Barriers and facilitators to HIV and syphilis rapid diagnostic testing in antenatal care settings in low-income and middle-income countries: a systematic review

Abstract

BackgroundTesting and treatment during pregnancy is a well-established and cost-effective prevention strategy, which relies largely on use of rapid diagnostic tests (RDTs). Yet, in many low-income and-middle-income countries, the uptake of RDTs is suboptimal. A qualitative meta-synthesis was conducted to identify the barriers and enablers to use of HIV and syphilis RDTs among pregnant women in low-income and middle-income countries.MethodsThis review was conducted using PRISMA guidelines. Eligible studies included peer-reviewed publications, which used qualitative methods to explore HIV and syphilis RDT in antenatal care clinics in low-income and middle-income countries. Studies focusing on perspectives of pregnant women, healthcare workers and/or stakeholders were included. We used an inductive approach informed by a modified socioecological model to synthesise the data.Results62 manuscripts met the eligibility criteria. For pregnant women, initial acceptance of the RDT and continuation in antenatal care depends on the perception that engaging in testing will be a beneficial experience for their baby and themselves, often influenced by the provision of services that are gender-sensitive, confidential, respectful, flexible and considers their well-being into the future. Local sociocultural beliefs about pregnancy and diseases, awareness of diseases and gender roles in society also influenced RDT acceptability among pregnant women. For healthcare workers, the ability to provide high-quality RDT care required ongoing training, accurate and easy to use tests, support from supervisors and communities, sufficient resources and staffing to provide services, and reliable salary. At the stakeholder level, well-developed guidelines and health system infrastructures were imperative to the delivery of RDT in antenatal clinics.ConclusionOur findings highlight clear gaps to the provision of sustainable and culturally acceptable maternal HIV and/or syphilis screening using RDTs. In addition, greater attention needs to be paid to community stakeholders in promoting the uptake of RDT in antenatal clinics.PROSPERO registration numberCRD42018112190.

Challenges to integrating programs for the elimination of mother-to-child transmission of HIV, syphilis, and hepatitis B into antenatal care: Experiences from Indonesia

“…A systematic review noted that among 13 studies from low and middle income countries that reported on the availability of point-ofcare diagnostic testing for syphilis, malaria, HIV, hepatitis B virus, blood pressure, diabetes, and dyslipidaemia, 11 described frequent stock-outs of test kits [33]. Similar issue regarding the clinical supply stock-outs was also noted in a recent systematic review on barriers of HIV and syphilis rapid diagnostic tests in antenatal care settings in low and middle income countries [34]. This points to the importance of strong supply chain management when planning for the scale-up of EMTCT programmes.…”

“…The research only took the views of health providers and policymakers. The intention was to explore the views and experiences of those implementing the EMTCT program in Indonesia, complementing earlier studies exploring the experiences of pregnant women in Indonesia on HIV and syphilis testing [ 21 ] and in other low and middle income countries [ 34 ]. Future interdisciplinary studies on challenges in implementing EMTCT program would benefit from jointly exploring the views of pregnant women, their partners, health cadres, and community organizations in the same study setting.…”

The feasibility of novel point-of-care diagnostics for febrile illnesses at health centres in Southeast Asia: a mixed-methods study

“…The results of our study corroborated the need for ongoing training. 10 , 11 , 13 , 24 , 25 Procedures initially found to be difficult can be accomplished with more training and practice. 10 , 23 Training should include start-to-finish instructions, minimise abstract concepts (e.g.…”

A Systematic Review of the Healthcare Access and Utilization Barriers Faced by Refugees in Uganda

“…Refugees' mistrust and opposition to the healthcare system resulted from this condition (Abrahamsen, 2019;Id et al, 2022;. This was also shown by articles that were published all over the world and said that healthcare services for refugees were inadequate because of a variety of obstacles (Davidson et al, 2022;Korri et al, 2021;Zhang et al, 2022). The healthcare system particularly marginalises immigrants (Albright et al, 2022).…”