Replication Study: Assessing the Operational Feasibility of Point-of-Care CD4 Technologies for Same-Day Antiretroviral Therapy Initiation in Rural Zambezi Region Clinics, Namibia

Same-day antiretroviral therapy (ART) initiation improves linkage to care. Original research demonstrated the operational feasibility of point-of-care (POC) CD4 technologies for this purpose in urban settings. This study replicates that investigation within the distinct context of rural, resource-limited clinics in the Zambezi Region, Namibia. To assess the operational feasibility—defined as the practicality and acceptability of integration into routine workflows—of using POC CD4 machines to facilitate same-day ART initiation in rural Namibian clinics, thereby testing the transferability of the original study's findings. A mixed-methods, observational replication study was conducted in selected rural clinics. Data were collected through structured observations of clinic workflows, key informant interviews with healthcare workers, and analysis of routine programme data on testing and initiation timelines. Operational feasibility was constrained. While POC testing reduced the median time to receive CD4 results substantially, only a minority of eligible clients initiated ART on the same day. Key barriers included inadequate staffing for counselling, stock-outs of essential medicines, and lengthy pre-ART counselling sessions dictated by clinic protocols. The replication indicates that while POC CD4 technology delivers a necessary technical prerequisite for same-day ART, its operational feasibility in rural Zambezi clinics is limited by systemic health system constraints not fully captured in the original, urban-centred study. Programmes must address critical health system barriers, including staffing norms and commodity supply chains, alongside technology deployment. Protocol adaptations for rural settings, such as streamlined counselling, should be considered to realise the potential of POC testing. operational feasibility, point-of-care testing, CD4 count, antiretroviral therapy, same-day initiation, rural health services, replication This replication study provides critical evidence on the contextual limitations of transferring a health technology intervention from urban to rural settings, highlighting that technological efficacy alone is insufficient without parallel health systems strengthening.