Factors affecting availability of HIV Viral Load/Early Infant Diagnosis Point of Care testing Commodities and performance of testing platforms in public health facilities in Masaka region, Uganda

Background The Joint United Nations Programme on HIV/AIDS has set ambitious targets to improve diagnosis and treatment rates, aiming for 95% of people living with HIV to know their status and receive treatment. However, challenges persist, especially concerning the HIV Viral Load (VL)/Early Infant Diagnosis (EID) testing coverage and commodity availability, leading to stock-outs and delays in testing processes. This study assessed the factors influencing commodity availability and testing platform performance in public health facilities. Methods A cross-sectional study design was used, incorporating both quantitative and qualitative data collection methods. Primary and secondary data were collected, with a data abstraction form from stock cards/stock books and Point of Care (POC) data systems for HIV VL and EID POC consumption data in the respective facilities. In-depth interviews, guided by an interview guide, were conducted with healthcare workers to capture factors affecting HIV EID/VL POC testing commodities and platform performance. STATA 15.0 was used for quantitative data analysis, while thematic analysis was used for qualitative data. Results Overall, the average stock-out duration per month was 9 days for VL POC cartridges and 8 days for EID POC cartridges. Most of the facilities 59% experienced EID cartridge stock-outs for fewer than 5 days per month, while 27% faced stock-outs exceeding 10 days. Similarly, 59% of facilities had VL POC cartridge shortages for fewer than 5 days, whereas 32% experienced stock-outs for more than 10 days. Stock availability was significantly associated with positivity rates. Furthermore, the mean equipment utilization rate was 47%, with only 18% of facilities achieving optimal utilization. Factors significantly influencing POC platform performance included device type (aOR = 3.3, P = 0.039), positivity rate (aOR = 12, P = 0.017), sample error rate (aOR = 5, P = 0.01), and frequent result uploads to national systems (aOR = 3.8, P = 0.019). Conclusions The findings highlight persistent supply chain inefficiencies, with some facilities experiencing prolonged stock-outs. Low platform utilization was driven by equipment downtime, cartridge shortages, and inadequate staff training. Key challenges included supply chain delays, funding constraints, infrastructure gaps, and staffing shortages. Strengthening forecasting, procurement, distribution, and staff training alongside better coordination and infrastructure investment will be crucial for improving POC testing services and enhancing early HIV diagnosis.