“The right time is just after birth”: acceptability of point-of-care birth testing in Eswatini: qualitative results from infant caregivers, health care workers, and policymakers

Abstract

Background: Testing for HIV at birth has the potential to identify infants infected in utero, and allows for the possibility of beginning treatment immediately after birth; point of care (POC) testing allows rapid return of results and faster initiation on treatment for positive infants. Eswatini piloted birth testing in three public maternities for over 2 years. Methods: In order to assess the acceptability of POC birth testing in the pilot sites in Eswatini, interviews were held with caregivers of HIV-exposed infants who were offered birth testing (N = 28), health care workers (N = 14), and policymakers (N = 10). Participants were purposively sampled. Interviews were held in English or SiSwati, and transcribed in English. Transcripts were coded by line, and content analysis and constant comparison were used to identify key themes for each respondent type. Results: Responses were categorized into: knowledge, experience, opinions, barriers and challenges, facilitators, and suggestions to improve POC birth testing. Preliminary findings reveal that point of care birth testing has been very well received but challenges were raised. Most caregivers appreciated testing the newborns at birth and getting results quickly, since it reduced anxiety of waiting for several weeks. However, having a favorable experience with testing was linked to having supportive and informed family members and receiving a negative result. Caregivers did not fully understand the need for blood draws as opposed to tests with saliva, and expressed the fears of seeing their newborns in pain. They were specifically grateful for supportive nursing staff who respected their confidentiality. Health care workers expressed strong support for the program but commented on the high demand for testing, increased workload, difficulty with errors in the testing machine itself, and struggles to implement the program without sufficient staffing, especially on evenings and weekends when phlebotomists were not available. Policymakers noted that there have been challenges within the program of losing mothers to follow up after they leave hospital, and recommended stronger linkages to community groups. Conclusions: There is strong support for scale-up of POC birth testing, but countries should consider ways to optimize staffing and manage demand.

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

“… 11 , 36 These findings were echoed by a study from Eswatini that showed POC testing delivered in a health facility reduced many of the costs and concerns related to travel time for caregivers who lived far from health facility EID services. 37 In our study, caregivers and HCWs alike both highlighted the compatibility and fit of the community POC model within the MOH EID program, which they perceived as offering faster EID testing, fewer barriers to testing access, and more timely availability of results and treatment for HIV-infected infants. However, some caregivers in our study raised concerns about the lack of privacy during community-based POC EID testing and reported anxiety about inadvertent disclosure of HIV status to neighbors or family members from testing in the community.…”

“…In a study done at health facilities in Eswatini, HCWs associated increased wait times with frequent POC EID machine errors and high demand for testing services. 37 In our study, study staff and caregivers thought that community-based POC EID testing would reduce the need for retesting due to misplaced or lost samples in facilities, which they indicated was common with traditional DBS-based PCR testing. Concerns about retesting were not trivial, as they generally related to worries surrounding the need to collect additional blood, which were perceived by some participants to be harmful to the infant or young child.…”

Facilitators and barriers of the implementation of point-of-care devices for cardiometabolic diseases: a scoping review

“…Among them, we can highlight: the lack of communication between different stakeholders in the healthcare system hinder the adoption and scaling-up of POCT usage [ 38 , 39 ], the increase workload for HCP discouraging them to use new technologies [ 39 , 40 ], and the differentiated background among users (e.g. medical/non-medical or specialized/non-specialized) plus the absence of continuum training cause lack of confidence in the POCT and the results [ 41 , 42 ]. Nevertheless, common facilitators were identified, such as: HCP enthusiasm to obtain same-day results [ 43 ], reduce re-consultations [ 14 , 40 ] and save patient’ travel expenses [ 44 ], the test influence patient-HCP interaction [ 45 , 46 ], and the non-requirement of specialized skills to operate the devices [ 47 ].…”

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

“…Previous studies in Kenya and Eswatini found POC BT to be highly acceptable to infant caregivers, as the reduction in waiting time for test results greatly reduced anxiety and fear, although many families noted feeling concern about infant pain or fragility. POC BT was also found to be acceptable to health workers, although they also expressed concerns about capacity, workload, sustainability, and post-test engagement of patients in care ( 20,21 ). Following the introduction of POC BT in Zimbabwe, we carried out a qualitative study on the acceptability of POC BT among health workers and infant caregivers.…”