Examining reporting of quality elements in a provider-initiated HIV testing and counseling and implications for rights-based approaches: a literature review
Background:
Provider-initiated
HIV testing and counseling (PITC) was first adopted by Botswana and Kenya in
2004. In 2007, WHO/UNAIDS responded to country-level operational guidance with
its publication: Provider initiated HIV testing and counselling in health
facilities. In 2009, WHO
commissioned a literature review to map-out implementation successes and challenges
and define areas for further study.
Methods:
This review
through PubMed and conference abstracts returned 147 studies (including 80 journal
articles) from 1/2003-7/2009 describing PITC implementation in developing
countries. Search terms combined “HIV testing” with “provider-initiated”,
“routine” or “opt-out”. Studies were coded with 1-3 emergent themes. If
available, testing acceptance, HIV-seroprevalence and return/post-test
counselling rates were recorded. Publications were sorted categorically and
analyzed for convergent/divergent themes.
Results:
Among all developing
countries, 75% of studies were based in sub-Saharan Africa. Key themes
included: 1)PITC increases testing
uptake and is widely acceptable (n=67; 55% had >90% acceptance;
range:31.5-99.9%); 2)results are returned
to the majority of testers (n=13;
mean return-rate: 87%; range:49-99%); 3)Studies examining informed consent are limited (n=3). 4)Absence of pre-test
information and “forced” testing are reported(n=4). Patient-refusal due
to fear, perceptions of non-confidentiality, low-risk and providers not
offering testing can be factors in patients declining testing (n=15); 5)Loss to post-test
follow-up, particularly in PMTCT-contexts remains challenging (n=14, mean PMTCT
enrollment=51.2%; range:14.9-86%); 6)Poor quality or no counseling/pre-test information
is reported; 7)Low rates of partner testing/involvement and disclosure
reported (n=3).
Conclusions:
As countries expand PITC, it remains critical that all patients
are recommended quality HIV testing and counselling, and informed consent must
be clearly communicated., In the spirit of the WHO guidance, PITC programs
should address adequate counseling/information, confidentiality/privacy,
loss-to-follow up, and increasing partner involvement/disclosure. Future
studies assessing these and other aspects of implementation can help inform
programs, improve PITC delivery, and ensure due attention is paid to human rights
in HIV testing.
V. Wong1,2, M. Sabin1
1World Health Organisation, Department of HIV/AIDS, Geneva, Switzerland, 2US Agency for International Development, Office of HIV/AIDS, Washington, United States