{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,12]],"date-time":"2026-06-12T17:58:00Z","timestamp":1781287080423,"version":"3.54.1"},"reference-count":29,"publisher":"Public Library of Science (PLoS)","issue":"6","license":[{"start":{"date-parts":[[2026,6,12]],"date-time":"2026-06-12T00:00:00Z","timestamp":1781222400000},"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"}]},{"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"}]},{"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":"<jats:sec id=\"sec001\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Near point-of-care (n)POC Human Immunodeficiency Virus (HIV) viral load (VL) monitoring, consisting of VL testing in laboratories close to HIV treatment facilities, improves turnaround time from sampling to result. Other benefits of using nPOC monitoring are reduced laboratory workload, and limited loss of results, all leading to improved clinic retention and treatment adherence. However, the specific implementation bottlenecks are still unclear. This study aims to investigate the bottlenecks in the implementation of nPOC HIV VL monitoring among children and young people (ages 0\u201324 years) living with HIV, as experienced by healthcare workers (HCWs) in Tanzania.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec002\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We conducted observations in clinics and in-depth interviews with HCWs from January 2023 to January 2024 at Tanzanian intervention sites within the East Africa Point-of-Care Viral Load Monitoring (EAPOC-VL) study. The EAPOC-VL study was conducted in four countries in East Africa (Tanzania, Kenya, Rwanda, Uganda). It was a cluster-randomised controlled trial, in which participants were tested at three time points (months 0, 6, and 12). We purposively selected 25 HCWs involved in implementing nPOC at the intervention sites for in-depth interviews. We interviewed HCWs at baseline (month 0) and after the initiation of nPOC HIV VL monitoring (months 1 and 6). We conducted deductive thematic framework analysis using the Measurement Instrument for Determinants of Innovations (MIDI), to which an inductive approach was added to identify facilitators and barriers across intervention, provider, organisational, social and political contexts. We used NVivo 12 to organise the data.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec003\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>A total of 75 interviews were conducted among 43 HCWs across 3 time points: 33 at baseline (T0), 25 at month 1 (T1; 19 participants from T0 and 6 new participants) and 17 at month 6 follow up (T2;6 participants from T1, 7 returning participants from T0 and 4 new participants). Observations and interviews showed that nPOC HIV VL testing improved result turnaround time and enabled same-day counselling, which motivated both HCWs and clients. This data showed that knowledge, confidence, and adherence to procedures after training. Near POC, HIV VL was supported by compatibility with existing practices, strong teamwork, and management commitment. However, challenges included clients waiting at the clinic for over two hours to receive their results, the scarcity of resources, such as rooms and electricity, and staff shortages. Finally, delays were observed when samples had to be transported to nearby laboratories.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec004\">\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Near POC HIV VL monitoring shortens turnaround times and enables immediate counselling. To maximise these benefits, there is a need to prioritise investment in staff training, infrastructure, improving sample handling\/turnaround time and guideline alignment. Developing these areas will enhance service delivery and allow for improved outcomes among children and young people living with HIV.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1371\/journal.pone.0351304","type":"journal-article","created":{"date-parts":[[2026,6,12]],"date-time":"2026-06-12T17:24:23Z","timestamp":1781285063000},"page":"e0351304","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":0,"title":["Implementation bottlenecks of near point of care HIV viral load monitoring for children and young people in Tanzania: A Qualitative Study"],"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":"Alan","family":"Mtenga","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rehema","family":"Maro","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rhoda","family":"Akello","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Iraseni Ufoo","family":"Swai","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Blandina T.","family":"Mmbaga","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ria","family":"Reis","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marion Sumari-de","family":"Boer","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2026,6,12]]},"reference":[{"key":"pone.0351304.ref001","author":"UNAIDS","year":"2024"},{"key":"pone.0351304.ref002","author":"Ofisi ya Taifa ya Takwimu"},{"key":"pone.0351304.ref003","year":"2023"},{"key":"pone.0351304.ref004","author":"UNAIDS","year":"2025"},{"issue":"8","key":"pone.0351304.ref005","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0255227","article-title":"To achieve 95-95-95 targets we must reach men and youth: High level of knowledge of HIV status, ART coverage, and viral suppression in the Botswana Combination Prevention Project through universal test and treat approach","volume":"16","author":"R Lebelonyane","year":"2021","journal-title":"PLoS One"},{"key":"pone.0351304.ref006","article-title":"Viral suppression among children and their caregivers living with HIV in western Kenya","author":"JM Humphrey","year":"2019","journal-title":"J Int AIDS Soc"},{"issue":"5","key":"pone.0351304.ref007","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0276411","article-title":"Barriers and facilitators to anti-retroviral therapy adherence among adolescents aged 10 to 19 years living with HIV in sub-Saharan Africa: A mixed-methods systematic review and meta-analysis","volume":"18","author":"LD Hlophe","year":"2023","journal-title":"PLoS One"},{"key":"pone.0351304.ref008","author":"D Meg","year":"2021"},{"key":"pone.0351304.ref009","author":"World Health Organization","year":"2017"},{"key":"pone.0351304.ref010","author":"UNAIDS","year":"2020"},{"issue":"4","key":"pone.0351304.ref011","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":"1","key":"pone.0351304.ref012","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":"7","key":"pone.0351304.ref013","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"},{"issue":"1","key":"pone.0351304.ref014","doi-asserted-by":"crossref","first-page":"33","DOI":"10.1186\/s12981-024-00619-2","article-title":"Xpert HIV-1 qual point-of-care testing for HIV early infant diagnosis in Tanzania: experiences and perceptions of health care workers in a 2016 study","volume":"21","author":"S Boniface","year":"2024","journal-title":"AIDS Res Ther"},{"key":"pone.0351304.ref015","doi-asserted-by":"crossref","first-page":"59","DOI":"10.1177\/1525822X05279903","article-title":"How many interviews are enough?: An experiment with data saturation and variability","volume":"18","author":"G Guest","year":"2006","journal-title":"Field Methods"},{"issue":"5","key":"pone.0351304.ref016","doi-asserted-by":"crossref","first-page":"587","DOI":"10.1177\/1049732315576699","article-title":"\u201cData were saturated\u2026\u201d","volume":"25","author":"JM Morse","year":"2015","journal-title":"Qual Health Res"},{"issue":"5","key":"pone.0351304.ref017","doi-asserted-by":"crossref","first-page":"501","DOI":"10.1093\/intqhc\/mzu060","article-title":"Towards a measurement instrument for determinants of innovations","volume":"26","author":"MAH Fleuren","year":"2014","journal-title":"Int J Qual Health Care"},{"issue":"4","key":"pone.0351304.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.0351304.ref019","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.0351304.ref020","doi-asserted-by":"crossref","first-page":"72","DOI":"10.3390\/diagnostics14010072","article-title":"\u201cIt Soothes Your Heart\u201d: A Multimethod Study Exploring Acceptability of Point-of-Care Viral Load Testing among Ugandan Pregnant and Postpartum Women Living with HIV","volume":"14","author":"A Nakyanzi","year":"2023","journal-title":"Diagnostics (Basel)"},{"issue":"3","key":"pone.0351304.ref021","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":"1","key":"pone.0351304.ref022","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"},{"issue":"3","key":"pone.0351304.ref023","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":"1","key":"pone.0351304.ref024","doi-asserted-by":"crossref","first-page":"222","DOI":"10.1186\/s12879-023-08155-6","article-title":"Decentralization of viral load testing to improve HIV care and treatment cascade in rural Tanzania: observational study from the Kilombero and Ulanga Antiretroviral Cohort","volume":"23","author":"D Mnzava","year":"2023","journal-title":"BMC Infect Dis"},{"issue":"1","key":"pone.0351304.ref025","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","volume":"24","author":"CE Boeke","year":"2021","journal-title":"J Int AIDS Soc"},{"key":"pone.0351304.ref026","doi-asserted-by":"crossref","first-page":"44","DOI":"10.1093\/heapol\/czad111","article-title":"Using queueing models as a decision support tool in allocating point-of-care HIV viral load testing machines in Kisumu County, Kenya","volume":"39","author":"Y Wang","year":"2024","journal-title":"Health Policy and Planning"},{"issue":"2","key":"pone.0351304.ref027","doi-asserted-by":"crossref","first-page":"258","DOI":"10.1097\/QAI.0000000000002555","article-title":"Near Point-of-Care HIV Viral Load: Targeted Testing at Large Facilities","volume":"86","author":"P Ganesh","year":"2021","journal-title":"J Acquir Immune Defic Syndr"},{"issue":"1","key":"pone.0351304.ref028","doi-asserted-by":"crossref","first-page":"863","DOI":"10.1186\/s12913-021-06797-3","article-title":"Operational experiences associated with the implementation of near point-of-care early infant diagnosis of HIV in Myanmar: a qualitative study","volume":"21","author":"WL Yee","year":"2021","journal-title":"BMC Health Serv Res"},{"issue":"4","key":"pone.0351304.ref029","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","volume":"23","author":"T Kufa","year":"2020","journal-title":"J Int AIDS Soc"}],"container-title":["PLOS One"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0351304","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,12]],"date-time":"2026-06-12T17:24:32Z","timestamp":1781285072000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0351304"}},"subtitle":[],"editor":[{"given":"Hamufare Dumisani","family":"Mugauri","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2026,6,12]]},"references-count":29,"journal-issue":{"issue":"6","published-online":{"date-parts":[[2026,6,12]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0351304","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,6,12]]}}}