POC viral load testing in an antenatal clinic setting for Ugandan pregnant women living with HIV: a qualitative implementation process analysis

Point of care viral load (POC VL) testing improves viral suppression and retention in HIV care, and is increasingly being integrated into routine health services for African pregnant women living with HIV. We examined processes of implementing POC VL testing in antenatal care and at delivery for Ugandan mothers living with HIV as part of a pilot randomized trial (Clinical Trial Number: NCT05092997). We conducted individual qualitative interviews with 12 clinical and research staff who implemented POC VL testing and 22 mothers who received POC VL testing using the Xpert® HIV-1 Viral Load Assay (Cepheid Inc., Sunnyvale, CA, USA). An inductive, content analytic approach was used to examine the interview transcripts. The analysis addressed the question: How did a group of Ugandan health care providers approach the process of implementing POC VL testing in antenatal care and at delivery for mothers living with HIV? The analysis yielded three themes. (1) Staff created an efficient system of communication and then relied on that system to coordinate testing procedures. (2) They also found ways of increasing the speed and efficiency of the testing process. (3) They adopted a “mother-centered” approach to implementation, prioritizing the needs, preferences, and well-being of women in planning and carrying out testing procedures. As POC VL testing becomes more widely used across high HIV burden settings, understanding how implementers approach the implementation process and what they do to make an intervention successful will be an important part of evaluating feasibility. Clinical Trial Number: NCT05092997.