Technology is nothing, the terrain is everything: Factors influencing the implementation of point of care testing for Malaria, Human Immunodeficiency Virus (HIV) and Tuberculosis within East Africa.

Abstract

Point-of-care testing is a central strategy for controlling the infectious diseases Malaria, Human Immunodeficiency Virus (HIV) and Tuberculosis (TB), especially in low and middle-income countries where access to laboratories is scarce. However, its routine implementation into frontline diagnostic practices remains inadequate to meet global targets. This study explored the factors influencing the implementation of malaria, HIV, and TB point-of-care (POC) testing by frontline health workers in primary healthcare settings in a rural county in Coastal Kenya. Adopting a pragmatic philosophical lens, this mixed-methods study drew on Normalisation Process Theory to explore how health providers implemented these POC testing interventions and how they became embedded in routine practice. Frontline health providers participated in a cross-sectional facility survey of 40 public and private primary health facilities, 11 semi-structured interviews, and 7 focus group discussions, providing a comprehensive understanding of the broad context and the in-depth experiences involved in implementing each POC testing process. Descriptive analysis of the survey data was performed using the statistical computing platform R. The qualitative data were analysed thematically using Ritchie & Spencer’s (1994) Social Framework Analysis Approach, with NVivo Version 11 software assisting in the management and systematic analysis process. Applying Cresswell's Convergent Mixed Methods Approach, the datasets were merged to provide a more comprehensive understanding of each POC testing process. The study identified three overarching contextual factors shaping the implementation of POC testing: the capacity to provide laboratory services, the value attributed to patient care and health providers’ work, and access to a supportive network, regardless of whether the POC testing focused on malaria, HIV or TB. In conclusion, the study highlights the dedication and resourcefulness of health providers who, despite the constraints typical of low and middle-income countries, work innovatively to embed the POC testing processes into routine diagnostic practices to enhance patient care.