{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,24]],"date-time":"2026-06-24T20:31:22Z","timestamp":1782333082429,"version":"3.54.5"},"reference-count":40,"publisher":"Public Library of Science (PLoS)","issue":"2","license":[{"start":{"date-parts":[[2026,2,4]],"date-time":"2026-02-04T00:00:00Z","timestamp":1770163200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100001713","name":"European and Developing Countries Clinical Trials Partnership","doi-asserted-by":"crossref","award":["RIA2019I R-2873"],"award-info":[{"award-number":["RIA2019I R-2873"]}],"id":[{"id":"10.13039\/501100001713","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"\n Background<\/jats:title>\n Viral load monitoring has rapidly increased among people living with HIV(PLHIV) in low- and middle-income countries (LMICs), resulting in an increased laboratory workload. The use of innovative Point of Care (PoC) or near Point of Care (n)PoC HIV Viral Load (HIV VL) monitoring has enabled improved patient care, a reduction in laboratory workload, improved clinic retention and reduced turnaround time of results. However, implementation bottlenecks of such methods are uncertain, especially when PoC or (n)PoC is implemented in remote areas in low-volume clinics.<\/jats:p>\n <\/jats:sec>\n \n Objectives<\/jats:title>\n The main aim of this study was to review implementation research outcomes of (n)PoC HIV VL monitoring for PLHIV in LMICs.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n We qualitatively synthesised peer-reviewed papers to explore implementation research outcomes (IROs) of (n)PoC HIV VL monitoring. We identified studies published between January 2013 and June 2024. We used the IROs described by Proctor et al., which are acceptability, adoption, appropriateness, cost, feasibility, fidelity, penetration and sustainability. We searched using the following Mesh terms: Point of care testing, HIV, viral load, acceptability, patient acceptance of health care, adoption, facilities and services utilisation, appropriateness, cost, feasibility, fidelity, penetration, coverage, sustainability and continuity of patient care through PubMed, Cochrane and Scopus. The PRISMA diagram in the Fig 1 presents the selection process of included papers.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n Twenty studies reported implementation outcomes of PoC or (n)PoC HIV VL monitoring. Near PoC HIV VL monitoring using GeneXpert is considered acceptable to patients and healthcare providers. Point of care HIV VL monitoring using mPIMA was feasible as patients received the results the same day. From a health service provider\u2019s perspective, PoC HIV VL monitoring was acceptable because it influenced patients to accept the illness and adhere to medication. Additionally, there was high testing coverage in routine PoC HIV VL monitoring centres. Fidelity was questionable in some settings due to (n)PoC HIV VL monitoring results not being delivered as intended. Additionally, we found in several studies that the (n)PoC costs are higher than standard of care test, USD 54.93 per test, at low testing volume clinics conducting 20VL tests per month compared to costs of USD 24.25 at high testing volume clinics conducting 100VL tests per month, while centralised testing costs USD 25.65 per test. However, costs are expected to be lower when (n)PoC HIV VL monitoring is scaled up and targeted for those at risk.<\/jats:p>\n <\/jats:sec>\n \n Conclusion<\/jats:title>\n Implementation of PoC or (n)PoC testing for HIV viral load monitoring is acceptable and feasible and can reach a vast population. However, higher costs, limited fidelity, lower penetration and limited sustainability may hinder using (n)PoC testing in improving patient care and health outcomes. More knowledge and training should be implemented to overcome these challenges.<\/jats:p>\n <\/jats:sec>\n \n Registration Number<\/jats:title>\n PROSPERO 2023 CRD42023394668<\/jats:p>\n <\/jats:sec>","DOI":"10.1371\/journal.pone.0313802","type":"journal-article","created":{"date-parts":[[2026,2,4]],"date-time":"2026-02-04T18:36:17Z","timestamp":1770230177000},"page":"e0313802","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":3,"title":["Implementation of point of care HIV viral load monitoring for people living with HIV in low- and middle-income countries: A systematic review on implementation research outcomes"],"prefix":"10.1371","volume":"21","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9315-5495","authenticated-orcid":true,"given":"Perry","family":"Msoka","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Iraseni","family":"Swai","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kennedy","family":"Ngowi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ria","family":"Reis","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andreja","family":"Lekic","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Blandina T.","family":"Mmbaga","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anita","family":"Hardon","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5433-0406","authenticated-orcid":true,"given":"Marion","family":"Sumari-de Boer","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2026,2,4]]},"reference":[{"key":"pone.0313802.ref001","unstructured":"UNAIDS. Fact Sheet 2024 - Latest Global and Regional HIV Statistics on the Status of the AIDS Epidemic.; 2024."},{"key":"pone.0313802.ref002","year":"2023"},{"key":"pone.0313802.ref003","author":"WHO. The role of HIV viral suppression in improving individual health and reducing transmission: policy brief","year":"2023"},{"issue":"2","key":"pone.0313802.ref004","doi-asserted-by":"crossref","first-page":"157","DOI":"10.1097\/COH.0000000000000352","article-title":"HIV viral load scale-up: multiple interventions to meet the HIV treatment cascade","volume":"12","author":"S Carmona","year":"2017","journal-title":"Curr Opin HIV AIDS"},{"key":"pone.0313802.ref005","volume":"3","author":"WHO","year":"2015","journal-title":"Consolidated Guidelines on HIV Testing Services 2015"},{"issue":"5","key":"pone.0313802.ref006","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0216277","article-title":"Performance of non-laboratory staff for diagnostic testing and specimen collection in HIV programs: A systematic review and meta-analysis","volume":"14","author":"L Vojnov","year":"2019","journal-title":"PLoS One"},{"issue":"4","key":"pone.0313802.ref007","article-title":"Near point-of-care HIV viral load testing: Cascade after high viral load in suburban Yangon, Myanmar","volume":"18","author":"NN Tun","year":"2023","journal-title":"PLoS One"},{"issue":"3","key":"pone.0313802.ref008","doi-asserted-by":"crossref","DOI":"10.1128\/CMR.00097-18","article-title":"Point-of-care HIV viral load testing: An essential tool for a sustainable global HIV\/AIDS Response","volume":"32","author":"PK Drain","year":"2019","journal-title":"Clin Microbiol Rev"},{"key":"pone.0313802.ref009","doi-asserted-by":"crossref","unstructured":"Meggi B, Bollinger T, Zitha A. Performance of a true point-of-care assay for HIV-1\/2 viral load measurement at antenatal and postpartum services. 2021.","DOI":"10.1097\/QAI.0000000000002621"},{"issue":"9","key":"pone.0313802.ref010","doi-asserted-by":"crossref","first-page":"3377","DOI":"10.1128\/JCM.00593-14","article-title":"SAMBA HIV semiquantitative test, a new point-of-care viral-load-monitoring assay for resource-limited settings","volume":"52","author":"AV Ritchie","year":"2014","journal-title":"J Clin Microbiol"},{"issue":"6","key":"pone.0313802.ref011","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0218369","article-title":"Systematic review of the performance and clinical utility of point of care HIV-1 RNA testing for diagnosis and care","volume":"14","author":"CA Agutu","year":"2019","journal-title":"PLoS One"},{"key":"pone.0313802.ref012","article-title":"Meeting Report. Molecular diagnostics integration global meeting report.","year":"2019"},{"issue":"2","key":"pone.0313802.ref013","doi-asserted-by":"crossref","first-page":"65","DOI":"10.1007\/s10488-010-0319-7","article-title":"Outcomes for implementation research: Conceptual distinctions, measurement challenges, and research agenda","volume":"38","author":"E Proctor","year":"2011","journal-title":"Adm Policy Ment Health"},{"key":"pone.0313802.ref014","article-title":"Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015: elaboration and explanation","volume":"350","author":"L Shamseer","year":"2015","journal-title":"BMJ"},{"key":"pone.0313802.ref015","unstructured":"Wells G, Shea B, Robertson J. The Newcastle-Ottawa Scale (NOS) for Assessing the Quality of Nonrandomized Studies in Meta-Analysis. 2023."},{"key":"pone.0313802.ref016","article-title":"PRISMA 2020 explanation and elaboration: Updated guidance and exemplars for reporting systematic reviews","volume":"372","author":"MJ Page","year":"2021","journal-title":"BMJ"},{"issue":"1","key":"pone.0313802.ref017","doi-asserted-by":"crossref","first-page":"140","DOI":"10.3390\/diagnostics11010140","article-title":"Costs of point-of-care viral load testing for adults and children living with HIV in Kenya","volume":"11","author":"MA Bulterys","year":"2021","journal-title":"Diagnostics (Basel)"},{"issue":"4","key":"pone.0313802.ref018","doi-asserted-by":"crossref","DOI":"10.1016\/S2352-3018(19)30402-3","article-title":"Point-of-care HIV viral load testing combined with task shifting to improve treatment outcomes (STREAM): Findings from an open-label, non-inferiority, randomised controlled trial","volume":"7","author":"PK Drain","year":"2020","journal-title":"Lancet HIV"},{"issue":"4","key":"pone.0313802.ref019","doi-asserted-by":"crossref","DOI":"10.1016\/S2352-3018(20)30279-4","article-title":"Cost-effectiveness of point-of-care testing with task-shifting for HIV care in South Africa: A modelling study","volume":"8","author":"M Sharma","year":"2021","journal-title":"Lancet HIV"},{"issue":"10","key":"pone.0313802.ref020","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0223669","article-title":"Comparative cost analysis of point-of-care versus laboratory-based testing to initiate and monitor HIV treatment in South Africa","volume":"14","author":"K Simeon","year":"2019","journal-title":"PLoS One"},{"issue":"1","key":"pone.0313802.ref021","doi-asserted-by":"crossref","first-page":"30","DOI":"10.1016\/j.bjid.2019.10.010","article-title":"Development and validation of a simple and rapid way to generate low volume of plasma to be used in point-of-care HIV virus load technologies","volume":"24","author":"I Vasconcellos","year":"2020","journal-title":"Braz J Infect Dis"},{"key":"pone.0313802.ref022","doi-asserted-by":"crossref","first-page":"100231","DOI":"10.1016\/j.eclinm.2019.12.001","article-title":"Determining virological suppression and resuppression by point-of-care viral load testing in a HIV care setting in sub-Saharan Africa","volume":"18","author":"G Villa","year":"2020","journal-title":"EClinicalMedicine"},{"issue":"15","key":"pone.0313802.ref023","doi-asserted-by":"crossref","first-page":"2531","DOI":"10.1097\/QAD.0000000000003031","article-title":"Feasibility and impact of near-point-of-care integrated tuberculosis\/HIV testing in Malawi and Zimbabwe","volume":"35","author":"M Wang","year":"2021","journal-title":"AIDS"},{"issue":"2","key":"pone.0313802.ref024","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0212972","article-title":"Economic and public health impact of decentralized HIV viral load testing: A modelling study in Kenya","volume":"14","author":"M de Necker","year":"2019","journal-title":"PLoS One"},{"issue":"8","key":"pone.0313802.ref025","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0221586","article-title":"Optimizing viral load testing access for the last mile: Geospatial cost model for point of care instrument placement","volume":"14","author":"SJ Girdwood","year":"2019","journal-title":"PLoS One"},{"key":"pone.0313802.ref026","doi-asserted-by":"crossref","first-page":"100607","DOI":"10.1016\/j.eclinm.2020.100607","article-title":"Cost-effectiveness of adoption strategies for point of care HIV viral load monitoring in South Africa","volume":"28","author":"SJ Girdwood","year":"2020","journal-title":"EClinicalMedicine"},{"key":"pone.0313802.ref027","doi-asserted-by":"crossref","DOI":"10.1002\/jia2.25663","article-title":"Evaluation of near point-of-care viral load implementation in public health facilities across seven countries in sub-Saharan Africa","author":"CE Boeke","year":"2021"},{"issue":"3","key":"pone.0313802.ref028","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pgph.0001678","article-title":"It takes more than a machine: A pilot feasibility study of point-of-care HIV-1 viral load testing at a lower-level health center in rural western Uganda","volume":"3","author":"RM Boyce","year":"2023","journal-title":"PLOS Glob Public Health"},{"issue":"9","key":"pone.0313802.ref029","doi-asserted-by":"crossref","first-page":"1483","DOI":"10.1097\/QAD.0b013e328360a4e5","article-title":"Cost-effectiveness of point-of-care viral load monitoring of antiretroviral therapy in resource-limited settings: mathematical modelling study","volume":"27","author":"J Estill","year":"2013","journal-title":"AIDS"},{"key":"pone.0313802.ref030","doi-asserted-by":"crossref","unstructured":"Ganesh P, Heller T, Chione B. Near point-of-care HIV viral load: targeted testing at large facilities. 2020.","DOI":"10.1097\/QAI.0000000000002555"},{"issue":"2","key":"pone.0313802.ref031","doi-asserted-by":"crossref","first-page":"184","DOI":"10.1111\/tmi.13519","article-title":"Implementation and operational feasibility of SAMBA I HIV-1 semi-quantitative viral load testing at the point-of-care in rural settings in Malawi and Uganda","volume":"26","author":"M Gueguen","year":"2021","journal-title":"Trop Med Int Health"},{"key":"pone.0313802.ref032","doi-asserted-by":"crossref","DOI":"10.1002\/jia2.25487","article-title":"Point-of-care HIV maternal viral load and early infant diagnosis testing around time of delivery at tertiary obstetric units in South Africa: A prospective study of coverage, results return and turn-around times","author":"T Kufa","year":"2020"},{"issue":"1","key":"pone.0313802.ref033","doi-asserted-by":"crossref","first-page":"1081","DOI":"10.1186\/s12913-020-05940-w","article-title":"Acceptability of point-of-care viral load testing to facilitate differentiated care: A qualitative assessment of people living with HIV and nurses in South Africa","volume":"20","author":"L Msimango","year":"2020","journal-title":"BMC Health Serv Res"},{"issue":"3","key":"pone.0313802.ref034","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0193577","article-title":"Multidisease testing for HIV and TB using the GeneXpert platform: A feasibility study in rural Zimbabwe","volume":"13","author":"Z Ndlovu","year":"2018","journal-title":"PLoS One"},{"issue":"8","key":"pone.0313802.ref035","doi-asserted-by":"crossref","DOI":"10.1002\/jia2.25387","article-title":"Point-of-care viral load monitoring: Outcomes from a decentralized HIV programme in Malawi","volume":"22","author":"S Nicholas","year":"2019","journal-title":"J Int AIDS Soc"},{"issue":"4","key":"pone.0313802.ref036","doi-asserted-by":"crossref","first-page":"409","DOI":"10.1080\/09540121.2021.1981816","article-title":"Point-of-care viral load testing among adolescents and young adults living with HIV in Haiti: A randomized control trial","volume":"34","author":"LK Reif","year":"2022","journal-title":"AIDS Care"},{"issue":"1","key":"pone.0313802.ref037","doi-asserted-by":"crossref","first-page":"408","DOI":"10.1186\/s12913-017-2353-6","article-title":"Making HIV testing work at the point of care in South Africa: A qualitative study of diagnostic practices","volume":"17","author":"N Engel","year":"2017","journal-title":"BMC Health Serv Res"},{"key":"pone.0313802.ref038","author":"UNICEF","year":"2018"},{"key":"pone.0313802.ref039","author":"T Tembo","year":"2022"},{"issue":"7","key":"pone.0313802.ref040","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0182005","article-title":"Health care workers\u2019 perceptions of point-of-care testing in a low-income country-A qualitative study in Southwestern Uganda","volume":"12","author":"R Rasti","year":"2017","journal-title":"PLoS One"}],"container-title":["PLOS One"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0313802","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,2,4]],"date-time":"2026-02-04T18:36:43Z","timestamp":1770230203000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0313802"}},"subtitle":[],"editor":[{"given":"Gideon","family":"Zulu","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2026,2,4]]},"references-count":40,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2026,2,4]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0313802","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,2,4]]}}}