Qualitative research on point-of-care testing strategies and programs for HIV

Abstract

Point-of-care (POC) testing in communities, home settings and primary healthcare centers plays an important role in cutting delays in HIV diagnosis and in the uptake of voluntary testing and counseling. Qualitative research methods have important potential to overcome the current challenges in expanding HIV POC testing programs and strategies, by examining the diagnostic processes, complex inter-relationships and patterns involved in making POC diagnostics work in real-world settings. This article reviews existing qualitative studies on POC testing strategies and programs for HIV. Qualitative research on POC diagnostics around the uptake of POC tests, the actual diagnostic and testing processes involved, the influence of POC tests on clinical decision-making, communication of decisions and decisions exercised by patients are limited. Equally limited are studies that explore adaptation of POC programs to various socio-cultural contexts. More qualitative research is needed to inform test developers, funders and policymakers.

Keywords:

• diagnostic processes
• HIV
• point-of-care testing
• qualitative methods

Financial & competing interests disclosure

The authors were supported by a grant from the Bill & Melinda Gates Foundation (BMGF OPP1061487). The funder had no role in this commentary. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

No writing assistance was utilized in the production of this manuscript.

Key issues

• Point-of-care (POC) testing for HIV is ongoing in communities, home settings and primary healthcare centers across the globe since the early 2000s and is important in uptake of voluntary testing and counseling.

• Current concerns are: expanding access to HIV testing, exploring the potential uptake of home testing, continuous HIV viral load monitoring and CD4-based staging of large numbers of patients in clinics, integration of multiplex POC testing strategies, evaluating the influence of POC testing on patient-centered outcomes and costs, and the extent to which POC testing will be integrated within established diagnostic ecosystems of high- and low-resource settings alike.

• Qualitative research approaches are well-suited to answer some of these concerns, as they allow to thoroughly assess the context and settings of use, and to examine the processes and complex relationships involved in making POC tests work more effectively in the real world.

• Despite this potential, this review identifies a big gap in high-quality qualitative research on HIV POC testing.

• Existing studies focus mainly on accessing HIV testing, patients’ journeys to diagnosis, downstream pathways to linkage to care and treatment, and what it means to live with an HIV diagnosis.

• Qualitative researchers should focus on a set of pressing questions that POC test developers have: How to take into account complex diagnostic ecosystems? How to scale-up and combine new and existing diagnostic tests and testing strategies into meaningful integrated routine programs? How to actively manage and foster innovation for POC tests at the country or global level? How to assess tests, strategies and programs, and evaluate their impact on reducing transmission, controlling infection and reducing morbidity?

• Our review shows that the potential of qualitative research to answer each of these questions is currently underused.

• Qualitative studies on POC diagnostics around the uptake of POC tests, the actual processes involved when diagnosing at POC, the influence of POC tests on clinical decision-making, and their eventual public health impact on controlling infections and preventing transmission are limited.