Abstract
BackgroundProvider-initiated HIV testing and counselling (PITC) is based on information-giving while voluntary counselling and testing (VCT) includes individualised client-centered counseling. It is not known if the provider-client experiences, perceptions and client satisfaction with the information provided differs in the two approaches.MethodsIn 2008, we conducted structured interviews with 627 individuals in Uganda; 301 tested through PITC and 326 through voluntary counselling and testing (VCT). We compared client experiences and perceptions based on the essential elements of consent, confidentiality, counseling, and referral for follow-up care. We conducted multivariate analysis for predictors of reporting information or counselling as sufficient.ResultsIn VCT, 96.6% (282) said they were asked for consent compared to 91.3% (198) in PITC (P = 0.01). About the information provided, 92.0% (286) in VCT found it sufficient compared to 78.7% (221) in PITC (P = <0.01). In VCT 79.9% (246) thought their results were kept confidential compared to 71.7% (200) in PITC (P = 0.02). Eighty percent (64) of HIV infected VCT clients said they were referred for follow-up care versus 87.3% (48) in PITC (p = 0.2). Predictors of perceived adequacy of information in PITC included an opportunity to ask questions (adj.RR 1.76, CI 1.41, 2.18) and expecting the test results received (adj.RR 1.18, CI 1.06, 1.33). For VCT significant factors included being given an opportunity to ask questions (adj.RR 1.62, CI 1.00, 2.60) and 3+ prior times tested, (adj.RR 1.05, CI 1.00, 1.09).ConclusionsThis study demonstrates good practices in the essential elements of HIV testing for both VCT and PITC. However, further quality enhancement is required in both testing approaches in relation to referral to HIV care post-test, client confidence in relation to confidentiality, and providing an opportunity to ask questions to address client-specific information needs.
Highlights
Provider-initiated HIV testing and counselling (PITC) is based on information-giving while voluntary counselling and testing (VCT) includes individualised client-centered counseling
VCT respondents were more often never married, 44.8% (145) compared to 18.4% (55) in PITC, p < 0.0001; and a larger proportion of respondents in VCT, 50.3% (157) were first-time testers compared to 39.0% (112) in PITC (Table 1)
The majority of respondents reported that they were asked if they agreed to be tested; significantly higher in VCT, 96.6% (282) than PITC, 91.3% (198), (p = 0.01)
Summary
Provider-initiated HIV testing and counselling (PITC) is based on information-giving while voluntary counselling and testing (VCT) includes individualised client-centered counseling. In addition to several emerging prevention tools, treatment as prevention has gained prominence with introduction of life-long treatment for HIV infected pregnant women and increasing CD4 cut-off for initiation of antiretroviral treatment for adults and adolescents [2,3,4,5]. All these interventions are hinged on large. The VCT protocol continues to demand detailed clientcentered HIV risk assessment and risk reduction counseling before and after the test [9]
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