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

Area of Science:

• Implementation Science
• Public Health
• Pediatric HIV

Background:

• At-birth and point-of-care (POC) testing are crucial for early infant diagnosis of HIV, aiming to improve infant outcomes.
• This study utilized the Consolidated Framework for Implementation Research (CFIR) to examine the implementation of an at-birth POC testing pilot.
• It focused on the perspectives of healthcare providers to identify factors influencing the scale-up of these interventions.

Purpose of the Study:

• To describe the implementation of an at-birth POC HIV testing pilot.
• To identify factors supporting and hindering the scale-up of at-birth POC HIV testing from the provider's viewpoint.
• To assess the feasibility and impact of at-birth POC HIV testing.

Main Methods:

• Conducted 28 focus group discussions (FGDs) with 48 providers across 4 study sites.
• Utilized a qualitative approach nested within a larger pilot study on at-birth and POC HIV testing.
• Analyzed audio-recorded and transcribed FGDs for themes related to CFIR constructs.

Main Results:

• Major themes centered on intervention characteristics, inner setting, and outer setting, with 30 of 39 CFIR constructs addressed.
• Provider enthusiasm was high due to rapid turnaround times and improved patient management, but machine breakdowns and workload posed challenges.
• Adaptations like improved communication and logistics were made, yet lack of leadership and outer stakeholder engagement hindered sustained implementation.

Conclusions:

• Despite demonstrated feasibility and provider enthusiasm, sustained implementation of at-birth POC testing is unlikely without greater outer setting support.
• The findings underscore the complex, multi-dimensional nature of implementation.
• Addressing facilitators and barriers across all five CFIR domains is essential for successful scale-up.