BACKGROUND: Malawi has successfully scaled up integration of HIV early infant diagnosis (EID) and viral load (VL) testing on Point of Care (POCs) devices, a shift from centralized testing on large equipment at laboratories located in urban areas. This has led to significant reduction in test results turn-around time and ART initiation from 56 days and 38 days to just 1 day for mPima EID and GeneXpert VL, and 3 days for GeneXpert EID. Proportion of infants initiated on ART within two months of birth has also improved by more than 50%[1]’[2].
DESCRIPTION: Introduction of POC EID and VL was in two phases, following two successful feasibility studies conducted between 2015 and 2017. ^1,2 Phase one was EID testing on Abbott mPima. Phase two was EID and VL testing on Cepheid GeneXpert. GeneXperts were readily available in Malawi and were used for tuberculosis testing. Currently, there 25 Pima and 48 GeneXpert sites across the country. These are supported with trainings, routine supervision and mentorship, supply chain, waste management, quality assurance and connectivity.
LESSONS LEARNED: Malawi’s successful shift to POC for EID and target VL is widely appreciated as a best practice example and there are lessons learnt worth sharing. Introduction of POC technology decongested molecular laboratories and partly helped address the gap in laboratory personnel. We also learnt that stakeholders’ engagement from the outset is critical. Stakeholders were engaged at each stage of implementation, thereby setting the intervention on a path to sustainability. In addition, supervision and mentorship are critical to ensure quality POC testing. Testing errors on GeneXpert and mPima were usually high soon after training but declined after mentorship. Furthermore, POC testing saved money for Ministry of Health and stakeholders by using existing infrastructure. Lastly, data management is crucial to ensure timely data visibility at decentralized system. Routine data on indicators such as TATs, rates of ART initiation and device functionality were used for decision making through-out the implementation.
CONCLUSIONS: POC EID and VL have significantly improved patient care in Malawi. Governments across similar contexts would benefit from insights on Malawi's experience in the roll out of POC testing interventions.

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