Published in PLOS One on 2026-02-09, 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: Zibusiso Ndlovu, Ruvimbo Nhandara, Kiyara Govender, Fingani Mpande-Nyasulu, Emmanuel Kabwe, Antonio Flores, Calorine Mekiedje, Laban Kyembe, Christine Bimansha, Tania Carmilla Tomas, Leticia Penna, Mariana da Silva, Micheque Jose Tauro, Ana Jossias Bonde, Luisa Rita Miguel, Pedro David Manusso, Gisele Mucinya, Yvonne Nzomukunda, Rollin Ndombe, Richard Ingwe Chuy, Aimé Mboyo, Tom Ellman, Geoffrey Fatti
Source: PLOS One • DOI 10.1371/journal.pone.0339469
Read the complete primary study ↗ · Creative Commons Attribution licence
From the researchers
Abstract
Mortality from advanced HIV disease (AHD) remains high and current strategies to promptly test people eligible for AHD screening, are insufficient. Task sharing for point of care (POC) testing utilizing lay health workers (LHW) is recommended, however it is marginally practised in many countries. This study sought to describe the feasibility and testing outcomes of task-shared implementation of the AHD POC diagnostic tests utilizing LHW and professional health care workers (HCW).
This was a cross-sectional mixed-methods implementation study in seven primary and three secondary health facilities, in Mozambique and Democratic Republic of Congo (DRC). From March to November 2022, consenting HIV positive adults eligible for AHD screening, were offered Visitect CD4 lateral flow assay (LFA), and or subsequently urinary Mycobacterium tuberculosis lipoarabinomannan antigen (TB LAM) and cryptococcal antigen (CrAg) tests. The primary study outcome was the proportion of testers (LHW and HCW) who found it ‘easy’ to integrate the 3 POC tests within their routine work together with their opinions on the value of task shared AHD POC testing.
A total of 1542 patients were screened for AHD by 35 LHW (34 counsellors, and 1 lay educator) and 45 professional HCW (28 nurses and 9 clinical officers and 8 doctors). In the study period, LHW conducted a median number of 27 [IQR: 16–34] Visitect CD4 LFA tests, whereas nurses, clinical officers together with doctors conducted 19 and 11 respectively. Visitect CD4 LFA increased CD4 testing by 10.7% in Munhava (Beira) and 22.9% in CHK (DRC), complementing existing CD4 testing instruments. Among testers who completed the feasibility survey, nearly sixty percent of testers (25/42; LHW in particular) found it easy to integrate AHD POC testing within their routine workflow.
The prevalence of AHD was 39.2% (604/1542). A total of 34% (146/430) and 5.4% (22/407) of patients tested positive for urine TB LAM and plasma CrAg respectively. Of these, 82.2% (120/146) and 36.4% (8/22) had a documented therapeutic intervention. The median time for completing the Visitect CD4 LFA and conveying the results to the clinician was 59 minutes [IQR: 48–71].
Task-shared integrated testing for AHD at POC among LHW and professional HCW, is feasible and can improve access to AHD testing. However, as POC testing responsibilities become shared, documentation of testing activities could increase in complexity and can be easily fragmented, especially when there is limited supervision. Nevertheless, LHW are well suited for POC testing due to limited availability and higher clinical workload of other HCW.
Introduction
Point-of-care testing (POCT) refers to any diagnostic test administered near or at the site of a patient where the specimen is collected as opposed to a conventional clinical laboratory setting. POCT can ensure quicker access to health services [1–4] and availability of POCT is set to be on the increase due to increasing advancements in in-vitro diagnostic medical technologies and patient-centred care [4]. Despite the sustained investments in the development of innovative POC devices, POCT at primary health care (PHC) facilities without laboratories, lacks the necessary support for testing and responsibility for quality assurance. This danger lacks the warranted urgency and planning for solutions, and it currently limits the possible impact of POCT [5,6].
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 Zibusiso Ndlovu, Ruvimbo Nhandara, Kiyara Govender, Fingani Mpande-Nyasulu, Emmanuel Kabwe, Antonio Flores, Calorine Mekiedje, Laban Kyembe, Christine Bimansha, Tania Carmilla Tomas, Leticia Penna, Mariana da Silva, Micheque Jose Tauro, Ana Jossias Bonde, Luisa Rita Miguel, Pedro David Manusso, Gisele Mucinya, Yvonne Nzomukunda, Rollin Ndombe, Richard Ingwe Chuy, Aimé Mboyo, Tom Ellman, Geoffrey Fatti. 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.
Explore connected evidence
- Evidence brief: High performance of point-of-care rapid tests for advanced HIV disease diagnosis by lay providers in Malawi: Results from a prospective diagnostic accuracy study supporting decentralized advanced HIV disease screening
- Evidence brief: Contribution of xpert MTB/RIF assay and Urine LF-LAM for the diagnosis of tuberculosis in children aged 5 – 14 years, at selected health facilities in Ethiopia, 2016 – 2019
- Evidence brief: The Asanté™ HIV-1 Rapid Recency® Assay is reliable, feasible, and acceptable for use at the point-of-care in Lusaka, Zambia
