title: Implementation of Point-of-Care Diagnostics in Rural Primary Healthcare Clinics in South Africa: Perspectives of Key Stakeholders.
abstract: BACKGROUND
  Key stakeholders' involvement is crucial to the sustainability of quality point-of-care (POC) diagnostics services in low-and-middle income countries. The aim of this study was to explore key stakeholder perceptions on the implementation of POC diagnostics in rural primary healthcare (PHC) clinics in South Africa.
  
  
  METHODS
  We conducted a qualitative study encompassing in-depth interviews with multiple key stakeholders of POC diagnostic services for rural and resource-limited PHC clinics. Interviews were digitally recorded and transcribed verbatim prior to thematic content analysis. Thematic content analysis was conducted using themes guided by the World Health Organisation (WHO) quality-ASSURED (Affordable, Sensitive, Specific, User friendly, Rapid and to enable treatment at first visit and Robust, Equipment free and Delivered to those who need it) criteria for POC diagnostic services in resource-limited settings.
  
  
  RESULTS
  11 key stakeholders participated in the study. All stakeholders perceived the main advantage of POC diagnostics as enabling access to healthcare for rural patients. Stakeholders perceived the current POC diagnostic services to have an ability to meet patients' needs, but recommended further improvement of the following areas: research on cost-effectiveness; improved quality management systems; development of affordable POC diagnostic and clinic-based monitoring and evaluation.
  
  
  CONCLUSIONS
  Key stakeholders of POC diagnostics in rural PHC clinics in South Africa highlighted the need to assess affordability and ensure quality assurance of current services before adopting new POC diagnostics and scaling up current POC diagnostics.
authors.affiliation: Discipline of Public Health Medicine, School of Nursing and Public Health, University of KwaZulu-Natal, Durban 4001, South Africa. Mashamba-Thompson@ukzn.ac.za.
authors.forename: Tivani P
authors.initials: TP
authors.lastname: Mashamba-Thompson
authors.affiliation: Discipline of Rural Health, School of Nursing and Public Health, University of KwaZulu-Natal, Durban 4001, South Africa. Jaman@ukzn.ac.za.
authors.forename: Ngcwalisa A
authors.initials: NA
authors.lastname: Jama
authors.affiliation: Discipline of Public Health Medicine, School of Nursing and Public Health, University of KwaZulu-Natal, Durban 4001, South Africa. Sartorius@ukzn.ac.za.
authors.forename: Benn
authors.initials: B
authors.lastname: Sartorius
authors.affiliation: International Clinical Research Center, Department of Global Health, University of Washington, Seattle, WA 98105, USA. pkdrain@uw.edu.|Division of Infectious Diseases, Department of Medicine, University of Washington, Seattle, WA 98105, USA. pkdrain@uw.edu.|Department of Epidemiology, University of Washington, Seattle, WA 98105, USA. pkdrain@uw.edu.|Department of Surgery, Massachusetts General Hospital, Boston, MA 02114, USA. pkdrain@uw.edu.
authors.forename: Paul K
authors.initials: PK
authors.lastname: Drain
authors.affiliation: Department of Maths, Science and Technology, Embury Institute, Durban, 4001, South Africa. rowant@eite.ac.za.
authors.forename: Rowan M
authors.initials: RM
authors.lastname: Thompson
keywords: key stakeholders; performance; point-of-care diagnostics; primary healthcare clinic