Background The COVID-19 pandemic required South African public sector HIV viral load (VL) laboratories to scale up Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) testing while maintaining essential HIV services. This placed additional pressure on diagnostic services. This dual mandate introduced significant occupational and environmental challenges (OEC) for staff that remain underexplored.

Objective This study aimed to investigate the OEC and effects that staff experienced during the implementation of COVID-19 testing at public sector VL laboratories in South Africa.

Methods A quantitative, cross-sectional study utilised a census approach among technical and support staff. Data were collected via a structured REDCap questionnaire using 5-point Likert scales. Pre- and post-implementation challenges were assessed across four domains: workload, environmental conditions (space, ventilation, waste), communication, and PPE availability. Statistical analyses included the Wilcoxon Signed-Rank and Spearman’s correlation tests.

Results Perceived occupational challenges increased significantly across all domains post-implementation. Staff workload saw the highest rise (mean score 3.02 to 3.53). Adverse health effects were pervasive; 80.2% of staff reported burnout/fatigue, and 76.5% reported increased anxiety/stress. A strong positive correlation was observed between post-COVID-19 challenges and adverse mental and physical health outcomes (rho = 0.449, p < 0.001). Furthermore, 35.8% of staff considered resigning due to increased job demands.

Conclusion Integrating COVID-19 testing exacerbated systemic weaknesses, causing measurable psychological injury and threatening workforce retention. Findings suggest that the diagnostic workforce requires formal crisis surge staffing models and institutionalised mental health support to safeguard personnel and maintain essential services during future health emergencies.

The authors have declared no competing interest.

The author(s) received no specific funding for this work.

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The details of the IRB/oversight body that provided approval or exemption for the research described are given below:

The study strictly adhered to all ethical guidelines and protocols prescribed by the University of Johannesburg (UJ) and the National Health Research Ethics Council (NHREC) of South Africa. Approval was received from the UJ Higher Degrees Committee prior to data collection. Formal ethical approval, with clearance number: REC-3556-2025, was secured from the UJ Research Ethics Committee. Respondents provided electronic informed consent via a tick box on REDCap before completing the questionnaire. Respondents who declined consent were unable to proceed with the survey, achieved by using branching logic. The survey was completely anonymous, with identifying details, such as names, employee numbers, or Internet Protocol (IP) addresses, not requested (S1). The data handling adhered strictly to the Protection of Personal Information Act (POPIA). The research was self-funded, and the authors declared they received no financial support for the research, authorship, and/or publication of this article. Furthermore, the authors declared no financial or personal relationship(s) that may have inappropriately influenced them in writing the article.

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