Published in PLOS One on 2026-08-28, this study is presented as an attributed evidence briefing. The excerpts below are the original researchers’ words, reproduced under their Creative Commons Attribution licence. Health Signal has selected the abstract and, where needed, opening background paragraphs; the complete methods, results, limitations and references remain in the linked paper.
Original authors: Carolina Vivas-Valencia, Karen A Webb, Clare F Flanagan, Kudakwashe Takarinda, Elif Coskun, Anesu Chimwaza, Caitlin M Dugdale, Adam Chindore, Kenneth A Freedberg, Angela Mushavi, Mohammad S Jalali, Andrea L Ciaranello
Source: PLOS One • DOI 10.1371/journal.pone.0350921
Read the complete primary study ↗ · Creative Commons Attribution licence
From the researchers
Abstract
Early HIV diagnosis in infants is essential for timely antiretroviral therapy (ART) initiation, but requires virologic testing – often performed in centralized laboratories, which can delay results and treatment initiation. Point-of-care (POC) testing delivers same-day results, facilitating prompt diagnosis and treatment, but availability is limited in low-resource settings. We aimed to optimally locate POC machines to improve life expectancy (LE) and net health benefit (NHB) for infants born to people with HIV in Zimbabwe.
We linked the validated CEPAC-Pediatric HIV microsimulation model, populated with detailed subnational programmatic data, with a location-optimization model for 122 clinics in Matabeleland South’s 7 districts. Simulating two testing strategies – conventional laboratory-based and POC machine-based – we projected: 30-day result-return, 30-day ART initiation for children with HIV (CWH), LE, HIV-related healthcare costs, and NHB. We maximized LE or NHB for infants tested at 6–10 weeks old.
With 17 POC devices in current locations, a projected 43.8% of tested infants would receive HIV test results, with 41.6% of CWH starting ART within 30 days. Undiscounted LE would be 67.85 years (25.91 among CWH), with average discounted lifetime costs of $202/infant. Optimizing locations to maximize LE would retain 6 devices in current locations and move 11 to new sites, leading to projected 52.6% 30-day result-return, 50.0% 30-day ART initiation, and 67.88 years LE (27.04 among CWH), costing $211/infant. Maximizing NHB with a willingness-to-pay threshold ≥ $1,164 (66% of Zimbabwe’s GDP per capita) would render the same optimal locations as maximizing LE. Additional optimally-located machines would further improve LE. Ensuring one machine per district while maximizing LE would require one additional machine and would increase 30-day result-return (to 53.3%), ART initiation (to 50.6%), and LE (to 67.88 years, 27.11 for CWH), costing $212/infant.
Data-driven optimization of POC machine location could improve HIV detection and increase life expectancy and net health benefit for infants undergoing HIV testing in Zimbabwe.
Introduction
Early infant HIV diagnosis (EID) for infants born to people living with HIV (PLWH) is critical to facilitate early antiretroviral therapy (ART) initiation, which can reduce the very high mortality observed among untreated infants with HIV by 76% [1,2]. In Zimbabwe, HIV prevalence among pregnant people is high at 13%, with 53,000 pregnant women receiving ART in 2021 [3,4]. However, while 84.1% of infants born to PLWH in Zimbabwe receive a diagnostic test within 2 months of birth [4], this does not always result in timely ART start. When conventional laboratory testing is used for EID, result-return at 1 month and ART initiation at 2 months can be low, e.g., 20% and 43% in a retrospective cohort study of 8 countries [5].
Reading this evidence
Use the full paper to check the study design, participant selection, comparator and outcome definitions before drawing a practical conclusion. An association does not by itself show cause and effect. A reported performance measure needs its denominator and uncertainty. A finding from a particular facility, sample or time period should retain that scope when it is discussed elsewhere.
This briefing makes the source accessible within the wider technology & industry desk. It does not assess an individual patient or certify a product. When considering relevance to another health system, examine the original authors’ account of context and limitations, then seek local implementation evidence. The related reporting below provides other studies to read alongside this one; it is a topic connection, rather than a claim that their results are directly comparable.
© 2026 Carolina Vivas-Valencia, Karen A Webb, Clare F Flanagan, Kudakwashe Takarinda, Elif Coskun, Anesu Chimwaza, Caitlin M Dugdale, Adam Chindore, Kenneth A Freedberg, Angela Mushavi, Mohammad S Jalali, Andrea L Ciaranello. Excerpts reproduced under CC BY. Selection, formatting and contextual notes by Health Signal. The researchers are the authors of the source study, not members of Health Signal’s staff.
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- Evidence brief: Implementation bottlenecks of near point of care HIV viral load monitoring for children and young people in Tanzania: A Qualitative Study
- Evidence brief: Provider costs of Antiretroviral therapy (ART) in Zimbabwe: The value of using time-driven activity based costing methods in a low resource setting
- Evidence brief: The Asanté™ HIV-1 Rapid Recency® Assay is reliable, feasible, and acceptable for use at the point-of-care in Lusaka, Zambia
