Deficiencies in accessibility to point-of-care (POC) diagnostics in PMTCT services in rural primary health care clinics in Zambia: Implementation Science perspective

Abstract

IntroductionPoint-of-care (POC) innovations are healthcare interventions that have great potential to improve diagnostic capacities of healthcare systems in low- and middle-income countries (LMICs). From the implementation science perspective, this study explores perceptions of key stakeholders on deficiencies in accessibility of POC diagnostics in the context of prevention of mother-to-child transmission (PMTCT) services in Zambia.MethodsA retrospective qualitative evaluation was conducted to understand factors that influence POC diagnostic implementation in rural primary healthcare (PHC) settings. The study was conducted among key implementing stakeholders in Zambia. In-depth interviews were held with 11 purposefully selected key informants, including clinical officers, midwives, nurses, environmental health technicians (EHTs), government and private health officials. The interviews were audio-recorded and transcribed verbatim. Following coding, thematic content analysis was applied and the main emerging themes were analysed through the lens of the Consolidated Framework for Implementation Research (CFIR). The CFIR was identified as the most appropriate model to interpret our findings.ResultsFactors influencing implementation were represented in all five domains. Major constructs as facilitators were the relative advantage of the intervention, external partnership, education and training, knowledge and belief, self-efficacy, and engagement of champions. Barriers were mainly found in the outer and inner settings, including constraints in financial resources, supply chain challenges resulting in stock-outs, insufficient human resources leading to increased workload, and other infrastructural issues like space limitations and lack of electricity in most rural primary healthcare settings.ConclusionsThe study identified key determinants that supported or hindered the implementation of POC diagnostics in the rural PHCs. Greater efforts are needed to overcome barriers at multi-sectoral level for effective implementation while leveraging on facilitators through a health system strengthening approach. These findings are key to informing future implementations, sustainability and scale-up of POC diagnostics interventions.