Feasibility and acceptability of implementing early infant diagnosis of HIV in Papua New Guinea at the point of care: a qualitative exploration of health worker and key informant perspectives. Issue 11 (19th November 2020)

• Record Type: Journal Article
• Authors: Mohamed, Yasmin; Kupul, Martha; Gare, Janet; Badman, Steven G; Silim, Selina; Vallely, Andrew J; Luchters, Stanley; Kelly-Hanku, Angela
• Other Names: author non-byline.; Luchters Stanley author non-byline.; Crowe Suzanne author non-byline.; Stoové Mark author non-byline.; Anderson David author non-byline.; Nightingale Claire author non-byline.; Agius Paul author non-byline.; Mohamed Yasmin author non-byline.; Htay Hla author non-byline.; Yee Win Lei author non-byline.; Kelly-Hanku Angela author non-byline.; Vallely Andrew author non-byline.; Badman Steven author non-byline.; Kombati Zure author non-byline.; Zaw Tin Maung author non-byline.; Chen Xiang-Sheng author non-byline.; Tin Htay Htay author non-byline.; Thein Win author non-byline.; Kyaw Latt Latt author non-byline.; Gare Janet author non-byline.; Silim Selina author non-byline.
• Is Part Of: BMJ open. Volume 10:Issue 11(2020)
• Publication Date: 2020-11-19
• Subjects: hiv & aids -- international health services -- paediatric infectious disease & immunisation -- public health; Medicine -- Research -- Periodicals; 610.72
• DOI: 10.1136/bmjopen-2020-043679
• Languages: English
• ISSNs: 2044-6055

Abstract

Abstract : Introduction: Early infant diagnosis (EID) of HIV and timely initiation of antiretroviral therapy can significantly reduce morbidity and mortality among HIV-positive infants. Access to EID is limited in many low-income and middle-income settings, particularly those in which standard care involves dried blood spots (DBS) sent to centralised laboratories, such as in Papua New Guinea (PNG). We conducted a qualitative exploration of the feasibility and acceptability of implementing a point-of-care (POC) EID test (Xpert HIV-1 Qualitative assay) among health workers and key stakeholders working within the prevention of mother-to-child transmission of HIV (PMTCT) programme in PNG. Methods: This qualitative substudy was conducted as part of a pragmatic trial to investigate the effectiveness of the Xpert HIV-1 Qualitative test for EID in PNG and Myanmar. Semistructured interviews were undertaken with 5 health workers and 13 key informants to explore current services, experiences of EID testing, perspectives on the Xpert test and the feasibility of integrating and scaling up POC EID in PNG. Coding was undertaken using inductive and deductive approaches, drawing on existing acceptability and feasibility frameworks. Results: Health workers and key informants (N=18) felt EID at POC was feasible to implement and beneficial to HIV-exposed infants and their families, staff and the PMTCT programme more broadly. All study participants highlighted starting HIV-positive infants on treatment immediately as the main advantage of POC EID compared with standard care DBS testing. Health workers identified insufficient resources to follow up infants and caregivers and space constraints in hospitals as barriers to implementation. Participants emphasised the importance of adequate human resources, ongoing training and support, appropriate coordination and a sustainable supply of consumables to ensure effective scale-up of the test throughout PNG. Conclusions: Implementation of POC EID in a low HIV prevalence setting such as PNG is likely to be both feasible and beneficial with careful planning and adequate resources. Trial registration number: 12616000734460.