Provider-Initiated HIV Testing and Counseling: Increased Uptake in Two Public Community Health Centers in South Africa and Implications for Scale-Up

Shona Dalal,Janet Moore,Allison Schilsky,Chung-Won Lee,Thato Farirai,Thurma Goldman,Naomi N Bock,Jos H Verbeek

doi:10.1371/journal.pone.0027293

Abstract

BackgroundInternational guidance recommends the scale up of routinely recommended, offered, and delivered health care provider-initiated HIV testing and counseling (PITC) to increase the proportion of persons who know their HIV status. We compared HIV test uptake under PITC to provider-referral to voluntary counseling and testing (VCT referral) in two primary health centers in South Africa.MethodsPrior to introducing PITC, clinical providers were instructed to refer systematically selected study participants to VCT. After PITC and HIV rapid test training, providers were asked to recommend, offer and provide HIV testing to study participants during the clinical consultation. Participants were interviewed before and after their consultation to assess their HIV testing experiences.ResultsHIV test uptake increased under PITC (OR 2.85, 95% CI 1.71, 4.76), and more patients felt providers answered their questions on HIV (104/141 [74%] versus 73/118 [62%] for VCT referral; p 0.04). After three months, only 4/106 (3.8%) HIV-positive patients had registered for onsite HIV treatment. Providers found PITC useful, but tested very few patients (range 0–15).ConclusionPITC increased the uptake of HIV testing compared with referral to onsite VCT, and patients reported a positive response to PITC. However, providing universal PITC will require strong leadership to train and motivate providers, and interventions to link HIV-positive persons to HIV treatment centers.

Highlights

Well into the third decade of the worldwide human immunodeficiency virus (HIV) epidemic, less than one-third of people in countries with generalized or emerging HIV epidemics know their HIV serostatus [1]
provider-initiated HIV testing and counseling (PITC) increased the uptake of HIV testing compared with referral to onsite voluntary counseling and testing (VCT), and patients reported a positive response to PITC
The revised Policy Statement on HIV Testing published by the Joint United Nations Programme on HIV/AIDS (UNAIDS) and the World Health Organization (WHO) in 2004 emphasized the importance of knowledge of HIV status for expanding access to prevention, treatment, and care, and the importance of a serostatus-based approach to prevention has been further delineated [7,8]

Summary

Introduction

Well into the third decade of the worldwide human immunodeficiency virus (HIV) epidemic, less than one-third of people in countries with generalized or emerging HIV epidemics know their HIV serostatus [1]. The recent results of a large multinational clinical trial indicating that earlier initiation of antiretroviral therapy among men and women infected with HIV reduced the risk of transmitting the virus to their sexual partners imparts even more urgency to the need for more widespread uptake of HIV testing and counseling [9]. International guidance recommends the scale up of routinely recommended, offered, and delivered health care provider-initiated HIV testing and counseling (PITC) to increase the proportion of persons who know their HIV status. We compared HIV test uptake under PITC to provider-referral to voluntary counseling and testing (VCT referral) in two primary health centers in South Africa

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Conclusion