Point-of-care (POC) innovations are healthcare interventions that have great potential to improve diagnostic capacities of healthcare systems in low- and middle-income countries (LMICs). From the implementation science perspective, this study explores perceptions of key stakeholders on deficiencies in accessibility of POC diagnostics in the context of prevention of mother-to-child transmission (PMTCT) services in Zambia.

Methods A retrospective qualitative evaluation was conducted to understand factors that influence POC diagnostic implementation in rural primary healthcare (PHC) settings. The study was conducted among key implementing stakeholders in Zambia. In-depth interviews were held with 11 purposefully selected key informants, including clinical officers, midwives, nurses, environmental health technicians (EHTs), government and private health officials. The interviews were audio-recorded and transcribed verbatim. Following coding, thematic content analysis was applied and the main emerging themes were analysed through the lens of the Consolidated Framework for Implementation Research (CFIR). The CFIR was identified as the most appropriate model to interpret our findings.

Results Factors influencing implementation were represented in all five domains. Major constructs as facilitators were the relative advantage of the intervention, external partnership, education and training, knowledge and belief, self-efficacy, and engagement of champions. Barriers were mainly found in the outer and inner settings, including constraints in financial resources, supply chain challenges resulting in stock-outs, insufficient human resources leading to increased workload, and other infrastructural issues like space limitations and lack of electricity in most rural primary healthcare settings.

Conclusions The study identified key determinants that supported or hindered the implementation of POC diagnostics in the rural PHCs. Greater efforts are needed to overcome barriers at multi-sectoral level for effective implementation while leveraging on facilitators through a health system strengthening approach. These findings are key to informing future implementations, sustainability and scale-up of POC diagnostics interventions.

The authors have declared no competing interest.

This work was supported through resources from the Sub-Saharan African Network for TB/HIV Research Excellence (SANTHE).

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The study was approved by the University of KwaZulu-Natal, Biomedical Research Ethics Committee (BREC Ref No: BE650/17) and the University of Zambia, Biomedical Research Ethics Committee (Approval Number: 012-02-18). Further permission and authority to collect data from the health facilities was obtained from the Zambia National Health Research Authority (ZNHA) and Provincial and District Health Office.

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