“Testing Can Be Done Anywhere”: A Qualitative Assessment of Targeted Community-Based Point-of-Care Early Infant Diagnosis of HIV in Lusaka, Zambia

Tembo, Tannia; Dale, Helen; Muttau, Nobutu; Itoh, Megumi; Williamson, Dhelia M.; Mwamba, Chanda; Manasyan, Albert; Beard, R. Suzanne; Cox, Mackenzie Hurlston; Herce, Michael E

doi:10.9745/ghsp-d-21-00723

Cited by 6 publications

(3 citation statements)

References 34 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Due to the unreliable power supply in most rural and semi urban settings, operationalization of PoC platforms would require a sustainable back up such as solar power as a means to ensure continued testing even in the event of power outages. This operational feature is important in resource constrained settings and PoC platforms with the ability to store charge or use a backup power supply have shown to function well even at community levels [ 16 ].…”

Section: Discussionmentioning

confidence: 99%

Xpert HIV-1 qual point-of-care testing for HIV early infant diagnosis in Tanzania: experiences and perceptions of health care workers in a 2016 study

Boniface,

Lwilla,

Mahiga

et al. 2024

AIDS Res Ther

View full text Add to dashboard Cite

Background HIV early infant diagnosis (HEID) at the centralized laboratory faces many challenges that impact the cascade of timely HEID. Point of Care (PoC) HEID has shown to reduce test turnaround times, allow for task shifting and has the potential to reduce infant mortality. We aimed at assessing the feasibility of nurse based PoC-HEID in five facilities of Mbeya region. Methods We analysed data from healthcare workers at five obstetric health facilities that participated in the BABY study which enrolled mothers living with HIV and their HIV exposed infants who were followed up until 6 weeks post-delivery. Nurses and laboratory personnel were trained and performed HEID procedures using the Xpert HIV-1 Qual PoC systems. Involved personnel were interviewed on feasibility, knowledge and competency of procedures and overall impression of the use of HIV-1 Qual PoC system in clinical settings. Results A total of 28 health care workers (HCWs) who participated in the study between 2014 and 2016 were interviewed, 23 being nurses, 1 clinical officer, 1 lab scientist and 3 lab technicians The median age was 39.5 years. Majority of the nurses (22/24) and all lab staff were confident using Gene Xpert PoC test after being trained. None of them rated Gene Xpert handling as too complicated despite minor challenges. Five HCWs (5/24) reported power cut as the most often occurring problem. As an overall impression, all interviewees agreed on PoC HEID to be used in clinical settings however, about half of them (11/24) indicated that the PoC-HEID procedures add a burden onto their routine workload. Conclusion Overall, health care workers in our study demonstrated very good perceptions and experiences of using PoC HEID. Efforts should be invested on quality training, targeted task distribution at the clinics, continual supportive supervision and power back up mechanisms to make the wide-scale adoption of nurse based PoC HEID testing a possibility.

show abstract

Section: Discussionmentioning

confidence: 99%

Xpert HIV-1 qual point-of-care testing for HIV early infant diagnosis in Tanzania: experiences and perceptions of health care workers in a 2016 study

Boniface,

Lwilla,

Mahiga

et al. 2024

AIDS Res Ther

View full text Add to dashboard Cite

show abstract

“…Given that early infant diagnosis is a crucial metric for assessing the effectiveness of PMTCT programmes, our ndings underscore the need for a strategy to diversify and decentralize laboratories to PMTCT sites and enhance the quali cations of staff conducting these tests. Within the African context, several studies [28][29][30][31][32] re ect this challenge, suggesting that the establishment of an effective PMTCT programme requires investments in deploying and maintaining early infant diagnosis equipment at care facilities, ensuring the availability of essential supplies, and providing training for health care staff. Institutional childbirth among seropositive pregnant women and early infant diagnosis at the national level are generally low, with concerns regarding the regions of Kindia, Kankan, and Boké.…”

Section: Discussionmentioning

confidence: 99%

Optimization of Mother-to-Child HIV Transmission Prevention in Guinea: Impact of the Improvement Plan on Performance Indicators at Large-Cohort Sites

CAMARA

2024

Preprint

View full text Add to dashboard Cite

Introduction This study assessed the prevention of mother‒to‒child transmission (PMTCT) in Guinea, focusing on the impact of the World Health Organization’s Option B + strategy for human immunodeficiency virus. This pilot study, conducted across 66 high-burden PMTCT sites, aimed to enhance service accessibility and utilization. The study evaluated the indicators of the mother-to-child transmission of human immunodeficiency virus before and after the implementation of the Option B + strategic plan. Methods Data from 66 large-cohort PMTCT sites from 2019 to 2022 were analysed to compare PMTCT metrics before (2019–2020) and after (2021–2022) the improvement initiative. Key indicators were reviewed, and trends were statistically analysed using Mann‒Whitney tests, with a p value less than 0.05 indicating statistical significance. Results The implementation of the strategy significantly increased the antiretroviral therapy rate among HIV-positive pregnant women from 66–94%, and full antiretroviral prophylaxis coverage was achieved in infants. However, early infant diagnosis via polymerase chain reaction testing fell short of the national target, highlighting deficiencies in laboratory and specimen transport capacities. The study also revealed regional disparities in the use of PMTCT services. Conclusion The improvement plan effectively enhanced antiretroviral therapy and prophylaxis use, demonstrating the benefits of structured interventions and capacity development. Despite improvements, challenges such as insufficient polymerase chain reaction (PCR) testing and uneven access to services remain. Future initiatives should aim to equip PMTCT sites with essential resources and promote community-driven health-seeking behaviours in underserved areas.

show abstract

“…Community POC testing on high-risk mother-infant pairs has also been explored in Zambia, and the results show that it minimizes the structural barriers to EID testing access. However, operational challenges such as client's confidentiality needs to be addressed [34]. We, in Malawi, recently showed that in a busy HIV care clinic, simple strategies (such as tagging of care mastercards), developed by its team using the model of improvement, improved the number of infants receiving their DNA-PCR results (unpublished).…”

Section: Hospitalsmentioning

confidence: 99%

Examining barriers to antiretroviral therapy initiation in infants living with HIV in sub‐Saharan Africa despite the availability of point‐of‐care diagnostic testing: a narrative systematic review

Chapuma,

Sakala,

Nyang'wa

et al. 2024

J Int AIDS Soc.

View full text Add to dashboard Cite

IntroductionAntiretroviral therapy (ART) initiation in infants living with HIV before 12 weeks of age can reduce the risk of mortality by 75%. Point‐of‐care (POC) diagnostic testing is critical for prompt ART initiation; however, despite its availability, rates of ART initiation are still relatively low before 12 weeks of age. This systematic review describes the barriers to ART initiation in infants before 12 weeks of age, despite the availability of POC.MethodsThis systematic review used a narrative synthesis methodology. We searched PubMed and Scopus using search strategies that combined terms of multiple variants of the keywords “early infant initiation on antiretroviral therapy,” “barriers” and “sub‐Saharan Africa” (initial search 18th January 2023; final search 1st August 2023). We included qualitative, observational and mixed methods studies that reported the influences of early infant initiation on ART. We excluded studies that reported influences on other components of the Prevention of Mother to Child Transmission cascade. Using a deductive approach guided by the updated Consolidated Framework of Implementation Research, we developed descriptive codes and themes around barriers to early infant initiation on ART. We then developed recommendations for interventions for the identified barriers using the action, actor, target and time framework from the codes.ResultsOf the 266 abstracts reviewed, 52 full‐text papers were examined, of which 12 papers were included. South Africa had most papers from a single country (n = 3) and the most reported study design was retrospective (n = 6). Delays in ART initiation beyond 12 weeks in infants 0–12 months were primarily associated with health facility and maternal factors. The most prominent barriers identified were inadequate resources for POC testing (including human resources, laboratory facilities and patient follow‐up). Maternal‐related factors, such as limited male involvement and maternal perceptions of treatment and care, were also influential.DiscussionWe identified structural barriers to ART initiation at the health system, social and cultural levels. Improvements in the timely allocation of resources for POC testing operations, coupled with interventions addressing social and behavioural barriers among both mothers and healthcare providers, hold a promise for enhancing timely ART initiation in infants.ConclusionsThis paper identifies barriers and proposes strategies for timely ART initiation in infants.

show abstract

“Testing Can Be Done Anywhere”: A Qualitative Assessment of Targeted Community-Based Point-of-Care Early Infant Diagnosis of HIV in Lusaka, Zambia

Abstract: Community-based point-of-care testing is an acceptable, appropriate, and feasible strategy for improving access to HIV diagnostic services for high-risk HIV-exposed infants.

Cited by 6 publications

References 34 publications

Xpert HIV-1 qual point-of-care testing for HIV early infant diagnosis in Tanzania: experiences and perceptions of health care workers in a 2016 study

Xpert HIV-1 qual point-of-care testing for HIV early infant diagnosis in Tanzania: experiences and perceptions of health care workers in a 2016 study

Optimization of Mother-to-Child HIV Transmission Prevention in Guinea: Impact of the Improvement Plan on Performance Indicators at Large-Cohort Sites

Examining barriers to antiretroviral therapy initiation in infants living with HIV in sub‐Saharan Africa despite the availability of point‐of‐care diagnostic testing: a narrative systematic review

Contact Info

Product

Resources

About