title: Point-of-care diagnostics: extending the laboratory network to reach the last mile.
abstract: More point-of-care (POC) diagnostic tests are becoming available for HIV diagnosis and treatment in resource-limited settings. These novel technologies have the potential to foster decentralized HIV care and treatment for the benefit of clinical laboratories, HIV clinics, and HIV-infected patients. There continue to be many business, technological, and operational challenges that limit product development and regulatory approval, which limits products available for the required operational and cost-effectiveness studies and delays policy adoption and implementation.
  
  
  
  Although the rapid HIV diagnostic test has been widely successful, the pathways for POC CD4 cell count and HIV viral load assay analyzers have been more challenging. We describe significant hurdles for product development, approval, and implementation, which include the business case, technical development, clinical impact, and integrating laboratory and clinical networks.
  
  
  
  The objective of this review is to highlight the obstacles for developing and implementing appropriate strategies for POC HIV testing assays to improve the clinical services for HIV-infected patients in resource-limited settings.
authors.affiliation: aDepartment of Global Health bDepartment of Medicine cDepartment of Epidemiology, University of Washington, Seattle, Washington dDepartment of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts eBill and Melinda Gates Foundation, Seattle, Washington, USA.
authors.forename: Paul K
authors.initials: PK
authors.lastname: Drain
authors.forename: Christine
authors.initials: C
authors.lastname: Rousseau
mesh_terms: D018791:CD4 Lymphocyte Count / Q000379:methods; D015658:HIV Infections / Q000175:diagnosis* / Q000276:immunology / Q000821:virology*; D006801:Humans; D019095:Point-of-Care Systems; D019562:Viral Load / Q000379:methods*