Factors influencing implementation of point-of-care tests for maternal and newborn screening and diagnosis in low-resource settings: a systematic review

BACKGROUND: Despite the potential of point-of-care (POC) tests to improve maternal and newborn health, implementation in low- and middle-income countries remains inconsistent. POC testing enables rapid, decentralized screening, but barriers across health system, facility, and individual levels may undermine uptake. This review synthesizes evidence on factors influencing the adoption, implementation, and sustainability of POC tests within maternal-child health programmes in low-resourced settings. METHODS: A comprehensive search was performed across major bibliographic databases and grey literature sources using Boolean combinations of terms related to POC testing, maternal and newborn health, implementation, and low-resourced settings. Studies were eligible if they reported on adoption, implementation, or sustainability of POC tests for maternal or infant screening or diagnosis in low-resourced contexts. Data were extracted using a structured form capturing study characteristics, test types, and implementation determinants. Thematic analysis combined deductive coding using the Consolidated Framework for Implementation Research (CFIR) domains with inductive identification of cross-cutting themes. Methodological quality was appraised using Joanna Briggs Institute critical appraisal tools. RESULTS: Forty studies from 19 low-resourced settings were included, with most evaluating POC testing for Human Immunodeficiency Virus (HIV), syphilis, and early infant HIV diagnosis, highlighting limited implementation evidence for other essential maternal and newborn diagnostics. Key facilitators of implementation included rapid turnaround time, portability, ease of use, perceived clinical benefit, supportive policy environments, and compatibility with existing workflows. Task-shifting, bundled testing, and integration with routine maternal-child health services supported sustainability. However, common barriers included weak supply chains, vertical funding, limited political will, training gaps, workforce shortages, and fragmented programme delivery. Sociocultural barriers, such as stigma and limited decision-making power among pregnant women, also constrained uptake. CONCLUSIONS: Effective implementation of POC tests in low-resourced maternal-child health settings requires system-adapted and people-centred approaches. Strengthened domestic ownership, cross-sector coordination, and integrated service delivery, will be critical to ensure equitable access and achieve global targets, including elimination of vertical transmission of HIV, syphilis, and hepatitis B. Expanded implementation research across a broader range of essential POC diagnostics and diverse geographic and infrastructure contexts is needed. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD420251008480.