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Qualitative assessment of South African healthcare worker perspectives on an instrument-free rapid CD4 test

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      Accurate measurement of CD4 cell counts remains an important tenet of clinical care for people living with HIV. We assessed an instrument-free point-of-care CD4 test (VISITECT® CD4) based on a lateral flow principle, which gives visual results after 40 min. The test involves five steps and categorises CD4 counts as above or below 350 cells/μL. As one component of a performance evaluation of the test, this qualitative study explored the views of healthcare workers in a large women and children’s hospital on the acceptability and feasibility of the test.


      Perspectives on the VISITECT® CD4 test were elicited through in-depth interviews with eight healthcare workers involved in the performance evaluation at an antenatal care facility in Johannesburg, South Africa. Audio recordings were transcribed in full and analysed thematically.


      Healthcare providers recognised the on-going relevance of CD4 testing. All eight perceived the VISITECT® CD4 test to be predominantly user-friendly, although some felt that the need for precision and optimal concentration in performing test procedures made it more challenging to use. The greatest strength of the test was perceived to be its quick turn-around of results. There were mixed views on the semi-quantitative nature of the test results and how best to integrate this test into existing health services. Participants believed that patients in this setting would likely accept the test, given their general familiarity with other point-of-care tests.


      Overall, the VISITECT® CD4 test was acceptable to healthcare workers and those interviewed were supportive of scale-up and implementation in other antenatal care settings. Both health workers and patients will need to be oriented to the semi-quantitative nature of the test and how to interpret the results of tests.

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      The online version of this article (10.1186/s12913-019-3948-x) contains supplementary material, which is available to authorized users.

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      Most cited references 35

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      Using thematic analysis in psychology

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        Point-of-Care Testing for Infectious Diseases: Diversity, Complexity, and Barriers in Low- And Middle-Income Countries

        Madhukar Pai and colleagues discuss a framework for envisioning how point-of-care testing can be applied to infectious diseases in low- and middle-income countries.
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          Diagnostic point-of-care tests in resource-limited settings.

          The aim of diagnostic point-of-care testing is to minimise the time to obtain a test result, thereby allowing clinicians and patients to make a quick clinical decision. Because point-of-care tests are used in resource-limited settings, the benefits need to outweigh the costs. To optimise point-of-care testing in resource-limited settings, diagnostic tests need rigorous assessments focused on relevant clinical outcomes and operational costs, which differ from assessments of conventional diagnostic tests. We reviewed published studies on point-of-care testing in resource-limited settings, and found no clearly defined metric for the clinical usefulness of point-of-care testing. Therefore, we propose a framework for the assessment of point-of-care tests, and suggest and define the term test efficacy to describe the ability of a diagnostic test to support a clinical decision within its operational context. We also propose revised criteria for an ideal diagnostic point-of-care test in resource-limited settings. Through systematic assessments, comparisons between centralised testing and novel point-of-care technologies can be more formalised, and health officials can better establish which point-of-care technologies represent valuable additions to their clinical programmes. Copyright © 2014 Elsevier Ltd. All rights reserved.

            Author and article information

            [1 ]ISNI 0000 0004 1937 1135, GRID grid.11951.3d, Wits Reproductive Health and HIV Institute (Wits RHI), Faculty of Health Sciences, , University of the Witwatersrand, ; Johannesburg, South Africa
            [2 ]ISNI 0000 0001 2224 8486, GRID grid.1056.2, Burnet Institute, ; Melbourne, Australia
            [3 ]ISNI 0000 0004 1936 7857, GRID grid.1002.3, School of Public Health and Preventive Medicine, , Monash University, ; Clayton, Victoria Australia
            [4 ]GRID grid.470490.e, Department of Population Health, , Aga Khan University, ; Nairobi, Kenya
            [5 ]ISNI 0000 0001 2069 7798, GRID grid.5342.0, International Centre for Reproductive Health, Department of Public Health and Primary Care, , Ghent University, ; Gent, Belgium
            BMC Health Serv Res
            BMC Health Serv Res
            BMC Health Services Research
            BioMed Central (London )
            14 February 2019
            14 February 2019
            : 19
            © The Author(s). 2019

            Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (, which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( applies to the data made available in this article, unless otherwise stated.

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            Research Article
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            © The Author(s) 2019

            Health & Social care

            cd4, south africa, hiv, point of care, acceptability, qualitative research


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