The Challenge of Scaling Up HIV Testing

Abstract

Background: Provider Initiated HIV Testing and Counselling (PITC) in routine healthcare settings is a key strategy in the global HIV prevention effort. However, PITC has met with variable success, and, in some settings, testing targets are not being met. Objective: PITC is primarily carried out by nurses and midwives (NaMs). Hence, in order to better understand the challenges involved in PITC implementation, this qualitative review sought to explore NaM's views and experiences of the provision and management of PITC - in any healthcare setting and in any country. Methods: A 3 step search strategy was utilised to search databases, grey literature and dissertations. The review adopted JBI's pragmatic meta-aggregative approach and utilised the JBI QARI instrument. Results: Fifteen papers relating to 12 research studies met the inclusion criteria (6 from high income and 6 from low income countries, covering a diverse range of healthcare settings). Two hundred and twelve findings were aggregated into 12 categories which were further analysed to produce 5 synthesised findings: - 1. NaM's are supportive of PITC if it is perceived to enhance patient care and to align with perceived professional roles. 2. Good care in PITC requires time and the ability to apply a patient centred approach. 3. NaM's ability to perform PITC well requires an appropriate infrastructure and adequate human and material resources. 4. At organisational level, NaM's engagement with PITC is facilitated by an inclusive, management structure, alongside the provision of ongoing training and clinical supervision. PITC is hindered by difficulties with fitting the process into existing workloads and routines. 5. The emotional work involved in PITC can be stressful. NaMs may require support to deal with complex moral/ethical issues. Discussion: NaMs are generally supportive of PITC, but it adds to already heavy workloads. Conclusion: Successful implementation of PITC requires adequate resources and sustained organisational support, training and clinical supervision. More attention is required to address operational challenges.