Making HIV testing work at the point of care in South Africa: a qualitative study of diagnostic practices

Abstract Background Mobile HIV testing approaches are a key to reaching the global targets of halting the HIV epidemic by 2030. Importantly, the number of clients reached through mobile HIV testing approaches, need to remain high to maintain the cost-effectiveness of these approaches. Advances in rapid in-vitro tests such as INSTI® HIV-1/HIV-2 (INSTI) which uses flow-through technologies, offer opportunities to reduce the HIV testing time to about one minute. Using data from a routine mobile HTS programme which piloted the use of the INSTI point-of-care (POC) test, we sought to estimate the effect of using a faster test on client testing volumes and the number of people identified to be living with HIV, in comparison with standard of care HIV rapid tests. Methods In November 2019, one out of four mobile HTS teams operating in Ekurhuleni District (South Africa) was randomly selected to pilot the field use of INSTI-POC test as an HIV screening test (i.e., the intervention team). We compared the median number of clients tested for HIV and the number of HIV-positive clients by the intervention team with another mobile HTS team (matched on performance and area of operation) which used the standard of care (SOC) HIV screening test (i.e., SOC team). Results From 19 to 20 December 2019, the intervention team tested 7,403 clients, and the SOC team tested 2,426 clients. The intervention team tested a median of 442 (IQR: 288–522) clients/day; SOC team tested a median of 97 (IQR: 40–187) clients/day (p<0.0001). The intervention team tested about 180 more males/day compared to the SOC team, and the median number of adolescents and young adults tested/day by the intervention team were almost four times the number tested by the SOC team. The intervention team identified a higher number of HIV-positive clients compared to the SOC team (142 vs. 88), although the proportion of HIV-positive clients was lower in the intervention team due to the higher number of clients tested. Conclusions This pilot programme provides evidence of high performance and high reach, for men and young people through the use of faster HIV rapid tests, by trained lay counsellors in mobile HTS units.

Download Full-text

Factors affecting acceptance of at-birth point of care HIV testing among providers and parents in Kenya: A qualitative study

PLoS ONE ◽

10.1371/journal.pone.0225642 ◽

2019 ◽

Vol 14 (11) ◽

pp. e0225642 ◽

Cited By ~ 3

Author(s):

Catherine Wexler ◽

May Maloba ◽

Melinda Brown ◽

Natabhona Mabachi ◽

Kathy Goggin ◽

...

Keyword(s):

Qualitative Study ◽

Hiv Testing ◽

Point Of Care ◽

Factors Affecting

Download Full-text

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

Implementation Science Communications ◽

10.1186/s43058-021-00188-9 ◽

2021 ◽

Vol 2 (1) ◽

Author(s):

Catherine Wexler ◽

Yvonne Kamau ◽

Elizabeth Muchoki ◽

Shadrack Babu ◽

Nicodemus Maosa ◽

...

Keyword(s):

Qualitative Study ◽

Hiv Testing ◽

Implementation Research ◽

Point Of Care ◽

A Priori ◽

Scale Up ◽

Turnaround Time ◽

Missed Opportunities ◽

Intervention Level ◽

Outer Setting

Abstract Background At-birth and point-of-care (POC) testing can expedite early infant diagnosis of HIV and improve infant outcomes. Guided by the Consolidated Framework for Implementation Research (CFIR), this study describes the implementation of an at-birth POC testing pilot from the perspective of implementing providers and identifies the factors that might support and hinder the scale up of these promising interventions. Methods We conducted 28 focus group discussions (FGDs) with 48 providers across 4 study sites throughout the course of a pilot study assessing the feasibility and impact of at-birth POC testing. FGDs were audio-recorded, transcribed, and analyzed for a priori themes related to CFIR constructs. This qualitative study was nested within a larger study to pilot and evaluate at-birth and POC HIV testing. Results Out of the 39 CFIR constructs, 30 were addressed in the FGDs. While all five domains were represented, major themes revolved around constructs related to intervention characteristics, inner setting, and outer setting. Regarding intervention characteristics, the advantages of at-birth POC (rapid turnaround time resulting in improved patient management and enhanced patient motivation) were significant enough to encourage provider uptake and enthusiasm. Challenges at the intervention level (machine breakdown, processing errors), inner settings (workload, limited leadership engagement, challenges with access to information), and outer setting (patient-level challenges, limited engagement with outer setting stakeholders) hindered implementation, frustrated providers, and resulted in missed opportunities for testing. Providers discussed how throughout the course of the study adaptations to implementation (improved channels of communication, modified implementation logistics) were made to overcome some of these challenges. To improve implementation, providers cited the need for enhanced training and for greater involvement among stakeholders outside of the implementing team (i.e., other clinicians, hospital administrators and implementing partners, county and national health officials). Despite provider enthusiasm for the intervention, providers felt that the lack of engagement from leadership within the hospital and in the outer setting would preclude sustained implementation outside of a research setting. Conclusion Despite demonstrated feasibility and enthusiasm among implementing providers, the lack of outer setting support makes sustained implementation of at-birth POC testing unlikely at this time. The findings highlight the multi-dimensional aspect of implementation and the need to consider facilitators and barriers within each of the five CFIR domains. Trial registration ClinicalTrials.gov, NCT03435887. Retrospectively registered on 19 February 2020

Download Full-text

Same-Day CD4 Testing to Improve Uptake of HIV Care and Treatment in South Africa: Point-of-Care Is Not Enough

AIDS Research and Treatment ◽

10.1155/2013/941493 ◽

2013 ◽

Vol 2013 ◽

pp. 1-7 ◽

Cited By ~ 11

Author(s):

Bruce A. Larson ◽

Kathryn Schnippel ◽

Alana Brennan ◽

Lawrence Long ◽

Thembi Xulu ◽

...

Keyword(s):

South Africa ◽

Hiv Testing ◽

Point Of Care ◽

Linkage To Care ◽

Retention In Care ◽

Baseline Period ◽

Hiv Care ◽

Hiv Positive ◽

Care And Treatment ◽

Cd4 Testing

Background. We evaluated whether a pilot program providing point-of-care (POC), but not rapid, CD4 testing (BD FACSCount) immediately after testing HIV-positive improved retention in care.Methods. We conducted a retrospective record review at the Themba Lethu Clinic in Johannesburg, South Africa. We compared all walk-in patients testing HIV-positive during February, July 2010 (pilot POC period) to patients testing positive during January 2008–February 2009 (baseline period). The outcome for those with a≤250cells/mm3when testing HIV-positive was initiating ART<16weeks after HIV testing.Results. 771 patients had CD4 results from the day of HIV testing (421 pilots, 350 baselines). ART initiation within 16 weeks was 49% in the pilot period and 46% in the baseline period. While all 421 patients during the pilot period should have been offered the POC test, patient records indicate that only 73% of them were actually offered it, and among these patients only 63% accepted the offer.Conclusions. Offering CD4 testing using a point-of-care, but not rapid, technology and without other health system changes had minor impacts on the uptake of HIV care and treatment. Point-of-care technologies alone may not be enough to improve linkage to care and treatment after HIV testing.

Download Full-text

Stakeholders’ Perspectives for the Development of a Point-of-Care Diagnostics Curriculum in Rural Primary Clinics in South Africa—Nominal Group Technique

Diagnostics ◽

10.3390/diagnostics10040195 ◽

2020 ◽

Vol 10 (4) ◽

pp. 195 ◽

Cited By ~ 1

Author(s):

Nkosinothando Chamane ◽

Desmond Kuupiel ◽

Tivani Phosa Mashamba-Thompson

Keyword(s):

South Africa ◽

Hiv Testing ◽

Point Of Care ◽

Nominal Group Technique ◽

Nominal Group ◽

Point Of Care Diagnostics ◽

Kwazulu Natal ◽

Hiv Testing And Counselling ◽

Professional Nurses ◽

Testing Standards

Poor knowledge and adherence to point-of-care (POC) HIV testing standards have been reported in rural KwaZulu-Natal (KZN), a high HIV prevalent setting. Improving compliance to HIV testing standards is critical, particularly during the gradual phasing out of lay counsellor providers and the shifting of HIV testing and counselling duties to professional nurses. The main objective of this study was to identify priority areas for development of POC diagnostics curriculum to improve competence and adherence to POC diagnostics quality standards for primary healthcare (PHC) nurses in rural South Africa. Method: PHC clinic stakeholders were invited to participate in a co-creation workshop. Participants were purposely sampled from each of the 11 KwaZulu-Natal Districts. Through the Nominal Group Technique (NGT), participants identified training related challenges concerning delivery of quality point of care diagnostics and ranked them from highest to lowest priority. An importance ranking score (scale 1–5) was calculated for each of the identified challenges. Results: Study participants included three PHC professional nurses, one TB professional nurse, one HIV lay councilor, one TB assistant and three POC diagnostics researchers, aged 23–50. Participants identified ten POC diagnostics related challenges. Amongst the highest ranked challenges were the following:absence of POC testing Curriculum for nurses, absence of training of staff on HIV testing and counselling as lay counsellor providers are gradually being phased out,. absence of Continuous Professional Development opportunities and lack of Staff involvement in POC Management programs. Conclusion: Key stakeholders perceived training of PHC nurses as the highest priority for the delivery of quality POC diagnostic testing at PHC level. We recommend continual collaboration among all POC diagnostics stakeholders in the development of an accessible curriculum to improve providers’ competence and ensure sustainable quality delivery of POC diagnostic services in rural PHC clinics.

Download Full-text

A Survey on Use of Rapid Tests and Tuberculosis Diagnostic Practices by Primary Health Care Providers in South Africa: Implications for the Development of New Point-of-Care Tests

PLoS ONE ◽

10.1371/journal.pone.0141453 ◽

2015 ◽

Vol 10 (10) ◽

pp. e0141453 ◽

Cited By ~ 9

Author(s):

Malika Davids ◽

Keertan Dheda ◽

Nitika Pant Pai ◽

Dolphina Cogill ◽

Madhukar Pai ◽

...

Keyword(s):

South Africa ◽

Health Care ◽

Health Care Providers ◽

Point Of Care ◽

Care Providers ◽

Diagnostic Practices ◽

Primary Health ◽

Primary Health Care Providers ◽

Rapid Tests ◽

Point Of Care Tests

Download Full-text

Field Evaluation of Performance of Alere and Cepheid Qualitative HIV Assays for Pediatric Point-of-Care Testing in an Academic Hospital in Soweto, South Africa

Journal of Clinical Microbiology ◽

10.1128/jcm.01021-17 ◽

2017 ◽

Vol 55 (11) ◽

pp. 3227-3235 ◽

Cited By ~ 12

Author(s):

Tanya Y. Murray ◽

Gayle G. Sherman ◽

Firdose Nakwa ◽

William B. MacLeod ◽

Nosisa Sipambo ◽

...

Keyword(s):

South Africa ◽

Hiv Testing ◽

Point Of Care ◽

Standard Of Care ◽

Field Evaluation ◽

Hospital Environment ◽

Current Standard ◽

Hiv Diagnosis ◽

Treatment Naïve ◽

Sensitivity Specificity

ABSTRACTPoint-of-care (POC) technologies for HIV diagnosis in infants have the potential to overcome logistical challenges that delay treatment initiation and prevent improvements in morbidity and mortality. This study aimed to evaluate the performance of two POC technologies against the current standard-of-care (SOC) laboratory-based assay in South Africa, when operated by nurses in a hospital environment. Children <18 months of age who were treatment naive (excluding prophylaxis) and in whom an HIV PCR test was indicated were eligible for the study. To increase the rate of enrollment of HIV PCR-positive children, HIV-exposed neonates at high risk of mother-to-child transmission and children requiring confirmatory HIV testing were preferentially enrolled. The two POC technologies demonstrated excellent concordance, with 315 (97.8%) results consistent with the SOC result. The POC technologies yielded 102 positive and 220 negative tests each. The SOC assay had 101 positive, 214 negative, 4 indeterminate, 1 invalid, and 2 specimen-rejected results. To include the indeterminate results in sensitivity/specificity calculations, a sensitivity analysis was performed, which yielded a simulated sensitivity of 0.9904 (interquartile range [IQR], 0.9808 to 0.9904) and a specificity of 0.9954 (IQR, 0.9954 to 1.0). This study confirmed that both POC technologies can be successfully used outside the laboratory environment to yield precise sensitivity/specificity values for pediatric, including neonatal, HIV testing.

Download Full-text