Task shifting of point-of-care testing to lay health workers in rural primary health facilities in Nsanje, Malawi

Background Point-of-care testing (POCT) can reduce diagnostic gaps, but because it frequently falls to overstretched frontline healthcare workers (HCW), its real-world effectiveness is diminished. Despite World Health Organization recommendations for task sharing (TS) with lay health workers (LHW), it remains underutilized.Objective To explore whether task-shifted POCT by LHWs can improve uptake compared to standard HCW-led care.Methods A retrospective study at 5 PHC facilities in Nsanje, Malawi, compared a pre-intervention (model 1) period where HCW conducted POCT (for rapid HIV, AHD, syphilis, hepatitis B and malaria), and post-intervention (model 2) where POCT was shifted to trained LHW. The primary outcome was the total number of POCT performed. The two-sample proportion test was used to assess differences in testing uptake in model 1 and 2.Results A total of 3,428 POC tests were conducted by LHWs in model 2 compared to 1,738 in model 1 (a near-2-fold increase). In both models, rapid HIV (38.9%), malaria (21.9%) and CD4 cell count (20.0%) tests were most common. The CD4 cell count testing had the highest incremental change in testing volume of 338% between models (from 192 to 840 tests; p < 0.001).Conclusions TS for POCT with LHW was feasible in rural PHC facilities and contributed to increased POCT volumes across multiple diseases, particularly for CD4 testing. As the range of POC tests expands, TS can improve uptake of diagnostics in these settings, but it must be accompanied by appropriate training and supportive oversight.