Factors affecting acceptance of at-birth point of care HIV testing among providers and parents in Kenya: A qualitative study

Autoři: Catherine Wexler aff001;  May Maloba aff002;  Melinda Brown aff001;  Natabhona Mabachi aff001;  Kathy Goggin aff003;  Brad Gautney aff005;  Beryne Odeny aff001;  Sarah Finocchario-Kessler aff001
Působiště autorů: Department of Family Medicine, University of Kansas Medical Center, Kansas City, Kansas, United States of America aff001;  Global Health Innovations, Nairobi, Kenya aff002;  Health Services and Outcomes Research, Children’s Mercy Kansas City, Kansas City, MO, United States of America aff003;  School of Medicine, University of Missouri-Kansas City, Kansas City, MO, United States of America aff004;  Global Health Innovations, Dallas, TX, United States of America aff005
Vyšlo v časopise: PLoS ONE 14(11)
Kategorie: Research Article
doi: 10.1371/journal.pone.0225642



At-birth and point-of-care (POC) HIV testing are emerging strategies to streamline infant HIV diagnosis and expedite ART initiation for HIV-positive infants. The purpose of this qualitative study was to evaluate factors influencing the provision and acceptance of at-birth POC testing among both HIV care providers and parents of HIV-exposed infants in Kenya.


We conducted semi-structured interviews with 26 HIV care providers and 35 parents of HIV-exposed infants (including 23 mothers, 6 fathers, and 3 mother-father pairs) at four study hospitals prior to POC implementation. An overview of best available evidence related to POC was presented to participants prior to each interview. Interviews probed about standard EID services, perceived benefits and risk of at-birth and POC testing, and suggested logistics of providing at-birth and POC. Interviews were audio recorded, translated (if necessary), and transcribed verbatim. Using the Transdisciplinary Model of Evidence Based Practice to guide analysis, transcripts were coded based on a priori themes related to environmental context, patient characteristics, and resources.


Most providers (24/26) and parents (30/35) held favorable attitudes towards at-birth POC testing. The potential for earlier results to improve infant care and reduce parental anxiety drove preferences for at-birth POC testing. Parents with unfavorable views towards at-birth POC testing preferred standard testing at 6 weeks so that mothers could heal after birth and have time to bond with their newborn before–possibly–learning that their child was HIV-positive. Providers identified lack of resources (shortage of staff, expertise, and space) as a barrier.


While overall acceptability of at-birth POC testing among HIV care providers and parents of HIV-exposed infants may facilitate uptake, barriers remain. Applying a task-shifting approach to implementation and ensuring providers receive training on at-birth POC testing may mitigate provider-related challenges. Comprehensive counseling throughout the antenatal and postpartum periods may mitigate patient-related challenges.

Klíčová slova:

Decision making – HIV diagnosis and management – Infants – Labor and delivery – Nurses – Pregnancy


1. Goggin K, Wexler C, Nazir N, Staggs VS, Gautney B, Okoth V, et al. Predictors of Infant Age at Enrollment in Early Infant Diagnosis Services in Kenya. AIDS and behavior. 2016;20(9):2141–50. Epub 2016/04/25. doi: 10.1007/s10461-016-1404-z 27108002; PubMed Central PMCID: PMC4995224.

2. Hassan AS, Sakwa EM, Nabwera HM, Taegtmeyer MM, Kimutai RM, Sanders EJ, et al. Dynamics and constraints of early infant diagnosis of HIV infection in Rural Kenya. AIDS and behavior. 2012;16(1):5–12. Epub 2011/01/08. doi: 10.1007/s10461-010-9877-7 21213034; PubMed Central PMCID: PMC3254874.

3. Wexler C, Cheng AL, Gautney B, Finocchario-Kessler S, Goggin K, Khamadi S. Evaluating turnaround times for early infant diagnosis samples in Kenya from 2011–2014: A retrospective analysis of HITSystem program data. PloS one. 2017;12(8):e0181005. Epub 2017/08/11. doi: 10.1371/journal.pone.0181005 28796791; PubMed Central PMCID: PMC5552093.

4. Finocchario-Kessler S, Gautney B, Cheng A, Wexler C, Maloba M, Nazir N, et al. Evaluation of the HIV Infant Tracking System (HITSystem) to optimise quality and efficiency of early infant diagnosis: a cluster-randomised trial in Kenya. The Lancet HIV. 2018;5(12):e696–e705. doi: 10.1016/S2352-3018(18)30245-5 30309787

5. Wexler C, Nazir N, Gautney B, Brown M, Maloba M, Goggin K, et al., editors. Predictors of timely ART initiation among HIV+ infants in Kenya. 22nd International AIDS Conference; 2018; Amsterdam, The Netherlands.

6. Violari A, Cotton MF, Gibb DM, Babiker AG, Steyn J, Madhi SA, et al. Early antiretroviral therapy and mortality among HIV-infected infants. The New England journal of medicine. 2008;359(21):2233–44. Epub 2008/11/21. doi: 10.1056/NEJMoa0800971 19020325; PubMed Central PMCID: PMC2950021.

7. Cepheid. Xpert® HIV-1 Qual 2018 [6/1/2018]. Available from: http://www.cepheid.com/en/cepheid-solutions/clinical-ivd-tests/virology/xpert-hiv-1-qual.

8. Abbott. Alere Q HIV-1/2 Detect 2018 [6/1/2018]. Available from: https://www.alere.com/en/home/product-details/alere-q-hiv-12-detect.html.

9. Meggi B, Vojnov L, Mabunda N, Vubil A, Zitha A, Tobaiwa O, et al. Performance of point-of-care birth HIV testing in primary health care clinics: An observational cohort study. PloS one. 2018;13(6):e0198344. Epub 2018/06/19. doi: 10.1371/journal.pone.0198344 29912987; PubMed Central PMCID: PMC6005575.

10. Technau KG, Kuhn L, Coovadia A, Murnane PM, Sherman G. Xpert HIV-1 point-of-care test for neonatal diagnosis of HIV in the birth testing programme of a maternity hospital: a field evaluation study. The lancet HIV. 2017;4(10):e442–e8. Epub 2017/07/18. doi: 10.1016/S2352-3018(17)30097-8 28711526; PubMed Central PMCID: PMC5623143.

11. Dunning L, Kroon M, Fourie L, Ciaranello A, Myer L. Impact of Birth HIV-PCR Testing on the Uptake of Follow-up Early Infant Diagnosis Services in Cape Town, South Africa. The Pediatric infectious disease journal. 2017;36(12):1159–64. doi: 10.1097/INF.0000000000001677 28767616.

12. Gill MM, Hoffman HJ, Mokone M, Tukei VJ, Nchephe M, Phalatse M, et al. Assessing Very Early Infant Diagnosis Turnaround Times: Findings from a Birth Testing Pilot in Lesotho. AIDS research and treatment. 2017;2017:2572594. Epub 2018/02/08. doi: 10.1155/2017/2572594 29410914; PubMed Central PMCID: PMC5749171.

13. Jani IV, Meggi B, Loquiha O, Tobaiwa O, Mudenyanga C, Zitha A, et al. Effect of point-of-care early infant diagnosis on antiretroviral therapy initiation and retention of patients. AIDS (London, England). 2018;32(11):1453–63. Epub 2018/05/11. doi: 10.1097/qad.0000000000001846 29746301.

14. Wexler C, Kamau Y, Halder R, Brown M, Maloba M, Mabachi N, et al. "Closing the Gap": Provider Recommendations for Implementing Birth Point of Care HIV Testing. AIDS and behavior. 2018. Epub 2018/12/14. doi: 10.1007/s10461-018-2363-3 30542834.

15. Hsiao NY, Dunning L, Kroon M, Myer L. Laboratory Evaluation of the Alere q Point-of-Care System for Early Infant HIV Diagnosis. PloS one. 2016;11(3):e0152672. Epub 2016/04/01. doi: 10.1371/journal.pone.0152672 27032094; PubMed Central PMCID: PMC4816318.

16. Dunning L, Kroon M, Hsiao NY, Myer L. Field evaluation of HIV point-of-care testing for early infant diagnosis in Cape Town, South Africa. PloS one. 2017;12(12):e0189226. Epub 2017/12/21. doi: 10.1371/journal.pone.0189226 29261707; PubMed Central PMCID: PMC5738050.

17. Jani IV, Meggi B, Mabunda N, Vubil A, Sitoe NE, Tobaiwa O, et al. Accurate early infant HIV diagnosis in primary health clinics using a point-of-care nucleic acid test. Journal of acquired immune deficiency syndromes (1999). 2014;67(1):e1–4. Epub 2014/06/17. doi: 10.1097/qai.0000000000000250 24933096.

18. Sabi I, Mahiga H, Mgaya J, Geisenberger O, Kastner S, Olomi W, et al. Accuracy and Operational Characteristics of Xpert Human Immunodeficiency Virus Point-of-Care Testing at Birth and Until Week 6 in Human Immunodeficiency Virus-exposed Neonates in Tanzania. Clinical infectious diseases: an official publication of the Infectious Diseases Society of America. 2019;68(4):615–22. Epub 2018/07/03. doi: 10.1093/cid/ciy538 29961841; PubMed Central PMCID: PMC6355822.

19. PEPFAR. PEPFAR 2018 Country Operational Plan Guidance for Standard Process Countries. 2018.

20. Bhairavabhotla R. Point-of-care testing as a solution for timely early infant diagnosis. 2018.

21. Ministry of Health. National Point of Care Testing Implementation Roadmap in Kenya. 2018.

22. Aarons GA, Sommerfeld DH, Chi BH, Ezeanolue EE, Sturke R, Guay L, et al. Concept Mapping of PMTCT Implementation Challenges and Solutions Across 6 sub-Saharan African Countries in the NIH-PEPFAR PMTCT Implementation Science Alliance. Journal of acquired immune deficiency syndromes (1999). 2016;72 Suppl 2:S202–6. Epub 2016/06/30. doi: 10.1097/qai.0000000000001064 27355510.

23. Bhardwaj S, Carter B, Aarons GA, Chi BH. Implementation Research for the Prevention of Mother-to-Child HIV Transmission in Sub-Saharan Africa: Existing Evidence, Current Gaps, and New Opportunities. Current HIV/AIDS reports. 2015;12(2):246–55. doi: 10.1007/s11904-015-0260-1 25877252.

24. Gupta S, Granich R. When will sub-Saharan Africa adopt HIV treatment for all? South Afr J HIV Med. 2016;17(1):459–. doi: 10.4102/sajhivmed.v17i1.459 29568615.

25. Gupta S, Granich R, Suthar AB, Smyth C, Baggaley R, Sculier D, et al. Global policy review of antiretroviral therapy eligibility criteria for treatment and prevention of HIV and tuberculosis in adults, pregnant women, and serodiscordant couples. Journal of acquired immune deficiency syndromes (1999). 2013;62(3):e87–97. Epub 2012/11/29. doi: 10.1097/QAI.0b013e31827e4992 23187942.

26. Pricilla RA, Brown M, Wexler C, Maloba M, Gautney BJ, Finocchario-Kessler S. Progress Toward Eliminating Mother to Child Transmission of HIV in Kenya: Review of Treatment Guidelines Uptake and Pediatric Transmission Between 2013 and 2016—A Follow Up. Maternal and child health journal. 2018;22(12):1685–92. doi: 10.1007/s10995-018-2612-0 30047080

27. Spring B, Hitchcock K. Evidence-Based Practice. In: Weiner I, Craighead W, editors. The Corsini Encyclopedia of Psychology2010.

28. Satterfield JM, Spring B, Brownson RC, Mullen EJ, Newhouse RP, Walker BB, et al. Toward a transdisciplinary model of evidence-based practice. The Milbank quarterly. 2009;87(2):368–90. Epub 2009/06/04. doi: 10.1111/j.1468-0009.2009.00561.x 19523122.

29. Hoffmann T, Glasziou P. Bringing shared decision making and evidence-based practice together. Shared Decision Making in Health Care. 3 ed. Oxford: Oxford University Press; 2016.

30. Hoffmann TC, Montori VM, Del Mar C. The Connection Between Evidence-Based Medicine and Shared Decision MakingEvidence-based Medicine and Shared Decision MakingEvidence-based Medicine and Shared Decision Making. JAMA. 2014;312(13):1295–6. doi: 10.1001/jama.2014.10186 25268434

31. National AIDS and STI Control Program. EID Dashboard 2018 [6/1/2018]. Available from: https://eid.nascop.org/.

32. Ministry of Health, National AIDS and STI Control Programme. Guidelines on Use of Antiretroviral Drugs for Treating and Preventing HIV Infection in Kenya: 2016 Edition 2016 [5/25/2018]. Available from: https://aidsfree.usaid.gov/sites/default/files/kenya_art_2016.pdf.

33. Meyer DZ, Avery LM. Excel as a Qualitative Data Analysis Tool. Field Methods. 2008;21(1):91–112. doi: 10.1177/1525822X08323985

34. Ose S. Using Excel and Word to Structure Qualitative Data. Journal of Applied Social Science. 2016;10. doi: 10.1177/1936724416664948

35. Mulenga C, Naidoo JR. Nurses' knowledge, attitudes and practices regarding evidence-based practice in the prevention of mother-to-child transmission of HIV programme in Malawi. Curationis. 2017;40(1):e1–e8. doi: 10.4102/curationis.v40i1.1656 28470071.

36. Organization WH. Health Workforce: The crisis 2019 [4 March, 2019]. Available from: https://www.who.int/hrh/strategy/information/en/.

37. Rogers AJ, Weke E, Kwena Z, Bukusi EA, Oyaro P, Cohen CR, et al. Implementation of repeat HIV testing during pregnancy in Kenya: a qualitative study. BMC Pregnancy and Childbirth. 2016;16(1):151. doi: 10.1186/s12884-016-0936-6 27401819

38. Edwards N, Kahwa E, Hoogeveen K. Results of an Integrative Analysis: A Call for Contextualizing HIV and AIDS Clinical Practice Guidelines to Support Evidence-Based Practice. Worldviews on evidence-based nursing. 2017;14(6):492–8. Epub 2017/07/30. doi: 10.1111/wvn.12247 28755393; PubMed Central PMCID: PMC5763348.

39. Wakaba M, Mbindyo P, Ochieng J, Kiriinya R, Todd J, Waudo A, et al. The public sector nursing workforce in Kenya: a county-level analysis. Human resources for health. 2014;12:6. Epub 2014/01/29. doi: 10.1186/1478-4491-12-6 24467776; PubMed Central PMCID: PMC3913960.

40. Burmen B, Owuor N, Mitei P. An assessment of staffing needs at a HIV clinic in a Western Kenya using the WHO workload indicators of staffing need WISN, 2011. Human resources for health. 2017;15(1):9. Epub 2017/01/28. doi: 10.1186/s12960-017-0186-3 28125990; PubMed Central PMCID: PMC5270228.

41. Smith J, Odera DN, Chege D, Muigai EN, Patnaik P, Michaels-Strasser S, et al. Identifying the Gaps: An Assessment of Nurses' Training, Competency, and Practice in HIV Care and Treatment in Kenya. Journal of the Association of Nurses in AIDS Care. 2016;27(3):322–30. doi: 10.1016/j.jana.2016.01.005 27086191

42. Deller B, Tripathi V, Stender S, Otolorin E, Johnson P, Carr C. Task shifting in maternal and newborn health care: key components from policy to implementation. International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics. 2015;130 Suppl 2:S25–31. Epub 2015/06/28. doi: 10.1016/j.ijgo.2015.03.005 26115853.

43. Ministry of Health. Kenya Task Sharing Policy Guidelines Nairobi, Kenya: 2017.

44. Wringe A, Zaba B, Reniers G, Todd J, Church K, Mee P, et al. Identifying gaps in HIV policy and practice along the HIV care continuum: evidence from a national policy review and health facility surveys in urban and rural Kenya. Health policy and planning. 2017;32(9):1316–26. doi: 10.1093/heapol/czx091 28981667

45. Jordan PJ, Bowers CA, Morton D. Barriers to implementing evidence-based practice in a private intensive care unit in the Eastern Cape2016.

46. Wexler C, Maloba M, Brown M, Gautney B, Goggin K, Mabachi N, et al. Evaluating the retention and efficiency of point-of-care HIV testing at birth and 6 weeks in Kenya. Under Review.

47. Wachira J, Braitstein P, Middlestadt S, Reece M, Peng C-YJ. Physician communication behaviors from the perspective of adult HIV patients in Kenya. International Journal for Quality in Health Care. 2014;26(2):190–7. doi: 10.1093/intqhc/mzu004 24519123

48. Ujiji OA, Rubenson B, Ilako F, Marrone G, Wamalwa D, Wangalwa G, et al. Is 'Opt-Out HIV Testing' a real option among pregnant women in rural districts in Kenya? BMC public health. 2011;11(1):151. doi: 10.1186/1471-2458-11-151 21385423

49. Weiser SD, Heisler M, Leiter K, Percy-de Korte F, Tlou S, DeMonner S, et al. Routine HIV testing in Botswana: a population-based study on attitudes, practices, and human rights concerns. PLoS medicine. 2006;3(7):e261. Epub 2006/07/13. doi: 10.1371/journal.pmed.0030261 16834458; PubMed Central PMCID: PMC1502152.

50. Medley AM, Kennedy CE, Lunyolo S, Sweat MD. Disclosure Outcomes, Coping Strategies, and Life Changes Among Women Living With HIV in Uganda. Qualitative Health Research. 2009;19(12):1744–54. doi: 10.1177/1049732309353417 19949223.

51. Kim MH, Ahmed S, Hosseinipour MC, Yu X, Nguyen C, Chimbwandira F, et al. Brief Report: Impact of Option B+ on the Infant PMTCT Cascade in Lilongwe, Malawi. Journal of acquired immune deficiency syndromes (1999). 2015;70(1):99–103. doi: 10.1097/QAI.0000000000000692 26322670.

52. Parker LA, Jobanputra K, Okello V, Nhlangamandla M, Mazibuko S, Kourline T, et al. Implementation and Operational Research: Barriers and Facilitators to Combined ART Initiation in Pregnant Women With HIV: Lessons Learnt From a PMTCT B+ Pilot Program in Swaziland. Journal of acquired immune deficiency syndromes (1999). 2015;69(1):e24–e30. Epub 2015/04/14. doi: 10.1097/QAI.0000000000000537 25622060.

Článek vyšel v časopise


2019 Číslo 11