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Pai NP, Wilkinson S, Deli-Houssein R, et al. Barriers to Implementation of Rapid and Point-of-Care Tests for Human Immunodeficiency Virus Infection: Findings From a Systematic Review (1996-2014). Point Care. 2015;14(3):81-87doi: 10.1097/POC.0000000000000056.
Pai, N. P., Wilkinson, S., Deli-Houssein, R., Vijh, R., Vadnais, C., Behlim, T., Steben, M., Engel, N., & Wong, T. (2015). Barriers to Implementation of Rapid and Point-of-Care Tests for Human Immunodeficiency Virus Infection: Findings From a Systematic Review (1996-2014). Point of care, 14(3), 81-87. https://doi.org/10.1097/POC.0000000000000056
Pai, Nitika Pant, et al. "Barriers to Implementation of Rapid and Point-of-Care Tests for Human Immunodeficiency Virus Infection: Findings From a Systematic Review (1996-2014)." Point of care vol. 14,3 (2015): 81-87. doi: https://doi.org/10.1097/POC.0000000000000056
Pai NP, Wilkinson S, Deli-Houssein R, Vijh R, Vadnais C, Behlim T, Steben M, Engel N, Wong T. Barriers to Implementation of Rapid and Point-of-Care Tests for Human Immunodeficiency Virus Infection: Findings From a Systematic Review (1996-2014). Point Care. 2015 Sep;14(3):81-87. doi: 10.1097/POC.0000000000000056. PMID: 26366129; PMCID: PMC4549862.
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Point Care. 2015 Sep;14(3):81-87. doi: 10.1097/POC.0000000000000056.

Barriers to Implementation of Rapid and Point-of-Care Tests for Human Immunodeficiency Virus Infection: Findings From a Systematic Review (1996-2014).

Point of care

Nitika Pant Pai, Samantha Wilkinson, Roni Deli-Houssein, Rohit Vijh, Caroline Vadnais, Tarannum Behlim, Marc Steben, Nora Engel, Tom Wong

Affiliations

  1. Department of Medicine, McGill University; †Division of Clinical Epidemiology, Department of Medicine, McGill University Health Centre; ‡INSPQ, Montreal, Quebec, Canada; §Department of Health, Ethics & Society, Research School for Public Health and Primary Care, Maastricht University, Maastricht, The Netherlands; and ?Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.

PMID: 26366129 PMCID: PMC4549862 DOI: 10.1097/POC.0000000000000056

Abstract

Implementation of human immunodeficiency virus rapid and point-of-care tests (RDT/POCT) is understood to be impeded by many different factors that operate at 4 main levels-test devices, patients, providers, and health systems-yet a knowledge gap exists of how they act and interact to impede implementation. To fill this gap, and with a view to improving the quality of implementation, we conducted a systematic review.

METHODS: Five databases were searched, 16,672 citations were retrieved, and data were abstracted on 132 studies by 2 reviewers.

FINDINGS: Across 3 levels (ie, patients, providers, and health systems), a majority (59%, 112/190) of the 190 barriers were related to the integration of RDT/POCT, followed by test-device-related concern (ie, accuracy) at 41% (78/190). At the patient level, a lack of awareness about tests (15/54, 28%) and time taken to test (12/54, 22%) dominated. At the provider and health system levels, integration of RDT/POCT in clinical workflows (7/24, 29%) and within hospitals (21/34, 62%) prevailed. Accuracy (57/78, 73%) was dominant only at the device level.

INTERPRETATION: Integration barriers dominated the findings followed by test accuracy. Although accuracy has improved during the years, an ideal implementation could be achieved by improving the integration of RDT/POCT within clinics, hospitals, and health systems, with clear protocols, training on quality assurance and control, clear communication, and linkage plans to improve health outcomes of patients. This finding is pertinent for a future envisioned implementation and global scale-up of RDT/POCT-based initiatives.

Keywords: HIV; barriers; implementation research; point-of-care tests; rapid

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