality control program across the screening pathway to minimise potential risks of screening
Have adequate resources available to set up and maintain a database of health information collected for the program Have a database of the target population that can invite people for initial screening, recall people for repeat screening, follow those with identified abnormalities, link with morbidity & mortality results, and monitor & evaluate the program and its impact
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