Implementing at-birth, point-of-care HIV testing in Kenya: a qualitative study using the Consolidated Framework for Implementation Research

Sustainable solutions to barriers of point-of-care diagnostic testing services in health facilities without laboratories in the bono region, Ghana: a qualitative study

BACKGROUND

A sustainable point-of-care (POC) diagnostic testing implementation in low-resourced facilities enhances quick diagnostic investigation and halts unnecessary referrals. This study identified the barriers impeding the implementation of POC diagnostic testing in health facilities without laboratories in the Bono Region of Ghana; as well as explored potential solutions that could enhance the accessibility and effectiveness of POC diagnostic testing, ultimately improving the quality of healthcare delivery.

METHODS

A total of twenty-eight participants were purposively selected from health facilities in low-resourced settings in the Bono Region for a descriptive qualitative study. Of the twenty-eight participants, seventeen including ten healthcare providers from CHPS facilities, six district health depot managers, and one regional depot manager were engaged in in-depth interviews. Additional eleven including nine healthcare providers and two district depot managers were also engaged in focus group discussions. NVivo version 12 software was employed for condensation, labelling, and grouping of themes. Data was analysed narratively.

RESULTS

Work overloads, limited POC testing services, stock-outs of POC tests at the facilities, and supply-related challenges of POC test kits were identified as major barriers to POC testing services. To solve these barriers, adequate funding, an effective delivery system, stakeholders' engagement and advocacy, and in-service and refresher training courses were suggested as potential solutions to POC diagnostic testing services implementation by the stakeholders.

CONCLUSIONS

This study's findings emphasize the need to address the barriers hindering the implementation of POC diagnostic testing in health facilities without laboratories in the Bono Region of Ghana. The suggested solutions provide a roadmap for improving the accessibility and effectiveness of POC testing, which has the potential to enhance the quality of healthcare delivery, reduce unnecessary referrals, and ultimately improve patient health outcomes in underserved settings.

Facilitators and barriers to in vitro diagnostics implementation in resource-limited settings: A scoping review

BACKGROUND

The World Health Organization (WHO) developed the model list of essential in vitro diagnostics (EDL) to guide countries to develop and update point-of-care (POC) per their disease priorities. The EDL includes POC diagnostic tests for use in health facilities without laboratories; however, their implementation might face several challenges in low- and middle-income countries (LMICs).

AIM

To identify facilitators and barriers to POC testing service implementations in the primary health care facilities in the LMICs.

SETTING

Low- and middle-income countries.

METHODS

This scoping review was guided by Arksey and O'Malley's methodological framework. A comprehensive keyword search for literature was conducted in Google Scholar, EBSCOhost, PubMed, Web of Science and ScienceDirect using the Boolean terms ('AND' and 'OR'), as well as Medical Subject Headings. The study considered published articles in the English language from 2016 to 2021 and was limited to qualitative, quantitative and mixed-method studies. Two reviewers independently screened the articles at the abstract and full-text screening phases guided by the eligibility criteria. Data were analysed qualitatively and quantitatively.

RESULTS

Of the 57 studies identified through literature searches, 16 met this study's eligibility criteria. Of the 16 studies, 7 reported on both facilitators and barriers; and the remainder reported on only barriers to POC test implementation such as inadequate funding, insufficient human resource, stigmatisation, et cetera.

CONCLUSION

The study demonstrated a wide research gap in facilitators and barriers, especially in the general POC diagnostic test for use in health facilities without laboratories in the LMICs. Extensive research in POC testing service is recommended to improve service delivery.Contribution: This study's findings contribute to a few works of literature on existing evidence of POC testing.

‘The baby will have the right beginning’: a qualitative study on mother and health worker views on point-of-care HIV birth testing across 10 sites in Zimbabwe

Background

The survival of HIV-infected infants depends on early identification and initiation on effective treatment. HIV-exposed infants are tested at 6 weeks of age; however, testing for HIV sooner (e.g., shortly after birth) can identify in utero infection, which is associated with rapid progression. Infant early diagnostic virologic tests often have long turnaround times, reducing the utility of early testing. Point-of-care (POC) testing allows neonates born in health facilities to get results prior to discharge. This study aimed to understand the views of mothers and health workers regarding the use and acceptability of POC birth testing.

Methods

Beginning in 2018, Zimbabwe offered standard HIV testing at birth to high-risk HIV-exposed infants; as part of a pilot program, at 10 selected hospitals, POC birth testing (BT) was offered to every HIV-exposed infant. In order to understand experiences at the selected sites, 48 interviews were held: 23 with mothers and 25 with health workers, including 6 nurses-in-charge. Participants were purposively sampled across the participating sites. Interviews were held in English, Shona, or Ndebele, and transcribed in English. Line-by-line coding was carried out, and the constant comparison method of analysis was used to identify key themes for each respondent type.

Results

Findings were organized under four themes: challenges with BT, acceptability of BT, benefits of BT, and recommendations for BT programs. Overall, BT was well accepted by mothers and health workers because it encouraged mothers to better care for their uninfected newborns or initiate treatment more rapidly for infected infants. While the benefits were well understood, mothers felt there were some challenges, namely that they should be informed in advance about testing procedures and tested in a more private setting. Mothers and HCWs also recommended improving awareness of BT, both among health care workers and in the community in general, as well as ensuring that facilities are well-stocked with supplies and can deliver results in a timely way before scaling up programs.

Conclusions

Mothers and health workers strongly support implementation and expansion of birth testing programs due to the benefits for newborns. The challenges noted should be taken as planning guidance, rather than reasons to delay or discontinue birth testing programs.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12887-022-03601-x.