abstract: 'Background The majority of HIV infection among children occurs through mother-to-child transmission. HIV exposed infants are recommended to have virological testing at birth or 4-6 weeks of age but challenges with centralized laboratory-based testing in Myanmar result in low testing rates and delays in result communication and treatment initiation. Decentralized point-of-care (POC) testing when integrated in prevention of mother-to-child transmission of HIV (PMTCT) services, can be an alternative to increase coverage of early infant diagnosis (EID) and timely engagement in HIV treatment and care. Aim This paper aims to explore experiences of caregivers of HIV-exposed infants enrolled in the PMTCT program in Myanmar and the perceived acceptability of point-of-care EID testing compared to conventional centralised laboratory-based testing. Methods This is a sub-study of the cluster randomised controlled stepped-wedge trial (Trial registration number: ACTRN12616000734460) that assessed the impact of near POC EID testing using Xpert HIV-1 Qual assay in four public hospitals in Myanmar. Caregivers of infants who were enrolled in the intervention phase of the main study, had been tested with both Xpert and standard of care tests and had received the results were eligible for this qualitative study. Semi-structured interviews were conducted with 23 caregivers. Interviews were audio recorded, transcribed verbatim and translated into English. Thematic data analysis was undertaken using NVivo 12 Software (QSR International). Results The majority of caregivers were satisfied with the quality of care provided by PMTCT services. However, they encountered social and financial access barriers to attend the PMTCT clinic regularly. Mothers had concerns about community stigma from the disclosure of their HIV status and the potential consequences for their infants. While medical care at the PMTCT clinics was free, caregivers sometimes experienced financial difficulties associated with out-of-pocket expenses for childbirth and transportation. Some caregivers had to choose not to attend work (impacting their income) or the adult antiretroviral clinic in order to attend the paediatric PMTCT clinic appointment. The acceptability of the Xpert testing process was high among the caregiver participants and more than half received the Xpert result on the same day as testing. Short turnaround time of the near POC EID testing enabled the caregivers to find out their infants'' HIV status quicker, thereby shortening the stressful waiting time for results. Conclusion Our study identified important access challenges facing caregivers of HIV exposed infants and high acceptability of near POC EID testing. Improving the retention rate in the PMTCT and EID programs necessitates careful attention of program managers and policy makers to these challenges, and POC EID represents a potential solution.' affiliation: 'Luchters, S (Corresponding Author), Burnet Inst, Melbourne, Vic, Australia. Luchters, S (Corresponding Author), Monash Univ, Sch Publ Hlth \& Prevent Med, Melbourne, Vic, Australia. Luchters, S (Corresponding Author), Aga Khan Univ, Dept Populat Hlth, Nairobi, Kenya. Luchters, S (Corresponding Author), Univ Ghent, Int Ctr Reprod Hlth ICRH, Dept Publ Hlth \& Primary Care, Ghent, Belgium. Yee, Win Lei; Than, Kyu Kyu; Htay, Hla, Burnet Inst, Yangon, Myanmar. Mohamed, Yasmin; Luchters, Stanley, Burnet Inst, Melbourne, Vic, Australia. Mohamed, Yasmin; Luchters, Stanley, Monash Univ, Sch Publ Hlth \& Prevent Med, Melbourne, Vic, Australia. Tin, Htay Htay; Thein, Win; Kyaw, Latt Latt; Yee, Win Win; Aye, Moe Myat, Minist Hlth \& Sports, Natl Hlth Lab, Yangon, Myanmar. Badman, Steven G.; Vallely, Andrew J.; Kelly-Hanku, Angela, UNSW Sydney, Kirby Inst Infect \& Immun Soc, Sydney, NSW, Australia. Vallely, Andrew J.; Kelly-Hanku, Angela, Papua New Guinea Inst Med Res, Sexual \& Reprod Hlth Unit, Goroka, Papua N Guinea. Luchters, Stanley, Aga Khan Univ, Dept Populat Hlth, Nairobi, Kenya. Luchters, Stanley, Univ Ghent, Int Ctr Reprod Hlth ICRH, Dept Publ Hlth \& Primary Care, Ghent, Belgium.' article-number: e0241245 author: Yee, Win Lei and Than, Kyu Kyu and Mohamed, Yasmin and Htay, Hla and Tin, Htay Htay and Thein, Win and Kyaw, Latt Latt and Yee, Win Win and Aye, Moe Myat and Badman, Steven G. and Vallely, Andrew J. and Luchters, Stanley and Kelly-Hanku, Angela and Grp, AAMI Study author-email: stanley.luchters@aku.edu author_list: - family: Yee given: Win Lei - family: Than given: Kyu Kyu - family: Mohamed given: Yasmin - family: Htay given: Hla - family: Tin given: Htay Htay - family: Thein given: Win - family: Kyaw given: Latt Latt - family: Yee given: Win Win - family: Aye given: Moe Myat - family: Badman given: Steven G. - family: Vallely given: Andrew J. - family: Luchters given: Stanley - family: Kelly-Hanku given: Angela - family: Grp given: AAMI Study da: '2023-09-28' doi: 10.1371/journal.pone.0241245 files: [] issn: 1932-6203 journal: PLOS ONE keywords-plus: CONCEPTUAL-FRAMEWORK; PREVENTION; STIGMA; DISCRIMINATION; TRANSMISSION language: English month: OCT 30 number: '10' number-of-cited-references: '35' orcid-numbers: 'Vallely, Andrew/0000-0003-1558-4822 Htay, Hla/0000-0003-1274-961X Anderson, David/0000-0002-9969-3905 Luchters, Stanley/0000-0001-5235-5629 Kelly-Hanku, Angela/0000-0003-0152-2954 Yee, Win Lei/0000-0002-6387-9396' papis_id: a154d061ab33f87e6bbefc559c17dc79 ref: Yee2020caregiverexperience times-cited: '2' title: 'Caregiver experience and perceived acceptability of a novel near point-of-care early infant HIV diagnostic test among caregivers enrolled in the PMTCT program, Myanmar: A qualitative study' type: article unique-id: WOS:000588368900012 usage-count-last-180-days: '1' usage-count-since-2013: '3' volume: '15' web-of-science-categories: Multidisciplinary Sciences year: '2020'