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Integrated point-of-care testing (POCT) for HIV, syphilis, malaria and anaemia at antenatal facilities in western Kenya: a qualitative study exploring end-users’ perspectives of appropriateness, acceptability and feasibility

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Young, Nicole, Achieng, Florence, Desai, Meghna, Phillips-Howard, Penelope ORCID: https://orcid.org/0000-0003-1018-116X, Hill, Jenny ORCID: https://orcid.org/0000-0003-1588-485X, Aol, George, Bigogo, Godfrey, Laserson, Kayla, terKuile, Feiko ORCID: https://orcid.org/0000-0003-3663-5617 and Taegtmeyer, Miriam ORCID: https://orcid.org/0000-0002-5377-2536 (2019) 'Integrated point-of-care testing (POCT) for HIV, syphilis, malaria and anaemia at antenatal facilities in western Kenya: a qualitative study exploring end-users’ perspectives of appropriateness, acceptability and feasibility'. BMC Health Services Research, Vol 19, Issue 1, e74.

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Abstract

Background:HIV, syphilis, malaria and anaemia are leading preventable causes of adverse pregnancy outcomes in sub-Saharan Africa yet testing coverage for conditions other than HIV is low. Availing point-of-care tests (POCTs) at rural antenatal health facilities (dispensaries) has the potential to improve access and timely treatment. Fundamental to the adoption of and adherence to new diagnostic approaches are healthcare workers’and pregnant women’s(end-users) buy-in. A qualitative approach was used to capture end-users’experiences of using POCTs for HIV, syphilis,malaria and anaemia to assess the appropriateness, acceptability and feasibility of integrated testing for ANC.

Methods: Seven dispensaries were purposively selected to implement integrated point-of-care testing for eight months in western Kenya. Semi-structured interviews were conducted with 18 healthcare workers (14 nurses, one clinical officer, two HIV testing counsellors, and one laboratory technician) who were trained, had experience doing integrated point-of-care testing, and were still working at the facilities 8–12 months after the intervention began. The interviews explored acceptability and relevance of POCTs to ANC, challenges with testing, training and supervision, and healthcare workers’perspectives of client experiences. Twelve focus group discussions with 118 pregnant women who had attended a first ANC visit at the study facilities during the intervention were conducted to explore their knowledge of HIV, syphilis, malaria, and anaemia, experience of ANC point-of-care testing services, treatments received, relationships with healthcare workers, and experience of talking to partners about HIV and syphilis results.

Results:Healthcare workers reported that they enjoyed gaining new skills, were enthusiastic about using POCTs,and found them easy to use and appropriate to their practice. Initial concerns that performing additional testing would increase their workload in an already strained environment were resolved with experience and proficiency with the testing procedures. However, despite having the diagnostic tools, general health system challenges such as high client to healthcare worker volume ratio, stock-outs and poor working conditions challenged the delivery of adequate counselling and management of the four conditions. Pregnant women appreciated POCTs, but reported poor healthcare worker attitudes, drug stock-outs, and fear of HIV disclosure to their partners as shortcomings to their ANC experience in general.

Conclusion:This study provides insights on the acceptability, appropriateness, and feasibility of integrating POCTs into ANC services among end-users. While the innovation was desired and perceived as beneficial, future scale-up efforts would need to address health system weaknesses if integrated testing and subsequent effective management of the four conditions are to be achieved.

Item Type: Article
Subjects: WA Public Health > Preventive Medicine > WA 243 Diagnositic services
WA Public Health > Health Problems of Special Population Groups > WA 310 Maternal welfare
WA Public Health > Health Administration and Organization > WA 525 General works
WC Communicable Diseases > Sexually Transmitted Diseases > WC 160 Syphilis
WC Communicable Diseases > Virus Diseases > Acquired Immunodeficiency Syndrome. HIV Infections > WC 503 Acquired immunodeficiency syndrome. HIV infections
WC Communicable Diseases > Tropical and Parasitic Diseases > WC 750 Malaria
WH Hemic and Lymphatic Systems > Hematologic Diseases. Immunologic Factors. Blood Banks > WH 155 Anemia
WQ Obstetrics > Pregnancy > WQ 200 General works
Faculty: Department: Clinical Sciences & International Health > Clinical Sciences Department
Clinical Sciences & International Health > International Public Health Department
Digital Object Identifer (DOI): https://doi.org/10.1186/s12913-018-3844-9
Depositing User: Stacy Murtagh
Date Deposited: 01 Feb 2019 15:00
Last Modified: 01 Feb 2019 15:53
URI: http://archive.lstmed.ac.uk/id/eprint/10062

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