Background: In 2003, World Health Organization recommendations to scale up the use of malaria rapid tests in resource-limited settings were accompanied by identification of key operational research needs to assess the factors that affect the implementation or expansion of use of malaria rapid tests at the national level. Such research findings can help guide the scale-up process and ensure high-quality testing. To date, there is limited literature assessing factors affecting the adoption of simple diagnostic technologies in resource-limited settings at the macro-level. Objective: This study evaluated the health facility characteristics associated with the early adoption of malaria rapid tests in Rwanda, Tanzania and Uganda. Methods: We used data from the MEASURE DHS Service Provision Assessment (SPA) surveys conducted in Rwanda (2007), Tanzania (2006) and Uganda (2007). The surveys included a total of 538 facilities in Rwanda, 611 in Tanzania and 491 in Uganda. We conducted univariable and multivariate logistic regression analysis to evaluate the impact of organizational and contextual factors on malaria rapid test use among health facilities with malaria diagnostic capacity. Results: Our analysis included 482 facilities in Rwanda, 233 in Tanzania and 157 in Uganda. In Rwanda 9% of facilities used rapid tests, in Tanzania 6% and in Uganda 9%. In Rwanda and Uganda malaria rapid tests were more likely to be used in capital city regions, while in Tanzania test use was not associated with region. In Tanzania malaria rapid tests were more likely to be used in private health facilities than in government facilities, while in Rwanda and Uganda there was little difference in test use between private and government facilities. Conclusion: Study findings suggest that region and operating authority are influential factors in the adoption of simple health technology devices in resource-limited settings. However, the extent to which these factors are important varies by country. Further analysis is recommended to find out why types of facilities identified in this study adopted malaria rapid tests and to develop adoption indicators applicable to resource-limited settings - See more at: http://www.popline.org/node/560793#sthash.0RWXiF4G.dpuf