Abstract
BackgroundSouth Africa endorses the global policy shift from primarily client-initiated voluntary counselling and testing (VCT) to routine/provider-initiated testing and counselling (PITC). The reason for this policy shift has been to facilitate uptake of HIV testing amongst at-risk populations in high-prevalence settings. Despite ostensible implementation of routine/PITC, uptake amongst tuberculosis (TB) patients in this country remains a challenge. This study presents the reasons that non-tested TB patients offered for their refusal of HIV testing and reflects on all TB patients' suggestions as to how this situation may be alleviated.MethodsIn February-March 2008, a cross-sectional survey was conducted amongst 600 TB patients across 61 primary health care facilities in four sub-districts in the Free State. Patient selection was done proportionally to the numbers registered at each facility in 2007. Data were subjected to bivariate tests and content analysis of open-ended questions.ResultsAlmost one-third (32.5%) of the respondents reported that they had not undertaken HIV testing, with the most often offered explanation being that they were 'undecided' (37.0%). Other self-reported reasons for non-uptake included: fear (e.g. of testing HIV-positive, 19.0%); perception of being at low risk of HIV infection (13.4%); desire first to deal with TB 'on its own' (12.5%); and because HIV testing had not been offered to them (12.0%). Many patients expressed the need for support and motivation not only from health care workers (33.3%), but also from their significant others (56.6%). Patients further expressed a need for (increased) dissemination of TB-HIV information by health care workers (46.1%).ConclusionsPatients did not undergo HIV testing for various patient-/individual-related reasons. Non-uptake of HIV testing was also due to health system limitations such as the non-offer of HIV testing. Other measures may be necessary to supplement routine/provider-initiation of HIV testing. From the TB patient's perspective, there is a need for (improved) dissemination of information on the TB-HIV link. Patients also require (repeated) motivation and support to undergo HIV testing, the onus for which rests not only on the public health authority and health care workers, but also on other people in the patients' social support networks.
Highlights
South Africa endorses the global policy shift from primarily client-initiated voluntary counselling and testing (VCT) to routine/provider-initiated testing and counselling (PITC)
In South Africa, provider-initiation of HIV testing for TB patients came into effect in 2007 with the adoption of the provider-initiated testing and counselling (PITC) strategy in the Tuberculosis Strategic Plan, 2007-2011 [4]
Findings of a study amongst providers in the Free State Province indicate that almost all nurses recommend HIV testing to TB patients, at inception of TB treatment (88%), but at every contact (61%) with the patient until acceptance of the test [5]
Summary
South Africa endorses the global policy shift from primarily client-initiated voluntary counselling and testing (VCT) to routine/provider-initiated testing and counselling (PITC). In April 2010, following limited success of existing HIV-testing policies, the South African government initiated a mass HIV counselling and testing (HCT) campaign aimed at identifying and treating as many eligible persons as possible - TB patients included - before June 2011 [8]. This step confirmed the concerns of government and other interest groups that, despite ostensible implementation of routine/provider-initiated HIV testing, too many TB patients are currently not undergoing HIV testing [1,9]. This study follows previous reports on predictors of uptake of HIV testing amongst the same patient population [10,11]
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