Acceptability of point-of-care viral load testing to facilitate differentiated care: a qualitative assessment of people living with HIV and nurses in South Africa

Abstract

Background Providing viral load (VL) results to people living with HIV (PLHIV) on antiretroviral therapy (ART) remains a challenge in low and middle-income countries. Point-of-care (POC) VL testing could improve ART monitoring and the quality and efficiency of differentiated models of HIV care. We assessed the acceptability of POC VL testing within a differentiated care model that involved task-shifting from professional nurses to less highly-trained enrolled nurses, and an option of collecting treatment from a community-based ART delivery programme. Methods We undertook a qualitative sub-study amongst clients on ART and nurses within the STREAM study, a randomized controlled trial of POC VL testing and task-shifting in Durban, South Africa. Between March and August 2018, we conducted 33 semi-structured interviews with clients, professional and enrolled nurses and 4 focus group discussions with clients. Interviews and focus groups were audio recorded, transcribed, translated and thematically analysed. Results Amongst 55 clients on ART (median age 31, 56% women) and 8 nurses (median age 39, 75% women), POC VL testing and task-shifting to enrolled nurses was acceptable. Both clients and providers reported that POC VL testing yielded practical benefits for PLHIV by reducing the number of clinic visits, saving time, travel costs and days off work. Receiving same-day POC VL results encouraged adherence amongst clients, by enabling them to see immediately if they were ‘good’ or ‘bad’ adherers and enabled quick referrals to a community-based ART delivery programme for those with viral suppression. However, there was some concern regarding the impact of POC VL testing on clinic flows when implemented in busy public-sector clinics. Regarding task-shifting, nurses felt that, with extra training, enrolled nurses could help decongest healthcare facilities by quickly issuing ART to stable clients. Clients could not easily distinguish enrolled nurses from professional nurses, instead they highlighted the importance of friendliness, respect and good communication between clients and nurses. Conclusions POC VL testing combined with task-shifting was acceptable to clients and healthcare providers. Implementation of POC VL testing and task shifting within differentiated care models may help achieve international treatment targets. Trial registration NCT03066128, registered 22/02/2017.

POC viral load testing in an antenatal clinic setting for Ugandan pregnant women living with HIV: a qualitative implementation process analysis

“…This qualitative evaluation privileges the voices of implementers. Implementer voices have been represented in a few other studies focusing on POC VL testing, usually to report perceived benefits and challenges, and/or suggestions for how testing can be improved [23][24][25]. In this study, we asked implementers to describe how they carried out testing activities.…”

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

“…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 ]. Future implementation of POCT for both infectious diseases and NCDs should learn from the facilitators and barriers previously identified when designing the components of the intervention in order to find ways to take advantage of facilitators and/or overcome barriers.…”

“It Soothes Your Heart”: A Multimethod Study Exploring Acceptability of Point-of-Care Viral Load Testing among Ugandan Pregnant and Postpartum Women Living with HIV

“…Few qualitative studies have assessed acceptability of POC VL testing among adults living with HIV. Two qualitative studies, one from South Africa [ 19 ] and another from Kenya [ 12 ], interviewed clients and providers who noted clear practical benefits of implementing POC VL testing, namely, faster turnaround times, fewer clinical encounters, and reduced burden on clients and providers. POC VL testing among PWLHIV has been found to significantly increase ART initiation in pregnancy and reduce the risk of vertical HIV transmission [ 20 ].…”