Provider-initiated HIV testing and counselling in Rwanda: acceptability among clinic attendees and workers, reasons for testing and predictors of testing.

Felix R Kayigamba,Judith Lammers,Maarten F Schim Van Der Loeff,Emmanuel Bagiruwigize,Anita Asiimwe,Veronicah Mugisha,Mirjam I Bakker,Matt A Price

doi:10.1371/journal.pone.0095459

Abstract

IntroductionRoutine provider-initiated HIV testing and counselling (PITC) may increase HIV testing rates, but whether PITC is acceptable to health facility (HF) attendees is unclear. In the course of a PITC intervention study in Rwanda, we assessed the acceptability of PITC, reasons for being or not being tested and factors associated with HIV testing.MethodsAttendees were systematically interviewed in March 2009 as they left the HF, regarding knowledge and acceptability of PITC, history of testing and reasons for being tested or not. Subsequently, PITC was introduced in 6 of the 8 HFs and a second round of interviews was conducted. Independent factors associated with testing were analysed using logistic regression. Randomly selected health care workers (HCWs) were also interviewed.Results1772 attendees were interviewed. Over 95% agreed with the PITC policy, both prior to and after implementation of PITC policy. The most common reasons for testing were the desire to know one’s HIV status and having been offered an HIV test by an HCW. The most frequent reasons for not being tested were known HIV status and test not being offered. In multivariable analysis, PITC, age ≥15 years, and not having been previously tested were factors significantly associated with testing. Although workload was increased by PITC, HIV testing rates increased and HCWs overwhelmingly supported the policy.ConclusionAmong attendees and HCWs in Rwandan clinics, the acceptability of PITC was very high. PITC appeared to increase testing rates and may be helpful in prevention and early access to treatment.

Highlights

Routine provider-initiated HIV testing and counselling (PITC) may increase HIV testing rates, but whether PITC is acceptable to health facility (HF) attendees is unclear
Characteristics of the Attendees We interviewed 1772 clinic attendees: 1365 at intervention HFs
Of the 407 attendees interviewed at the two control HFs, the median age was 28 years (IQR 22–36) and the majority (58%) was female

Summary

Introduction

Routine provider-initiated HIV testing and counselling (PITC) may increase HIV testing rates, but whether PITC is acceptable to health facility (HF) attendees is unclear. Despite VCT, many people [.61%] in sub-Saharan countries do not know their HIV status [1,2,3,4,5]. HIV testing among clinic attendees is low, even in high-risk populations in sub-Saharan Africa [1,6,7,8]. WHO, UNAIDS and CDC recommend provider-initiated testing and counselling (PITC) in health facilities (HFs) to increase the number of persons who know their HIV status, enable early clinical care and guide provision of specific medical services that would otherwise not be provided [1,9]. PITC may reduce stigma and discrimination, identifies undiagnosed HIV infection [10] and provides opportunities for women to access HIV testing without seeking permission from their partners [8,10]

Methods

Results

Discussion

Conclusion