“After viral load testing, I get my results so I get to know which path my life is taking me”: qualitative insights on routine centralized and point-of-care viral load testing in western Kenya from the Opt4Kids and Opt4Mamas studies

BMC Health Services Research

Research

Frederick Oluoch¹  Eunice Kinywa¹  James Wagude²  Shukri A. Hassan³  Rena C. Patel⁴  Grace C. John-Stewart⁵  Lisa L. Abuogi⁶  Irene Mukui⁷  Francesca Odhiambo⁸  Lindah Otieno⁸  Patrick Oyaro⁹  Andrea J. Scallon^1,10  Boaz Oyaro^1,11  Leonard Kingwara^1,12  Jody Gao^1,13  Shirley Rui W. Qian^1,13  Enericah Karauki^1,14  Nashon Yongo^1,14  Evelyn Brown^1,14 

[1] Department of Health, Kisumu, Kenya;Department of Health, Siaya, Kenya;Department of Medicine, University of Washington, Seattle, WA, USA;Department of Medicine, University of Washington, Seattle, WA, USA;Department of Global Health, University of Washington, Seattle, WA, USA;Department of Medicine, University of Washington, Seattle, WA, USA;Department of Global Health, University of Washington, Seattle, WA, USA;Department of Pediatrics, University of Washington, Seattle, WA, USA;Department of Epidemiology, University of Washington, Seattle, WA, USA;Department of Pediatrics, University of Colorado, Denver, CO, USA;Drugs for Neglected Diseases Initiative, Nairobi, Kenya;Family AIDS Care and Education Services, Kenya Medical Research Institute, Kisumu, Kenya;Health Innovations Kenya (HIK), Kisumu, Kenya;Jackson School of International Studies, University of Washington, Seattle, WA, USA;Kenya Medical Research Institute-CDC, Kisian, Kenya;National HIV Reference Laboratory, Kenya Ministry of Health, Nairobi, Kenya;School of Public Health, University of Washington, Seattle, WA, USA;University of Washington-Kenya, Nairobi, Kenya;

关键词: Viral suppression;    Viral load testing;    Point-of-care;    Children;    Pregnant/postpartum women;    Kenya;   

DOI  :  10.1186/s12913-022-08593-z

 received in 2022-06-18, accepted in 2022-09-21,  发布年份 2022

来源: Springer

【 摘 要 】

BackgroundViral suppression (VS) is a marker of effective HIV therapy, and viral load (VL) testing is critical for treatment monitoring, especially in high-risk groups such as children and pregnant/postpartum women. Although routine VL testing, via centralized laboratory networks, was implemented in Kenya starting in 2014, optimization and sustainable scale up of VL testing are still needed.MethodsWe conducted a mixed methods study to evaluate the impact of higher frequency, point-of-care (POC) VL testing in optimizing VS among children and pregnant/postpartum women on antiretroviral treatment (ART) in five HIV treatment facilities in western Kenya in the Opt4Kids and Opt4Mamas studies. We conducted 68 key informant interviews (KIIs) from December 2019 to December 2020 with children and pregnant women living with HIV, child caregivers, providers, laboratory/facility leadership, and county- or national-level policymakers. Our KII guide covered the following domains: (1) barriers and facilitators to ART use and VS, (2) literacy and experiences with VL in routine care and via study, and (3) opinions on how to scale up VL testing for optimal programmatic use. We used inductive coding and thematic analysis to identify dominant themes with convergent and divergent subthemes.ResultsThree main themes regarding VL testing emerged from our analysis. (1) Key informants uniformly contrasted POC VL testing’s faster results turnaround, higher accessibility, and likely cost-effectiveness against centralized VL testing. (2) Key informants also identified areas of improvement for POC VL testing in Kenya, such as quality control, human resource and infrastructure capacity, supply chain management, and integration of VL testing systems. (3) To enable successful scale-up of VL testing, key informants proposed expanding the POC VL testing scheme, electronic medical records systems, conducting quality checks locally, capacity building and developing strong partnerships between key stakeholders.ConclusionThe more accessible, decentralized model of POC VL testing was deemed capable of overcoming critical challenges associated with centralized VL testing and was considered highly desirable for optimizing VS for children and pregnant/postpartum women living with HIV. While POC VL testing has the potential to improve VS rates among these populations, additional research is needed to develop strategies for ensuring the sustainability of POC VL testing programs.Trial registrationNCT03820323, 29/01/2019

【 授权许可】

CC BY   
© The Author(s) 2022

【 图 表 】

Fig. 6

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