HIV Counseling Research Articles

Тестирование и консультирование по вопросам ВИЧ-инфекции: некоторые аспекты проблемы

The aim of the study was to analyze the attitude of the population to HIV testing and counseling and the frequency of testing-related counseling in a sample of the population of Kazan. Materials. An anonymous survey of various groups of the population permanently residing in the city of Kazan (n=301) was conducted using a questionnaire developed by us. The study involved 58.1% of women (175/301), 41.9% of men (126/301). Results. Most of the respondents had experience of undergoing HIV testing (95%, 286/301). Only 92 people out of 286 (32.2%) were examined on their own initiative. HIV testing was mainly carried out in the polyclinic at the place of residence/stay (66.8%, 191/286), while counseling, according to respondents, was carried out only in 16.20% of respondents (31/191). Conclusions. It is important to conduct a high-quality procedure of pre-and post-test counseling in the conditions of primary health care. It is necessary to train the medical staff of the polyclinic level in the skills of counseling on epidemiology and prevention of HIV infection.

Organization and planning for the creation of the HIV testing and counselling center.

To analyze the process of creating the HIV Testing and Counselling Center in the municipality of Nova Iguaçu, in the state of Rio de Janeiro. qualitative research, with a historical approach. The direct sources consisted of written documents and 11 oral testimonies. in order to create this Testing and Counselling Center, investment was made in the implementation of a Municipal Management Unit for the STD/AIDS Program; in the elaboration of the Project for the Creation of the Testing and Counselling Center; in the process of attracting, selecting and training human resources; and choosing the right place for its operation. the nurse who coordinated this investment had the support of the authorities of that municipality and had an authorized speech on HIV/AIDS in the municipality of Nova Iguaçu; planned each stage of this service and used effective strategies to create the Testing and Counselling Center.

Prevalence of HIV, Hepatitis C and its related risk behaviours among women who inject drugs in the Kathmandu Valley, Nepal: a cross-sectional study.

Background:People who inject drugs (PWID) are at great risk of HIV and Hepatitis C Virus (HCV). In order to properly design interventions and develop programmes for women who inject drugs, this study assessed the prevalence of HIV, Hepatitis B, Hepatitis C, and syphilis and its risk behaviours among women who inject drugs in the Kathmandu Valley, Nepal.Methods:Through modified network sampling in three districts in the Kathmandu Valley, Nepal, this cross-sectional study enrolled a total of 160 women who inject drugs. Participants’ serum samples were tested for HIV, HCV, Hepatitis B virus (HBV) and syphilis and risk behaviours were assessed through a structured questionnaire. Primary outcome variables were HIV, HCV, HBV and syphilis prevalence, and secondary outcome variables were sharing needles in the past month and using condom in last sexual intercourse. Stepwise logistic regression was used to determine micro- and macroenvironmental factors associated with secondary outcomes.Results:The prevalence of HIV, HCV, and HBV was 8.8%, 21.3%, and 1.9%, respectively. HIV-HCV co-infection rate was 5.6%. Fifteen percent of women who inject drugs reported transactional sex for drugs or money. One in four women who inject drugs (27.5%) reported that they were imprisoned or detained for drug related reasons. In multivariable analysis, women living with HIV who inject drugs were almost four times more likely to use a previously used needle/syringe than women who inject drugs who were HIV negative (aOR: 4.2 CI: 1.1-15.9, p = 0.03), but were almost four times more likely to use a condom during sexual intercourse (aOR: 3.5 CI: 1.1-28.9, p = 0.03). Enrolment in family planning was the main determinant for using condoms in last sexual intercourse (aOR 4.9 CI: 1.6-16.7, p = 0.006). Participants with access to HIV test and counselling (HTC) services were less likely to share needles (aOR: 0.3, 95% CI: 0.1–0.8, p = 0.01).Conclusion:Prevalence of HIV and HCV is high among women who inject drugs in Kathmandu valley of Nepal. Women who inject drugs enrolled in national programmes such as family planning and HTC were positively associated with condom use, and less likely to share needles.

Prevalence and Predictors of Non-Uptake of HIV Voluntary Counseling and Testing among Undergraduates of Tertiary Institution in Abia State, Nigeria

Background: One of the key strategies in the HIV/AIDS prevention and control programs in Nigeria is Voluntary HIV counseling and testing (VCT). However, its utilization among young adults, particularly undergraduates, is very low. The aim of the present study was to determine the prevalence and predictors of non-uptake of VCT among undergraduates. Methods: A cross sectional study using quantitative methods was conducted. Using simple random sampling, three faculties were selected out of nine and 422 respondents were selected from three faculties. Interviews were conducted using pre-tested semi-structured questionnaires. Data analysis was done using statistical package for social sciences version 20. Prevalence was measured by the percentage of respondents that had never used VCT. Analytical statistics were done using chi-square test to measure strength of association between VCT uptake and knowledge and attitude of respondents. Association with P-value 0.05 was considered significant. Logistic regression was used to identify predictors of non-uptake of VCT. The associations were presented as odds ratios (OR) and 95% confidence intervals. Results: Overall, 59.3% of respondents were knowledgeable about VCT while majority, 64.7% had negative attitude towards it. Knowledge (X2 = 9.89, P-value 2 = 10.78, P-value OR 1.874 (1.058 - 3.289), P Conclusions: VCT uptake among undergraduates was low and determined by VCT-related ignorance, poor attitude, fear of positive result and HIV/AIDS-related stigma/discrimination. In order to change the narrative, HIV/AIDS prevention and control programs in Nigeria should address the identified predictors of non-VCT uptake. There is a need to focus on young adults when designing, expanding and implementing VCT services in the country.

626. Tackling the HIV Epidemic in South Florida: Patient Insights on Approaches for HIV Counseling, Testing, and Access to Prevention or Treatment

BackgroundThe South Florida Metropolitan Statistical Area has for several years recorded the highest HIV incidence in the nation, and prevalence in the top three of all counties. To address the alarming disparity in HIV impact, we developed a survey study to learn about the beliefs, attitudes, and perspectives of persons who accessed services at an HIV community-based organization in South Florida.MethodsSurveys were administered in English and Spanish to 109 persons who visited a community-based HIV service provider (Latinos Salud) at any of its three South Florida sites in April 2019. The survey evaluated the participants’ perspectives on different avenues for HIV counseling, screening, and accessing HIV medications for prevention or treatment.ResultsThe majority of survey participants were male (90%), homosexual/gay/queer (75%), and Hispanic/Latino (56%; Table 1). Participants’ self-reported their HIV status as negative (64%), positive (30%), or unknown (6%; Table 1). Of those not currently living with HIV, 77% reported having been tested within the past 6 months, and 81% reported recent engagement in high-risk activities (Table 1).Most participants considered using social media to promote awareness of HIV and related services a good idea (Table 2). Large proportions of participants endorsed receiving HIV counseling through in-person conversations with clinicians (91%), staff at community-based organizations (83%), friends (83%), telehealth visits (69%), conversations with teachers (63%), or church members (56%; Table 2). Most participants endorsed a range of both clinical (e.g. local health clinic) and non-clinical (e.g. mobile van) locations as acceptable settings for HIV testing (Table 2). Large proportions of participants endorsed receiving medications to prevent or treat HIV immediately after testing (82%), by home delivery (78%), or through telehealth (60%; Table 2). Meaningful associations were found between certain patient demographics (race/ethnicity, testing history, or insurance status) and the participants’ perspectives on specific strategies (Table 3).Table 1. Participant Characteristics Table 2. Participants’ Views on Strategies for HIV Counseling, Testing, and Access to Medications Table 3. Participants’ Views on Strategies for HIV Counseling, Testing, and Access to Medications Stratified by Patient Characteristics ConclusionThese real-world findings can be used to inform clinic- and community-based interventions tailored to individual patient characteristics.Disclosures Tamar Sapir, PhD, Gilead Sciences, Inc. (Other Financial or Material Support, Independent medical education grant)

Sexually transmitted disease clinics in the United States: Understanding the needs of patients and the capabilities of providers

Reports of bacterial sexually transmitted infections are at the highest levels ever reported in the United States, and state and local budgetary issues are placing specialized sexually transmitted disease (STD) care at risk. This study collected information from 4138 patients seeking care at 26 STD clinics in large metropolitan areas across the United States with high levels of reported STDs to determine patient needs and clinic capabilities. Surveys were provided to patients attending these STD clinics to assess their demographic information as well as reasons for coming to the clinic and surveys were also provided to clinic administrators to determine their operational capacities and services provided by the clinic. For this initial study, we conducted univariate analyses to report all data collected from these surveys. Patients attending STD clinics across the country indicated that they do so because of the relative ease of getting an appointment; including walk-in and same-day appointments as well as the welcoming environment and expertise of the staff at the clinic. Additionally, STD clinics provide specialized care to patients; including HIV testing and counseling as well as on-site, injectable medications for the treatment of gonorrhea and syphilis in an environment that helps to reduce the role of stigma in seeking this kind of care. Sexually transmitted disease clinics continue to play an important role in helping to curb the rising epidemic of sexually transmitted infections.

HIV Prevalence among Meical Inward Patients in the National Hospital of Sri Lanka (NHSL) with the Assessment of Patient Acceptance, the Feasibility and Challenges of the Hospital Based Rapid HIV Diagnostic Test

<strong>Introduction: </strong>Hospital based HIV Rapid Diagnostic Testing (RDT) was introduced in 2018, following programmatic decision. However, being the province with the highest HIV prevalence in the country, the number of hospital based rapid testing carried out in Western province was not impressive, leading to missed opportunities and late diagnosis. Therefore, RDT was re-implemented in selected medical wards of NHSL. <strong> </strong> <strong>Objective: </strong>To assess the case detection rate, the feasibility and challenges of the rapid HIV testing services among inpatients of medical wards of NHSL. <strong> </strong> <strong>Method: </strong>A descriptive demonstration study, carried out among consecutive 3,395 new admissions to selected medical wards of the NHSL within three months period. HIV status was tested on finger prick blood, using FDA and WHO approved 4th generation HIV RDT (with 100% sensitivity, 99.7% specificity) following informed consent. Patient information were extracted from bed head tickets. Focus Group Discussions (FGD) were carried out with the relevant hospital staff to assess the challenges. Confidentiality of patients ensured by training all the health care workers involved in RDT and followed up of the positive test results, according to the national guidelines <strong> </strong> <strong>Results: </strong>Among the 3395 participants, eight (8) were found to be positive, with the HIV prevalence of 0.23 %. The patient acceptance rate was 96%. Out of the positives, majority were males (n=6) and married (n=5) and half of them were from the Colombo district. Only two (25 %) had AIDS defining symptoms while the majority (n=5) had baseline CD4 count less than 200 cells/μl . Work overload, consent taking, lack of confidence in post-test HIV counselling were identified as major areas of concern. <strong> </strong> <strong>Conclusions: </strong>Hospital-based HIV rapid testing is one of the high yielding programmatic strategies implemented in the country so far. The positivity rate of the study sample was 0.23% which is higher than the HIV positivity rate reported through different testing strategies including the general public (0.03%), and STD samples (0.1%). Further, beating up the challenge of missed opportunities and late diagnosis was highlighted. Therefore, addressing the identified barriers through policy and administrative support and further scaling up of hospital-based HIV testing is highly recommended.

Survival Analysis of Time to Retest for HIV Among Men Who Have Sex with Men from Metro Manila, Philippines: A Single-Center Prospective Study

Background: Regular HIV testing means early detection of the virus and prompt access to treatment. However, factors affecting retesting following receipt of a non-reactive test result are not yet well understood. This study aims to determine the predictors of time to repeat HIV testing among men who have sex with men (MSM) from Metro Manila, Philippines within six months following receipt of a non-reactive test result.&#x0D; Methods: A prospective study was implemented at a community-based HIV testing and counseling center. A total of 250 non-reactive MSM from Metro Manila and with a recent risk of acquiring HIV were the respondents. At baseline, data on socio-demographic factors were gathered; while at follow-up, repeat test status of each participant within six months after baseline was collected.&#x0D; Results: Two retests per 1,000 person-weeks were recorded. Mean survival time was 23.93 weeks, 95% CI: [23.18 - 24.68]. Cox proportional hazards regression demonstrated that statistically significant factors of time to retest were age (HR = 0.90, 95% CI [0.85, 0.96]) and number of tests in lifetime (HR = 1.12, 95%CI [1.06, 1.18]).&#x0D; Conclusion: Although the average time to return is within the recommended period of three to six months, the low return rate suggests the call for encouraging repeat HIV testing among MSM with non-reactive results and recent risk of acquiring HIV. Repeat testing has been shown to be facilitated by age and previous testing history. HIV/AIDS counselors and program administrators can aim for MSM who are older and with relatively low testing history to help meet the global target of ending the HIV/AIDS global epidemic.

Availability and readiness to provide sexually transmitted infections and HIV testing and counselling services in Nepal: evidence from comprehensive health facility survey

ObjectiveWe assessed the availability and readiness of health facilities to provide sexually transmitted infections (STI) and HIV testing and counselling (HTC) services in Nepal.DesignThis was a cross-sectional study.SettingWe used data...

Strategies to Eliminate Mother-to-Child Transmission of HIV in Addis Ababa, Ethiopia (Qualitative Study).

ObjectiveGlobally, nearly 38 million people are living with HIV, and 1.8 million are children. Each day approximately 5600 people acquire HIV. Since the emerging of HIV, 78 million people have been infected and close to 39 million have died. In developing countries, from all new HIV infections, half are because of mother-to-child transmission (MTCT). The aim of this study is to evaluate the effect of option B+ prevention of mother-to-child HIV transmission (PMTCT) and to develop strategies that contribute to eliminate MTCT in Addis Ababa, Ethiopia.MethodsThe study was conducted in three hospitals of Addis Ababa, Ethiopia, with a qualitative approach. Sixteen (16) in-depth interviews of HIV-positive mothers who had PMTCT follow-up and six focus group discussions with health professionals who work at a PMTCT unit were conducted. To analyse the data ATLAS.ti version 7 was used.ResultsAccording to the findings of this study mother-to-child HIV transmission was associated with lack of HIV-discordant couples counselling guideline, lack of HIV disclosure strategy and counselling guidelines, unavailability of special PMTCT counselling guideline for HIV-positive commercial sex worker mothers and lack of HIV-free human breast milk (banked human breast milk) for PMTCT. Based on the study findings, a strategy that contributes to eliminate MTCT was developed.ConclusionBased on the research finding, the following four strategies were developed. Strategy 1: establish and use banked human breast milk for elimination of MTCT; Strategy 2: incorporate obligatory policy for discordant couple testing, counselling and disclosure with option B+ PMTCT; Strategy 3: develop disclosure policy and counselling guideline for PMTCT; and Strategy 4: formulate special PMTCT guideline for HIV-positive commercial sex worker mothers.

Predictors of First-Time and Repeat HIV Testing Among HIV-Positive Individuals in Kenya.

Despite a doubling of HIV testing coverage in Kenya over the past decade, approximately 2 in 10 people with HIV remained unaware of their infection in 2018. HIV testing is most effective in identifying people with undiagnosed HIV through frequent and strategic testing in populations at high risk. An assessment of testing frequency and predictors of first-time and repeat testing is critical for monitoring effectiveness of testing strategies. We conducted a cross-sectional analysis of adults aged ≥18 years who tested HIV-positive at 4 HIV testing and counseling clinics in Kenya from February 2015 to February 2016. We categorized individuals based on testing history, used Wilcoxon rank-sum tests to assess differences in intervals between the most recent and current HIV test, and used log-binomial regression to determine characteristics associated with first-time and repeat testing. Among 1136 people testing HIV-positive, 336 (30%) had never tested before and 800 (70%) had, of whom 208 (26%) had previously tested positive. Among previously negative repeat testers, the median intertest interval was 414 days in key/priority populations (interquartile range = 179-1072) vs. 538 in the general population (interquartile range = 228-1299) (P = 0.09). Compared with previously negative repeat testers, being a first-time tester was associated with being age ≥40 years [vs. 18-24; adjusted risk ratio = 1.67, 95% confidence interval (CI): 1.23 to 2.26], men (vs. women; adjusted risk ratio = 1.45, 95% CI: 1.21 to 1.71), and testing through provider-initiated testing and counseling (vs. client initiated; 1.19, 95% CI: 1.00 to 1.40). There is a need to increase HIV testing among older individuals and men, increase testing frequency in key/priority populations, and maintain provider-initiated and facility-based testing to reach first-time testers.

Sexual and reproductive health knowledge, attitudes and service uptake barriers among Zambian in-school adolescents: a mixed methods study

ABSTRACT The provision of comprehensive sexuality education (CSE) accords opportunities for scientifically accurate information about sexual and reproductive health (SRH). We used a mixed-methods study to characterise adolescent SRH knowledge, attitudes and service utilisation experiences in the context of CSE implementation in Zambia. In-school young people aged 12–24 years (N = 1,612) in the North-Western Province were randomly surveyed. A 29-item index was constructed to measure alignment of knowledge, attitudes and values (KAV) with the CSE curriculum. Logistic regression, stratifying by sexual debut status, modelled associations of past-year HIV counselling and testing and family planning service access, respectively, with CSE-KAV index scores. Focus group discussions further explored perceptions of and experiences accessing SRH services. Despite moderate SRH knowledge and acceptability of SRH services, fewer than half of sexually experienced young people reported accessing SRH services. Among sexually experienced youth, neither HIV testing nor family planning service utilisation in the previous year were associated with higher CSE-KAV index scores. Salient barriers to SRH service uptake included limited perceived benefits, unsupportive household and community environments, and negative interactions with health providers. To increase accessibility and uptake of youth SRH services, linking school-based CSE to SRH services is recommended.

TB and HIV Epidemiology and Collaborative Service: Evidence from Ethiopia, 2011-2015.

BackgroundIntegrating and scaling up tuberculosis (TB) and HIV services are essential strategies to achieve the combined goals ending both TB and HIV, especially in TB and HIV high burden countries. This study aimed to examine the prevalence of TB and HIV co-infection and the implementation of collaborative services in Ethiopia.MethodsWe used a national sentinel surveillance TB/HIV co-infection collected between 2010 and 2015. The Ethiopian Public Health Institute collected and collated the data quarterly from 79 health facilities in nine regional states and two city administrations.ResultsA total of 55,336 people living with HIV/AIDS were screened for active TB between 2011 and 2015. Of these, 7.3% were found co-infected with TB, and 13% TB-negative PLWHA were on isoniazid preventive therapy. Nine out of ten (89.2%) active TB patients were screened for HIV counselling and 17.8% were found to be HIV positive; 78.2% and 53.0% of HIV/TB co-infected patients were receiving cotrimoxazole preventive therapy and antiretroviral treatment, respectively.ConclusionThis study showed that the prevalence of TB and HIV co-infection failed to decrease over the study period, and that, while there was an increasing trend for integration of collaborative services, this was not uniform over time. Aligning and integrating TB and HIV responses are still needed to achieve the target of ending TB and HIV by 2030.

Feasibility of home-based HIV counselling and testing and linking to HIV services among women delivering at home in Geita, Tanzania

Feasibility of home-based HIV counselling and testing and linking to HIV services among women delivering at home in Geita, Tanzania

Understanding Structural Determinants of HIV Testing in a Resource-Limited Setting: The Case of Ethiopian Women

Knowing HIV serostatus is a vital component of HIV prevention. Although significant progress is being made in controlling HIV infection, the uptake of HIV Testing and Counselling (HTC) remains low. Previous studies have mainly focused on individual level risk factors; however, structural determinants relevant to HIV prevention including HIV testing are largely unknown. The study objective was to identify key structural factors associated with HIV screening among women living in resource-poor countries like Ethiopia. Using Ethiopia’s Demographic and Health Survey (sample = 8382), we examined structural determinants of HIV testing. The study revealed that four-in-ten women were ever tested for HIV. Both HIV testing enabling and inhibiting (barrier) environments significantly associated with HIV testing status. Exposure to mass media significantly improved HIV testing. Women who visited a health facility in the last 12 months were 94% more likely to be tested for HIV than women who did not. Among women who said physical structure related factors were a big problem, 32% were less likely to be tested than women who did not think these factors were a problem. Our findings suggest that structural interventions may improve the uptake of HIV testing among Ethiopian women.

Framing the Material Global: The Grounded Politics of HIV Testing Scale-Up

Abstract Drawing on the framework of transnational materiality (Gille 2014), a conceptual contribution from the Framing the Global project, this article examines how HIV testing and counselling services became a site of political contestation in Taiwan since expanding service delivery was proposed as a response to the HIV epidemic by global health institutions in the 2000s. This global scheme, the study argues, not only reshaped the organization and practices of HIV service delivery, but also generated vulnerability as these practices connected to HIV-positive people’s lives were largely governed by global models and national programs that may not fully reflect local concerns. In response, local NGO workers politicize service delivery in part by transnationally adopting and promoting practices that attend more carefully to localized forms of vulnerability. Using qualitative data collected in Taiwan, the analysis reveals a grounded politics of HIV service delivery that highlights the materialization of vulnerability and its management.

POLICY IMPLEMENTATION FOR HIV/AIDS AND SEXUALLY TRANSMITTED INFECTIOUS DISEASE PROGRAMS IN THE FIRST LEVEL OF HEALTH FACILITY

The number of HIV/AIDS and Sexually Transmited Infectious Diseases (PIMS) incidence in Indonesia, especially in Central Java are growing every year. Provincial government set a regulation in controlling disease that refers to the HIV/ AIDS Control Program and PIMS in the First Level of Health Facilities by the Ministry of Health in 2016. It is hoped that this program can break the chain of HIV/AIDS and PIMS cases while at the same time making a generation that healthy and productive quality. The aim of this study was to determine the implementation of programs to control HIV/AIDS and PIMS in Banyumas regency. The design of this study was descriptive qualitative through in-depth interviews. The main informants were ten HIV Counseling and Testing (KTHIV) of Public Health Center, triangulation informants were People Living With HIV/AIDS (PLWHA) patients, Clinical Doctors, Head of Department of Health Services P2P. The data were collected by in-depth interview technique. In addition to the interview, a survey was also conducted with PLWHA. Processing and analysis of data were using taxonomic analysis. The implementation of HIV/AIDS control program policies has not been optimal in its implementation. The lack of optimal implementation of HIV/AIDS and PIMS prevention policies is due to several aspects, i.e. policy accuracy, implementation accuracy, target accuracy, environmental accuracy, and process accuracy. Increasing monitoring and evaluation related to a program's policies is needed. Morover, it is important to improve the quality of human resources and careful planning related to the control program.

Maternal and newborn healthcare practices: assessment of the uptake of lifesaving services in Hoima District, Uganda

BackgroundThe current maternal mortality ratio in Uganda is 336 maternal deaths per 100,000 live births. Infant mortality is 43 deaths per 1000 live births, with 42% of the mortality occurring during the neonatal period. This might be related to a weak health system in the country. This study aimed at assessing the uptake of lifesaving services during pregnancy and childbirth in Hoima District, Uganda.MethodsThe study used a cross-sectional quantitative design among 691 women with a child under 5 years. Households were randomly sampled from a list of all the villages in the district with the ENA for SMART software using the EPI methodology. Pre-coded questionnaires uploaded in the Open Data Kit were used for data collection. The data was cleaned and analysed using MS Excel and SPSS software. Descriptive results are presented.ResultsOf the 55.1% women attending at least four antenatal care (ANC) visits, only 24.3% had the first ANC within the first trimester. Moreover, ANC services generally was of poor quality, with only 0.4% meeting all the requirements for quality of ANC service. The highest contributors to this poor quality included poor uptake of iron-folic acid (adherence 28.8%), the six-required birth preparedness and complication readiness items (13.2%), and recognition of the seven danger signs of pregnancy (3.0%). Adherence to the seven essential newborn care actions was very low (0.5%), mainly caused by three practices: initiating breastfeeding within 1 h (59.9%), lack of postnatal care within 24 h (20.1%), and failure to recognize the 6 danger signs of the newborn (2.4%). Only 11.1% of the males participated in all maternal and newborn care requirements, by encouraging women to seek healthcare (39.9%), accompanying them to healthcare (36.9%), and HIV counselling and support services (26.2%).ConclusionThe study reveals poor maternal and newborn practices throughout the continuum of care, from ANC and skilled birth attendance to newborn care during childbirth. With such poor results, it is not surprising that Hoima is sixth of 10 districts that have the highest numbers of deaths due to maternal mortality in Uganda.

\u201cVital\u201d: HIV counselling and testing staff\u2019s views of addressing mental health with HIV in Uganda

BackgroundMental health is linked to HIV outcomes, including linkage into care and adherence to medication. Integrated care for mental and physical health is recommended. HIV testing and counselling sessions represent an opportunity to implement interventions to address mental health, however it is first necessary to understand the roles, current practice, knowledge and attitudes of the testing and counselling staff.MethodsThis qualitative study used semi-structured interviews with HIV testing and counselling staff at four centres of a HIV healthcare provider charity in Uganda. Interviews focused on their current practice, perceptions of mental health and their role in supporting this, challenges of this work, training and support needs, and views of potential greater emphasis on mental health work in their role. Data were audio-recorded, transcribed verbatim, and analysed thematically.ResultsData from twenty-one testing and counselling staff revealed five themes. Clients presented to counselling staff with needs spanning bio-psycho-social domains, where psychological health was intertwined with HIV management, medication adherence, and seen as “inseparable” from HIV itself. Mental health was largely thought about as “madness”, identifiable from extreme behaviour. As such, common mental health problems of anxiety and depression were not often seen as part of mental health. Approaches to intervening with mental health were seen as behavioural, with some ideas about changing thinking styles. Participants demonstrated significant practice of common techniques to address mental health. Needs were identified for further training in suicide risk assessment and identification of depression, together with greater clinical supervision. Participants described significant conflict within their roles, particularly balancing time demands and need to achieve testing targets against the need to offer adequate mental health support to clients in need.ConclusionsHIV testing and counselling staff described a diverse role that already includes addressing mental health. Mental health is “vital” to their work, however the time needed to address it is at odds with current testing targets. They require more training and resources to effectively address mental health, which is vital to optimising HIV outcomes. Interventions to integrate mental health support into HIV testing and counselling sessions need to be further researched and optimised.

Using discrete choice experiments to design interventions for heterogeneous preferences: protocol for a pragmatic randomised controlled trial of a preference-informed, heterogeneity-focused, HIV testing offer for high-risk populations

IntroductionApproximately one million undiagnosed persons living with HIV in Southern and Eastern Africa need to test for HIV. Novel approaches are necessary to identify HIV testing options that match the...