POC Viral Load Testing in an Antenatal Clinic Setting for Ugandan Pregnant Women Living with HIV: An Implementation Process Analysis.

Introduction: Viral suppression during pregnancy and postpartum sustains the health of mothers living with HIV and reduces risk of transmitting HIV to newborns. Point of care viral load (POC VL) testing improves viral suppression and retention in 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).

Methods: We conducted individual qualitative interviews with 12 (of 16) clinical and research staff who implemented POC VL testing ("implementers"), and 22 (of 151) mothers who received POC VL testing using the Xpert^® HIV-1 Viral Load Assay (Cepheid Inc., Sunnyvale, CA, USA) as part of the trial. Implementer interviews covered knowledge, perceptions and experiences of implementing POC VL testing. Mothers' interviews covered attitudes, perceptions and experiences of receiving POC VL testing. Interview data were collected from December 2021 to September 2022. An inductive, content analytic approach was used to examine the interview transcripts. The goal was to develop thematic content categories addressing the question: How did a group of Ugandan health care providers ("implementers") approach the process of implementing POC VL testing in antenatal care and at delivery for mothers living with HIV?

Results: The inductive analysis of implementers' and mothers' qualitative accounts yielded three themes that speak to how health care staff approached implementation of POC VL testing in the pilot randomized trial. They created an efficient system of communication and then relied on that system to coordinate POC VL testing procedures. They also looked for and found ways of increasing the speed and efficiency of the testing process. Finally, they adopted a "mother-centered" approach to implementation, prioritizing the needs, preferences, and well-being of women in planning and carrying out testing procedures.

Conclusion: As POC VL testing becomes more widely used across high HIV burden settings, understanding how implementers think about and approach the implementation process and what they do to make an intervention successful will be an important part of evaluating feasibility.