Repeat HIV Testing at Voluntary Testing and Counseling Centers in Croatia: Successful HIV Prevention or Failure to Modify Risk Behaviors?

Julian W Tang,Vlatka Matković Puljić,Tatjana Nemeth Blažić,Marija Kavić,Mirjana Lana Kosanović Ličina

doi:10.1371/journal.pone.0093734

Abstract

HIV testing plays a critical role in preventing the spread of the virus and identifying infected individuals in need of care. Voluntary counseling and testing centers (VCTs) not only conduct testing but they also provide counseling. Since a proportion of people who test negative for HIV on their previous visit will return for retesting, the frequency of retesting and the characteristics of those who retest may provide insights into the efficacy of testing and counseling strategies. In this cross-sectional, retrospective study of 1,482 VCT clients in Croatia in 2010, 44.3% had been tested for HIV before. The rate of repeat HIV testing is lower in Croatia than in other countries. Men who have sex with men (MSM) clients, those with three or more sexual partners in the last 12 months, consistent condom users with steady partners, and intravenous drug users were more likely to be repeat testers. This finding suggests that clients presenting for repeat HIV testing are those who self-identify as being at a higher risk of infection. Our data showed that testing positive for HIV was not associated with repeat testing. However, the effects of repeat testing on HIV epidemiology needs to be explored.

Highlights

Voluntary counseling and testing centers (VCTs) are the frontline actors in human immunodeficiency virus (HIV) prevention strategies in most countries [1]
All counselors were university-educated in psychological or medical sciences and had been trained as ‘‘HIV counselors’’ in a 3-day course conducted by the National Institute of Public Health using a curriculum designed according to the Centers for Disease Control and Prevention (CDC), the Joint United Nations Programme on HIV/AIDS (UNAIDS), and the World Health Organization (WHO) guidelines [9,10,11]
We retrospectively analyzed factors associated with repeat HIV testing in 2010 at two VCTs covering approximately 75% of all anonymous HIV tests in Croatia

Summary

Introduction

Voluntary counseling and testing centers (VCTs) are the frontline actors in HIV prevention strategies in most countries [1]. VCTs allow individuals to learn their human immunodeficiency virus (HIV) serostatus in a confidential environment, and they provide pre- and post-test counseling about HIV, risk factors, and prevention strategies. Clients can discuss their personal risk profile (sexuality, drug use) and receive guidance on how to change their and perhaps their partners’ risk behaviors [2]. In this way, VCTs play an important dual role: first, in preventing HIV infection by encouraging behavioral change; and secondly, in enhancing early presentation to care by serving individuals who test HIV-positive as an entry point and/or referral to care and treatment. Repeat testers from Thailand are more likely to be male sex workers, older, and employed, to live away from the family, and to have an insertive anal sex role [7]

Methods

Results

Conclusion