title: Barriers to Implementation of Rapid and Point-of-Care Tests for Human Immunodeficiency Virus Infection: Findings From a Systematic Review (1996-2014).
abstract: Implementation of human immunodeficiency virus rapid and point-of-care tests (RDT/POCT) is understood to be impeded by many different factors that operate at 4 main levels-test devices, patients, providers, and health systems-yet a knowledge gap exists of how they act and interact to impede implementation. To fill this gap, and with a view to improving the quality of implementation, we conducted a systematic review.
  
  
  METHODS
  Five databases were searched, 16,672 citations were retrieved, and data were abstracted on 132 studies by 2 reviewers.
  
  
  RESULTS
  Across 3 levels (ie, patients, providers, and health systems), a majority (59%, 112/190) of the 190 barriers were related to the integration of RDT/POCT, followed by test-device-related concern (ie, accuracy) at 41% (78/190). At the patient level, a lack of awareness about tests (15/54, 28%) and time taken to test (12/54, 22%) dominated. At the provider and health system levels, integration of RDT/POCT in clinical workflows (7/24, 29%) and within hospitals (21/34, 62%) prevailed. Accuracy (57/78, 73%) was dominant only at the device level.
  
  
  CONCLUSIONS
  Integration barriers dominated the findings followed by test accuracy. Although accuracy has improved during the years, an ideal implementation could be achieved by improving the integration of RDT/POCT within clinics, hospitals, and health systems, with clear protocols, training on quality assurance and control, clear communication, and linkage plans to improve health outcomes of patients. This finding is pertinent for a future envisioned implementation and global scale-up of RDT/POCT-based initiatives.
authors.affiliation: Department of Medicine, McGill University; †Division of Clinical Epidemiology, Department of Medicine, McGill University Health Centre; ‡INSPQ, Montreal, Quebec, Canada; §Department of Health, Ethics & Society, Research School for Public Health and Primary Care, Maastricht University, Maastricht, The Netherlands; and ∥Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Nitika Pant
authors.initials: NP
authors.lastname: Pai
authors.affiliation: Department of Medicine, McGill University; †Division of Clinical Epidemiology, Department of Medicine, McGill University Health Centre; ‡INSPQ, Montreal, Quebec, Canada; §Department of Health, Ethics & Society, Research School for Public Health and Primary Care, Maastricht University, Maastricht, The Netherlands; and ∥Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Samantha
authors.initials: S
authors.lastname: Wilkinson
authors.affiliation: Department of Medicine, McGill University; †Division of Clinical Epidemiology, Department of Medicine, McGill University Health Centre; ‡INSPQ, Montreal, Quebec, Canada; §Department of Health, Ethics & Society, Research School for Public Health and Primary Care, Maastricht University, Maastricht, The Netherlands; and ∥Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Roni
authors.initials: R
authors.lastname: Deli-Houssein
authors.affiliation: Department of Medicine, McGill University; †Division of Clinical Epidemiology, Department of Medicine, McGill University Health Centre; ‡INSPQ, Montreal, Quebec, Canada; §Department of Health, Ethics & Society, Research School for Public Health and Primary Care, Maastricht University, Maastricht, The Netherlands; and ∥Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Rohit
authors.initials: R
authors.lastname: Vijh
authors.affiliation: Department of Medicine, McGill University; †Division of Clinical Epidemiology, Department of Medicine, McGill University Health Centre; ‡INSPQ, Montreal, Quebec, Canada; §Department of Health, Ethics & Society, Research School for Public Health and Primary Care, Maastricht University, Maastricht, The Netherlands; and ∥Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Caroline
authors.initials: C
authors.lastname: Vadnais
authors.affiliation: Department of Medicine, McGill University; †Division of Clinical Epidemiology, Department of Medicine, McGill University Health Centre; ‡INSPQ, Montreal, Quebec, Canada; §Department of Health, Ethics & Society, Research School for Public Health and Primary Care, Maastricht University, Maastricht, The Netherlands; and ∥Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Tarannum
authors.initials: T
authors.lastname: Behlim
authors.affiliation: Department of Medicine, McGill University; †Division of Clinical Epidemiology, Department of Medicine, McGill University Health Centre; ‡INSPQ, Montreal, Quebec, Canada; §Department of Health, Ethics & Society, Research School for Public Health and Primary Care, Maastricht University, Maastricht, The Netherlands; and ∥Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Marc
authors.initials: M
authors.lastname: Steben
authors.affiliation: Department of Medicine, McGill University; †Division of Clinical Epidemiology, Department of Medicine, McGill University Health Centre; ‡INSPQ, Montreal, Quebec, Canada; §Department of Health, Ethics & Society, Research School for Public Health and Primary Care, Maastricht University, Maastricht, The Netherlands; and ∥Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Nora
authors.initials: N
authors.lastname: Engel
authors.affiliation: Department of Medicine, McGill University; †Division of Clinical Epidemiology, Department of Medicine, McGill University Health Centre; ‡INSPQ, Montreal, Quebec, Canada; §Department of Health, Ethics & Society, Research School for Public Health and Primary Care, Maastricht University, Maastricht, The Netherlands; and ∥Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Tom
authors.initials: T
authors.lastname: Wong
keywords: HIV; barriers; implementation research; point-of-care tests; rapid