Feasibility of integrating a point of care triage test into routine antiretroviral therapy monitoring in Mozambique: a qualitative evaluation

Introduction Viral load monitoring is central to assessing antiretroviral therapy (ART) effectiveness, yet timely access remains challenging in resource-constrained settings. Point-of-care (POC) triage tests may improve ART monitoring efficiency by identifying clients requiring confirmatory viral load testing while reducing unnecessary testing among those likely to be virally suppressed. We explored perceptions of integrating a POC triage test that measures interferon-gamma-induced protein 10 (IP-10) - a chemokine strongly correlated with HIV viral load - into routine ART monitoring among people living with HIV (PLHIV) on ART, healthcare providers, and HIV programme stakeholders. Methods This qualitative study was nested within a clinical evaluation of the IP-10 POC triage test in two primary healthcare facilities in Maputo Province, Mozambique (2023-2024). We conducted three rounds of interviews with PLHIV on ART who underwent IP-10 testing, and one-off interviews with healthcare providers and HIV programme stakeholders across different health system levels. PLHIV were purposively sampled to capture diverse IP-10 and viral load outcomes. Interviews explored experiences of ART monitoring, perceptions of the IP-10 POC test, and implementation considerations. Data were analysed thematically using an inductive-deductive approach. Results Routine viral load monitoring was widely valued and understood as essential for treatment adherence and effectiveness, but participants described barriers including laboratory delays, access challenges, and health system constraints. The IP-10 POC triage test was broadly acceptable; same-day results were perceived to reduce anxiety, support adherence, and enable timely clinical decision-making. Providers and stakeholders emphasised its potential to improve monitoring efficiency by prioritising clients who require confirmatory viral load testing and adherence support. Concerns were raised regarding test accuracy and the need to maintain confirmatory viral load testing, underscoring the importance of clear communication and client education. Successful implementation would require training, workflow integration, and quality assurance. Conclusions An IP-10 POC triage test could strengthen ART monitoring by enabling same-day identification of clients requiring confirmatory viral load testing and targeted adherence support. By reducing unnecessary viral load testing for virally suppressed clients, it may contribute to more efficient monitoring and support differentiated care approaches. Careful integration into existing ART monitoring algorithms will be critical to maximise impact.