You are here

  • Home
  • Archive
  • Volume 8, Issue Suppl 10
  • PA-277 Changes in standard care overtaking research: the case of the East African point-of-care (EAPOC) viral load monitoring study in Kilimanjaro and Arusha regions, Tanzania

Article Text

Article menu

Download PDFPDF

Abstracts of Poster and e-Poster Presentations
PA-277 Changes in standard care overtaking research: the case of the East African point-of-care (EAPOC) viral load monitoring study in Kilimanjaro and Arusha regions, Tanzania
Free
  1. Marion Sumari-de Boer1,2,3,
  2. Perry C Msoka1,2,4,
  3. Iraseni U Swai1,4,5,
  4. Alan E Mtenga1,
  5. Kennedy M Ngowi1,
  6. Margaretha Sariko1,
  7. Ria Reis2
  1. 1Kilimanjaro Clinical Research Institute, United Republic of Tanzania
  2. 2Amsterdam Institute for Global Health and Development, The Netherlands
  3. 3Kilimanjaro Christian Medical University College, Tanzania
  4. 4Amsterdam Institute for Social Science Research, The Netherlands
  5. 5Amsterdam UMC, Department of Global Health, The Netherlands

Abstract

Background The proportion of virologically suppressed (83%) people living with HIV (PLHIV) in Tanzania is below the 95%-target. Enhanced adherence counselling (EAC) is given when the viral load (VL) is >1000 copies/ml. Centralised laboratory VL monitoring hinders reaching the 95%-target due to challenges like long turn-around times. Point-of-care (POC) tests may overcome this. The aim was to assess the feasibility of POC monitoring.

Methods We assessed pre-feasibility during preparations of the EAPOC-study, a cluster randomised trial on the effectiveness, acceptability, and feasibility of POC-VL monitoring using m-PIMA in East Africa. M-PIMA gives results within 70 minutes, displayed as <800 copies/ml, or if above 800, an actual number. We used the ‘Measurement Instrument for Determinants of Innovations’ (MIDI) framework to determine feasibility comprising determinants of (1) the innovation, (2) the end-users, (3) the organisation, and (4) the socio-political context. We deployed the MIDI on narratives from meeting minutes, informal conversations, emails, and WhatsApp conversations. We did a thematic framework analysis to identify themes.

Results Considering the innovation, POC was expected to be complex, and there was unclarity in the need for centrifuges. Regarding end-users, nurse counsellors think they can give results rapidly, have beliefs about better treatment outcomes, understand the process and need training. Themes related to the organisation included time availability, re-arrangement of clinic staff to use POC inside the counselling room, counsellors’ self-efficacy, and cartridges’ availability. A central socio-political theme was a change of standard care in study sites whereby EAC was done at VL>50 copies/ml.

Conclusion We identified challenges that may hinder the feasibility of POC for viral load monitoring. We recommend having good manuals and thorough training of staff, well-defined staff duties and available time and a good supply of cartridges. In addition, we advocate for POC devices that display VL copies as low as 50 copies/ml.

https://doi.org/10.1136/bmjgh-2023-EDC.139

Statistics from Altmetric.com

    Request Permissions

    If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.