Factors associated with HIV rapid Proficiency Testing performance in Mid-Eastern Uganda

Abstract

Background: HIV Proficiency Testing (HIV-PT) is a critical quality assurance mechanism designed to ensure the accuracy, reliability, and consistency of HIV diagnostic services. Despite Uganda's national External Quality Assessment (EQA) framework, suboptimal HIV-PT performance persists in the Mid-Eastern region, undermining progress toward the UNAIDS 95-95-95 goals. Objective: This study assessed the factors associated with HIV-PT performance among healthcare workers in Mid-Eastern Uganda, with a focus on individual, facility-level, and systemic influences. Methods: A convergent parallel mixed-methods study design was employed. Quantitative data were collected from 345 HIV testers across various facility types using a structured questionnaire and proficiency testing results from the Uganda Virus Research Institute (UVRI). Modified Poisson regression was used to identify factors associated with satisfactory HIV PT performance. Qualitative data from key informant interviews were thematically analysed to contextualize operational barriers. Results: Among 3120 HIV PT enrolled testers in the Mid-Eastern Region of Uganda, the overall HIV-PT response rate was 93%, with 76.8 % of testers achieving satisfactory scores. Laboratory personnel were significantly more likely to pass proficiency testing than lay and medical non-laboratory testers (aPR = 2.99 and 2.52, respectively). Lack of formal training and mentorship were strongly associated with unsatisfactory outcomes, with untrained and non-mentored testers at significantly higher risk of failing. Qualitative findings highlighted persistent barriers, including inconsistent refresher training, limited mentorship, irregular supervision, and frequent stockouts of testing kits and supplies, particularly in private and lower-tier facilities. Conclusion: HIV rapid proficiency testing performance in Mid-Eastern Uganda was shaped by both individual and institutional factors. Tester cadre, training, and mentorship were key factors, with laboratory and medical non-laboratory staff performing better than lay testers. Gaps in refresher training, mentorship, staffing, and resources, alongside systemic challenges such as outdated SOPs, supply stockouts, and limited feedback, negatively affected HIV-PT outcomes.