Xpert HIV-1 qual point-of-care testing for HIV early infant diagnosis in Tanzania: experiences and perceptions of health care workers in a 2016 study

Abstract

Background: HIV early infant diagnosis (HEID) at the centralized laboratory faces many challenges that impact the cascade of timely HEID. Point of Care (PoC) HEID has shown to reduce test turnaround times, allow for task shifting and has the potential to reduce infant mortality. We aimed at assessing the feasibility of nurse based PoC-HEID in five facilities of Mbeya region.

Methods: We analysed data from healthcare workers at five obstetric health facilities that participated in the BABY study which enrolled mothers living with HIV and their HIV exposed infants who were followed up until 6 weeks post-delivery. Nurses and laboratory personnel were trained and performed HEID procedures using the Xpert HIV-1 Qual PoC systems. Involved personnel were interviewed on feasibility, knowledge and competency of procedures and overall impression of the use of HIV-1 Qual PoC system in clinical settings.

Results: A total of 28 health care workers (HCWs) who participated in the study between 2014 and 2016 were interviewed, 23 being nurses, 1 clinical officer, 1 lab scientist and 3 lab technicians The median age was 39.5 years. Majority of the nurses (22/24) and all lab staff were confident using Gene Xpert PoC test after being trained. None of them rated Gene Xpert handling as too complicated despite minor challenges. Five HCWs (5/24) reported power cut as the most often occurring problem. As an overall impression, all interviewees agreed on PoC HEID to be used in clinical settings however, about half of them (11/24) indicated that the PoC-HEID procedures add a burden onto their routine workload.

Conclusion: Overall, health care workers in our study demonstrated very good perceptions and experiences of using PoC HEID. Efforts should be invested on quality training, targeted task distribution at the clinics, continual supportive supervision and power back up mechanisms to make the wide-scale adoption of nurse based PoC HEID testing a possibility.

Keywords: Early infant diagnosis; HIV; Point-of-care testing; Primary healthcare workers; Vertical HIV transmission.

Fig. 1

Perception of the level of training provided to health care workers at study initiation. a Perception on adequacy of the level of Xpert PoC test training on knowledge and abilities b Perception on the adequacy of training time in acquiring intended skills. c Perception on adequacy of opportunities to run Xpert test samples. d Perception on level of confidence in using Xpert PoC test after the training

Fig. 2

Use of the user manual and handling of the Xpert HIV-1 qual assay by health care workers. a Response on the frequency of using the GeneXpert user manual. b Perception on how easy it was to understand the GeneXpert user manual. c Rating on the overall handling and feasibility of the HIV Qual Testing using the GeneXpert System. d Rating on how easy it was to prepare the test tubes (heel pricking, pipetting, mixing with buffer). e Rating on how easy it was in interpreting the test results

Fig. 3

Operational Xpert PoC test performance at the health facilities

Fig. 4

Overall impression on the use of PoC gene xpert system in public setting (N = 24)