Provider-initiated HIV Testing And Counseling Research Articles

Enhancing HIV positivity yield in southern Mozambique: The effect of a Ministry of Health training module in targeted provider-initiated testing and counselling.

In Mozambique, targeted provider-initiated HIV testing and counselling (PITC) is recommended where universal PITC is not feasible, but its effectiveness depends on healthcare providers' training. This study aimed to evaluate the effect of a Ministry of Health training module in targeted PITC on the HIV positivity yield, and identify factors associated with a positive HIV test. We conducted a single-group pre-post study between November 2018 and November 2019 in the triage and emergency departments of four healthcare facilities in Manhiça District, a resource-constrained semi-rural area. It consisted of two two-month phases split by a one-week targeted PITC training module ("observation phases"). The HIV positivity yield of targeted PITC was estimated as the proportion of HIV-positive individuals among those recommended for HIV testing by the provider. Additionally, we extracted aggregated health information system data over the four months preceding and following the observation phases to compare yield in real-world conditions ("routine phases"). Logistic regression analysis from observation phase data was conducted to identify factors associated with a positive HIV test. Among the 7,102 participants in the pre- and post-training observation phases (58.5% and 41.5% respectively), 68% were women, and 96% were recruited at triage. In the routine phases with 33,261 individuals (45.8% pre, 54.2% post), 64% were women, and 84% were seen at triage. While HIV positivity yield between pre- and post-training observation phases was similar (10.9% (269/2470) and 11.1% (207/1865), respectively), we observed an increase in yield in the post-training routine phase for women in triage, rising from 4.8% (74/1553) to 7.3% (61/831) (Yield ratio = 1.54; 95%CI: 1.11-2.14). Age (25-49 years) (OR = 2.43; 95%CI: 1.37-4.33), working in industry/mining (OR = 4.94; 95%CI: 2.17-11.23), unawareness of partner's HIV status (OR = 2.50; 95%CI: 1.91-3.27), and visiting a healer (OR = 1.74; 95%CI: 1.03-2.93) were factors associated with a positive HIV test. Including these factors in the targeted PITC algorithm could have increased new HIV diagnoses by 2.6%. In conclusion, providing refresher training and adapting the current targeted PITC algorithm through further research can help reach undiagnosed PLHIV, treat all, and ultimately eliminate HIV, especially in resource-limited rural areas.

Characteristics and communication skills of health professionals in implementing provider-initiated HIV testing and counselling (PITC) for Indonesian pregnant women

Background: HIV testing for pregnant women is an important test during pregnancy. HIV testing for pregnant women is a way to prevent mother-to-child HIV transmission. Objectives: To investigate the relationship between the characteristics and communication skills of health professionals while conducting provider-initiated HIV testing and counselling (PITC) for pregnant women. Methods: This was an observational study with a cross-sectional approach. The study was conducted at 23 public health centres with 80 health professionals who conduct PITC. The data was analysed using the Chi-Square test. Results: There was a correlation between the characteristics and communication skills of respondents. Relationships were observed between respondents trained on PITC and communication with patients during PITC sessions (p=0.002); work experience and non-verbal communication skills (p=0.047), and type of profession of respondents and non-verbal communication skills (p=0.029). Conclusions: Communication skills had a relationship with experienced training on PITC, work experience, and type of profession. Increasing the communication skill of health professionals through work experience and training or education to improve the ability of health professionals in PITC services.

Factors associated with offer and uptake of provider-initiated HIV testing and counselling among men attending healthcare facilities in Moshi Municipality, Northern Tanzania.

HIV Testing and Counseling is a critical entry-point for HIV care, treatment and prevention. Tanzania adopted the WHO recommendations of Provider-Initiated HIV Testing and Counseling (PITC) in 2007 with the aim of increasing early HIV diagnosis and timely access to treatment and support services. However, approximately 55% of men are still unaware of their HIV status. This study aimed to determine the level of PITC uptake and factors associated with PITC availability and uptake among men attending healthcare facilities in Moshi Municipality, Northern Tanzania. A facility-based cross-sectional study was conducted in July 2019 in five selected healthcare facilities in Moshi Municipal, Kilimanjaro region. Exit interviews were conducted with men aged 18 years and above who attended for care in the selected facilities. Modified Poisson regression modelling with robust standard errors were used to determine factors independently associated with being offered and accepting the PITC offer. A total of 562 men participated in this study. The median age of participants at enrollment was 37 (IQR: 26-59) years. Only 58% of participants reported to have been offered provider-initiated HIV counseling. Of these, 83% accepted the offer of HIV testing. Age between 35-59 years (aPR = 1.2; 95% Confidence Interval (CI): 1.0, 1.4; p = 0.033) and having primary education (aPR = 0.7; 95% CI: 0.6, 0.9; p = 0.010) were factors independently associated with being offered PITC. Age between 35-59 years (aPR = 0.8; 95% CI: 0.7, 0.9; p = 0.002); having been previously tested for HIV (aPR = 1.3; 95% CI: 1.1, 1.5; p = 0.011) and visiting a health facility twice or more in previous year (aPR = 1.3; 95% CI: 1.2, 1.5; p<0.001) were independently associated with uptake of HIV testing. Despite high PITC uptake, about 2 in 5 men attending healthcare facilities in Moshi municipality were not offered the service. Providers should target men aged ≤ 34 years, with primary education, visiting facilities for the first time and who have never been tested for HIV.

Provider-initiated HIV testing and TB screening in the era of universal coverage: Are the right people being reached? A cohort study in Blantyre, Malawi.

Patients with tuberculosis (TB) symptoms have high prevalence of HIV, and should be prioritised for HIV testing. In a prospective cohort study in Bangwe primary care clinic, Blantyre, Malawi, all adults (18 years or older) presenting with an acute illness were screened for TB symptoms (cough, fever, night sweats, weight loss). Demographic characteristics were linked to exit interview by fingerprint bioidentification. Multivariable logistic regression models were constructed to estimate the proportion completing same-visit HIV testing, comparing between those with and without TB symptoms. There were 5427 adult attendees between 21/5/2018 and 6/9/2018. Exit interviews were performed for 2402 (44%). 276 patients were excluded from the analysis, being already on antiretroviral therapy (ART). Presentation with any TB symptom was common for men (54.6%) and women (57.4%). Overall 27.6% (585/ 2121) attenders reported being offered testing and 21.5% (455/2121) completed provider-initiated HIV testing and counselling (PITC) and received results. The proportions offered testing were similar among participants with and without TB symptoms (any TB symptom: 29.0% vs. 25.7%). This was consistent for each individual symptom; cough, weight loss, fever and night sweats. Multivariable regression models indicated men, younger adults and participants who had previously tested were more likely to complete PITC than women, older adults and those who had never previously tested. Same-visit completion of HIV testing was suboptimal, especially among groups known to have high prevalence of undiagnosed HIV. As countries approach universal coverage of ART, identifying and prioritising currently underserved groups for HIV testing will be essential.

Improving inpatient provider-initiated HIV testing and counseling in Sierra Leone.

Only 47% of HIV-positive Sierra Leoneans knew their status in 2017, making expanded HIV testing a priority. National guidelines endorse provider-initiated HIV testing and counselling (PITC) to increase testing coverage, but PITC is rarely provided in Sierra Leone. In response, a Quality Improvement Collaborative (QIC) was implemented to improve PITC coverage amongst adult inpatients. Ten hospitals received the intervention between October 2017 and August 2018; there were no control facilites. Each hospital aimed to improve PITC coverage to ≥ 95% of eligible patients. Staff received training on PITC and QIC methods and a package of PITC best practices and tools. They then worked to identify additional contextually-appropriate interventions, conducted rapid tests of change, and tracked performance using shared indicators and time-series data. Supportive supervision bolstered QI skills, and quarterly meetings enabled diffusion of innovations while spurring friendly competition. Baseline PITC coverage was 4%. The hospital teams tested diverse interventions using QI methods, including staff training; data review meetings; enhanced workflow processes and supervision; and patient education and sensitization activities Nine hospitals reached and sustained the 95% target, and all saw rapid and durable improvement, which was sustained for a median of six months. Of the 5,238 patients tested for HIV, 311 (6%) were found to be HIV-positive and were referred for treatment. HIV rapid test kit stockouts occurred during the project period, limiting PITC services in some cases. The intervention led to swift and sustained improvement in inpatient PITC coverage and to the diagnosis of hundreds of people living with HIV. Sierra Leone's Ministry of Health and Sanitation plans to take the initiative to national scale, with close attention to the issue of test kit stockouts.

HIV testing uptake and HIV positivity among presumptive tuberculosis patients in Mandalay, Myanmar, 2014-2017.

The World Health Organization's framework for TB/HIV collaborative activities recommends provider-initiated HIV testing and counselling (PITC) of patients with presumptive TB. In Myanmar, PITC among presumptive TB patients was started at the TB outpatient department (TB OPD) in Mandalay in 2014. In this study, we assessed the uptake of PITC among presumptive TB patients and the number needed to screen to find one additional HIV positive case, stratified by demographic and clinical characteristics. This was a cross-sectional study using routinely collected data of presumptive TB patients who registered for PITC services at the TB OPD between August 2014 and December 2017 in Mandalay. Among 21,989 presumptive TB patients registered, 9,796 (44.5%) had known HIV status at registration and 2,763 (28.2%) were people already living with HIV (PLHIV). Of the remainder, 85.3% (10,401/12,193) were newly tested for HIV. Patients <55 years old, those registered in 2014, 2015 and 2017, those employed and those having a history of TB contact had higher uptakes of HIV testing. Among 10,401 patients tested for HIV, 213 (2.1%) patients were newly diagnosed with HIV and this included 147 (69.0%) who were not diagnosed as having TB. The overall prevalence of HIV (previously known and newly diagnosed) among presumptive TB patients was 14.8% (2,976/20,119). The number needed to screen to find one additional HIV case was 48: this number was lower (i.e., a higher yield) among patients aged 35-44 years and among those who were divorced or separated. Uptake of HIV testing among eligible presumptive TB patients was high with four out of five presumptive TB patients being tested for HIV. This strategy detected many additional HIV-positive persons, and this included those who were not diagnosed with TB. We strongly recommend that this strategy be implemented nationwide in Myanmar.

Practices and Obstacles to Provider-Initiated HIV Testing and Counseling (PITC) Among Healthcare Providers in C\xf4te d\u2019Ivoire

Practices of Provider-Initiated HIV Testing and Counseling (PITC) remains suboptimal in Côte d’Ivoire. The aim of this survey was to identify the practices and obstacles to PITC among healthcare professionals in Côte d'Ivoire. A nationally representative cross-sectional survey was conducted in 2018 by telephone among three separate samples of midwives, nurses and physicians practicing in Côte d'Ivoire. The number of HIV tests proposed during consultation in the month preceding the survey was collected for each professional. Factors associated with the number of proposed tests were identified through ordinal logistic regression models. A total of 298 midwives, 308 nurses and 289 physicians were interviewed. Midwives proposed the test more frequently, followed by nurses and physicians. Among midwives, a higher number of proposed tests was associated with the perception that HIV testing does not require specific consent compared to other diseases (aOR 4.00 [95% CI 1.37–14.29]). Among nurses, having received HIV training and the presence of community HIV counselors were associated with a higher number of proposed tests (aOR 2.01 [1.31–3.09] and aOR 1.75 [1.14–2.70], respectively). For physicians, the presence of a voluntary testing center was associated with a higher number of proposed tests (aOR 1.69 [1.01–2.86]). PITC practices and barriers differed across professions. Beyond improving environmental opportunities such as dedicated staff or services, strengthening the motivations and capabilities of healthcare professionals to propose testing could improve PITC coverage.

Inequalities in uptake of HIV testing despite scale-up

HIV testing is a necessary step for uptake of HIV prevention and treatment services. Since 2008 there have been large scale initiatives to intensify access to and uptake of HIV testing among untested populations at risk through provider-initiated HIV testing and counselling (PITC)1, community-based approaches2 and partner notification3, with Sub-Saharan Africa, the region worst affected by the HIV epidemic4, being most critically in need of these initiatives. As for other health interventions5,6 however, inequalities in uptake of HIV testing have been recorded7, and they may persist despite intensification of HIV testing efforts and treatment scale-up8.

Where are the positives? HIV testing in sub-Saharan Africa in the era of test and treat.

Where are the positives? HIV testing in sub-Saharan Africa in the era of test and treat.

Perspectives about policy implementation: A learning opportunity from the 2003-2013 Malawi HIV/AIDS Policy.

Malawi published its first ever HIV and AIDS policy in 2003. The implementation of the policy provided a very necessary and historic step in Malawi's organized response towards HIV and AIDS. Many achievements were registered in the period this policy was implemented. However, some components of the policy were not well-implemented. Our study explored barriers to implementation of provider initiated HIV testing and counseling (PITC) for sexually transmitted infections (STI) within general outpatient settings. Malawi also launched a revised HIV and AIDS Policy in December 2013. Although not part of this policy analysis, future years of implementation may face related issues observed during the implementation of the 2003-2013 policy. This is a non-experimental, descriptive study using a case study design. We examined the implementation of provider initiated HIV testing and counseling component of the Malawi HIV and AIDS policy from 2003-2013 focusing on STI and outpatient clinic settings. We sought to understand perspectives of various stakeholders and users of the policy. We conducted in-depth interviews with policy makers, health care worker supervisors, health care workers and health rights activists. Major problems which affected the implementation of the 2003-2013 HIV policy were: selective prioritization of policies by government, lack of involvement of implementers in the policy making process, non-awareness of health workers about the existence of the policy, lack of healthcare worker training, unsatisfactory supervision of policy implementation, poor harmonization of policies, lack of clarity about guidance to those directly implementing, unclear roles and reporting authority among the main national coordinating units. Good leadership, effective coordination, involvement of key players in the policy making process, dissemination to primary users and decentralization or empowerment of local supervisors is key to successful policy implementation.

How Do We Get Partners to Test for HIV?: Predictors of Uptake of Partner HIV Testing Following Individual Outpatient Provider Initiated HIV Testing in Rural Uganda.

In a sample of outpatients (152 females, 152 males) receiving individual provider-initiated HIV testing and counselling (PITC) we aimed to identify factors associated with subsequent uptake of partner HIV testing. Purposively sampled outpatients receiving PITC at a Ugandan hospital completed a questionnaire immediately prior to testing for HIV, and then at 3 and 6months post-test. By 6-month follow-up 96% of participants reported disclosing their HIV test results to their partner and 96.4% reported asking their partner to test. 38.8% of women and 78.9% of men reported that their partner tested and they knew their results. Recent (men AOR 5.84, 95.0% CI 1.90-17.99; women AOR 6.19, 95.0% CI 2.74-13.59) or any previous testing by the partner (women AOR 4.01, 95% CI 1.06-15.10) predicted uptake of partner testing by the 6-month follow-up. Among women, perceiving greater social support from their partner, which perhaps reflects better relationship quality, was predictive of their male partner testing for HIV (AOR 2.37, 95% CI 1.22-4.58). Notably intimate partner violence showed no negative association with partner testing. Our findings demonstrate that women are at a disadvantage compared to men in their ability to influence their partner to test for HIV, and that improving social support in intimate relationships should be a focus of HIV partner testing interventions. However, more research on interventions to improve partner testing is needed, particularly in identifying effective ways to support women in engaging their partners to test.

A comparison of effectiveness between oral rapid testing and routine serum-based testing for HIV in an outpatient dental clinic in Yuxi Prefecture, China: a case–control study

ObjectiveTo compare the outcomes of routine provider-initiated HIV testing and counselling (PITC) and oral rapid HIV testing for dental clinic outpatients in a hospital.DesignWe employed a case–control study design and...

Health System Barriers to Provider-Initiated HIV Testing and Counselling Services for Infants and Children: A Qualitative Study From 2 Districts in Njombe, Tanzania

There is low utilisation of provider-initiated HIV testing and counselling (PITC) services for infants and children under 5 years old in many low- and middle-income countries including Tanzania. Studies have shown that various factors contribute to low use of PITC, includes the unavailability of the polymerase chain reaction (PCR) test and other specialised techniques for testing children less than 18 months old as well as the reluctance of some parents and caregivers to undertake HIV testing for their children because of the fear of stigma associated with HIV/AIDS. This study explored health system barriers at the district and community levels affecting the provision of PITC for infants and children under 5 in Tanzania using a case study of 2 districts.A qualitative study was conducted in 1 urban and 1 rural district in the southern part of Tanzania. In-depth interviews, focus group discussions, and a desk review of documents were used to obtain the information. Respondents were purposively enrolled in the study and thematic analysis was used to generate findings.Provision of PITC services faces a number of district-level health system barriers, including lack of adequate health staff in health facilities both in number and skills, lack of adequate infrastructure, and erratic shortage of supplies. At the community level, community members' low understanding about the importance of PITC services as well as existing stigma associated with HIV/AIDS have constrained the provision of PITC services.This study concludes that for effective implementation of PITC, the health system should strengthen health facilities through training of service providers on PITC, deploying adequately skilled health workers, supplying sufficient medicines and other supplies, and promoting health campaigns focused on educating community members about the importance of early HIV testing for infants and children under 5.

Depression, alcohol use, and intimate partner violence among outpatients in rural Uganda: vulnerabilities for HIV, STIs and high risk sexual behavior

BackgroundIntimate partner violence (IPV), alcohol use, and depression are key vulnerabilities for HIV in Uganda, and taken together may have a synergistic effect on risk. Our objective was to investigate the associations between depression, IPV, and alcohol use and HIV-risk indicators among a sample of outpatients in rural Uganda, and the effect of co-occurrence of these factors on HIV-risk indicators.MethodsIn a structured interview we collected data on high-risk sexual behavior, depression symptoms, emotional and physical IPV, and alcohol use, as well as a blood sample for HIV and syphilis tests and a urine sample for chlamydia and gonorrhea tests from 325 male and female outpatients receiving provider-initiated HIV testing and counseling (PITC) at a public hospital outpatient clinic in rural Uganda. We used logistic regression and generalized linear modeling to test independent associations between depression, IPV, and alcohol use and HIV-risk indicators, as well as the effect of co-occurrence on HIV-risk indicators.ResultsTwelve percent of men and 15% of women had two or more of the following conditions: depression, IPV, and alcohol use; another 29% of men and 33% of women had 1 condition. Each condition was independently associated with HIV risk behavior for men and women, and for women, depression was associated with testing positive for HIV or a sexually transmitted infection (STI). Men with one condition (AOR 2.32, 95% CI 1.95–2.77) and two or more conditions (AOR 12.77, 95% CI 7.97–20.47) reported more high risk sex acts compared to those with no potential co-occurring conditions. For men, experiencing two or more conditions increased risky sex more than one alone (χ2 24.68, p < 0.001). Women experiencing one condition (AOR 3.33, 95% CI 137–8.08) and two co-occurring conditions (AOR 5.87, 95% CI 1.99–17.35) were more likely to test positive for HIV or an STI and women with two co-occurring conditions were also at increased risk for risky sex (AOR 2.18, 95% CI 1.64–2.91). We also found preliminary evidence suggesting synergistic effects between depression and emotional IPV and between alcohol use and depression.ConclusionsThis study demonstrates the co-occurrence of depression, IPV, and alcohol use in men and women in an outpatient setting in rural Uganda. The co-occurrence of these factors was associated with greater HIV risk, highlighting the need for a more holistic approach to HIV prevention and care research and programming.

Health System Barriers to Provider-Initiated HIV Testing and Counselling Services for Infants and Children: A Qualitative Study From 2 Districts in Njombe, Tanzania

Background:There is low utilisation of provider-initiated HIV testing and counselling (PITC) services for infants and children under 5 years old in many low- and middle-income countries including Tanzania. Studies have shown that various factors contribute to low use of PITC, includes the unavailability of the polymerase chain reaction (PCR) test and other specialised techniques for testing children less than 18 months old as well as the reluctance of some parents and caregivers to undertake HIV testing for their children because of the fear of stigma associated with HIV/AIDS. This study explored health system barriers at the district and community levels affecting the provision of PITC for infants and children under 5 in Tanzania using a case study of 2 districts.Methods:A qualitative study was conducted in 1 urban and 1 rural district in the southern part of Tanzania. In-depth interviews, focus group discussions, and a desk review of documents were used to obtain the information. Respondents were purposively enrolled in the study and thematic analysis was used to generate findings.Results:Provision of PITC services faces a number of district-level health system barriers, including lack of adequate health staff in health facilities both in number and skills, lack of adequate infrastructure, and erratic shortage of supplies. At the community level, community members’ low understanding about the importance of PITC services as well as existing stigma associated with HIV/AIDS have constrained the provision of PITC services.Conclusion:This study concludes that for effective implementation of PITC, the health system should strengthen health facilities through training of service providers on PITC, deploying adequately skilled health workers, supplying sufficient medicines and other supplies, and promoting health campaigns focused on educating community members about the importance of early HIV testing for infants and children under 5.

EVALUASI PELAKSANAAN DAN KEPUASAAN KLIEN PROVIDER INITIATED HIV TESTING AND COUNSELING (PITC) DI BBKPM SURAKARTA

Provider Initiated HIV Testing and Counseling (PITC) at BBKPM Surakarta formed of collaboration to avaoid TB-HIV. The purpose of this study was to known the implementation of PITC and satisfaction of client of BBKPM Surakarta. This research was qualitative descriptive with an evaluation study design. The information collected from PITC program holder and PITC clients. The instruments of this research were structured interview guidelines, indepth interview guidelines, focus group discussions guidelines, observation and documentation. The results showed that PITC input indicator appropriated by guidelines. Process indicator, service procedures was appropriate guidelines. There were some interference, double responsible position, counseling must paid and CST holder insufficiently. Output indicator, targets PITC targets was unreached, form reports as appropriate guidelines and client satisfy with score 75,38%. The advices can be given were redesigning counseling room, adding PITC’s room keeper and CST holder, intern discussion among all BBKPM services and providing suggestion box. Keywords: Evaluation; PITC

Predictors of provider- initiated HIV testing and counseling refusal by outpatient department clients in Wolaita zone, Southern Ethiopia: a case control study.

BackgroundDespite different strategies designed to rapidly identify HIV infected individuals, majority of HIV-infected people are unaware of their sero-status in developing countries. The objective of this study was to assess predictors of provider-initiated HIV testing and counseling (PITC) refusal by outpatient department (OPD) clients in Wolaita zone, Southern Ethiopia.MethodsFacility based unmatched case control study was conducted on outpatient department clients in randomly selected seven health facilities in Wolaita zone, Southern Ethiopia in February 2012. A total of 291 participants (97 cases and 194 controls) were included in our study. Cases were patients who refused HIV test while controls were patients who tested for HIV after provider-initiated HIV testing and counseling (PITC) recommendation by outpatient department (OPD) clinicians. We used both quantitative and qualitative methods of data collection. Pretested interviewer administered questionnaires were used to collect quantitative data by trained nurses, and in-depth interview with 14 OPD clinicians was conducted by principal investigator to supplement quantitative findings. Bivariate and multivariate analyses were done to identify independent predictors of provider-initiated HIV testing and counseling refusal by OPD clients.ResultStudy participants who had stigmatizing attitude [AOR = 6.09, (95 % CI: 1.70, 21.76)], who had perceived risk for HIV infection [AOR = 5.23, (95 % CI: 2.22, 12.32)], who did not perceive the benefits of provider-initiated HIV testing and counseling [AOR = 4.64, (95 % CI: 1.79, 12.01)], who did not get minimum recommended pretest information from their providers [AOR = 2.98, (95 % CI: 1.06, 8.35)], who ever not heard of provider-initiated HIV testing and counseling service [AOR = 2.41, (95 % CI: 1.14, 5.09)], and who were from urban area [AOR = 2.40, (95 % CI = 1.26, 4.57)] were more likely to refuse provider-initiated HIV testing and counseling service than their counterparts.ConclusionKnowledge on HIV/AIDS, attitude towards people living with HIV/AIDS and perceived risk for HIV infection by clients were the major barriers for provider-initiated HIV testing and counseling acceptance. Health professionals working at outpatient department should give due attention to overcome these barriers so as to enhance HIV testing acceptance by their clients.

Provider-Initiated HIV testing and counseling among patients with presumptive tuberculosis in Democratic Republic of Congo.

IntroductionProvider-initiated HIV testing and counseling (PITC) of patients with presumptive tuberculosis (TB) is not widely implemented and the burden of HIV among them is not well characterized. We assessed the uptake of PITC and prevalence of HIV among patients with presumptive TB in primary care settings in the Democratic Republic of Congo.MethodsPITC was implemented in primary care TB clinics in Kinshasa and Kisangani, respectively. In each of the clinics, all patients presenting with cough lasting more than two weeks or any other symptom suggestive of TB were offered HIV testing and counseling and those found to be HIV+ were linked to HIV care and treatment.ResultsBetween November 2011 and June 2013, 43,145 patients with presumptive TB were registered in 65 clinics in Kinshasa of whom 84.0% were counseled; 92.4% of those counseled were tested and 4,320 (12.9%) were found to be HIV+. Similarly, in Kisangani, of the 6,687 patients with presumptive TB were registered in 13 clinics, 80.5% were counseled; 99.3% were tested for HIV and 619 (11.6%) were found to be HIV+.ConclusionImplementation of PITC among patients with presumptive TB in primary care clinics was associated with high uptake of HIV testing and identification of high number of HIV+ patients.

Impact of WHO 2010 Guidelines on Antiretroviral Therapy Initiation among Patients with HIV-Associated Tuberculosis in Clinics with and without Onsite HIV Services in the Democratic Republic of Congo.

Background. We assessed the impact of WHO's 2010 guidelines that removed the requirement of CD4 count before ART, on timely initiation of ART among HIV/TB patients in the Democratic Republic of Congo (DRC). Methods. Data collected to monitor implementation of provider initiated HIV testing and counseling (PITC) and linkage to HIV care from 65 and 13 TB clinics in Kinshasa and Kisangani, respectively, between November 2010 and June 2013. Results. Prior to the WHO's 2010 guidelines, in Kinshasa, 79.1% (401/507) of HIV/TB patients referred for HIV services were initiated on ART in clinics with onsite ART services compared to 50.0% (63/123) in clinics without. Following the implementation of the new guidelines, 89.8% (714/795) and 93.0% (345/371) of HIV/TB patients referred for HIV services were initiated on ART, respectively, in clinics with onsite and without onsite ART services. Similarly, in Kisangani, 69.7% (53/120) and 36.4% (16/44) in clinics with and without onsite ART service, respectively, were initiated on ART prior to the 2010 guidelines and 88.8% (135/152) and 72.6% (106/146), respectively, after the new guidelines. Conclusion. Though implementation of the 2010 guidelines increased the proportion of HIV/TB patients initiated on ART substantially, it remained below the 100% target, particularly in clinics without onsite ART services.

Does provider-initiated HIV testing and counselling lead to higher HIV testing rate and HIV case finding in Rwandan clinics?

BackgroundProvider-initiated HIV testing and counselling (PITC) is promoted as a means to increase HIV case finding. We assessed the effectiveness of PITC to increase HIV testing rate and HIV case finding among outpatients in Rwandan health facilities (HF).MethodsPITC was introduced in six HFs in 2009-2010. HIV testing rate and case finding were compared between phase 1 (pre-PITC) and phase 3 (PITC period) for outpatient-department (OPD) attendees only, and for OPD and voluntary counseling & testing (VCT) departments combined.ResultsOut of 26,367 adult OPD attendees in phase 1, 4.7 % were tested and out of 29,864 attendees in phase 3, 17.0 % were tested (p < 0.001). The proportion of HIV cases diagnosed was 0.25 % (67/26,367) in phase 1 and 0.46 % (136/29864) in phase 3 (p < 0.001). In multivariable analysis, both testing rate and case finding were significantly higher in phase 3 for OPD attendees. In phase 1 most of the HIV testing was done in VCT departments rather than at the OPD (78.6 % vs 21.4 % respectively); in phase 3 this was reversed (40.0 % vs 60.0 %; p < 0.001). In a combined analysis of VCT and OPD attendees, testing rate increased from 18.7 % in phase 1 to 25.4 % in phase 3, but case finding did not increase. In multivariable analysis, testing rate was significantly higher in phase 3 (OR 1.67; 95 % CI 1.60-1.73), but case finding remained stable (OR 1.09; 95 % CI 0.93-1.27).ConclusionPITC led to a shift of HIV testing from VCT department to the OPD, a higher testing rate, but no additional HIV case finding.Electronic supplementary materialThe online version of this article (doi:10.1186/s12879-016-1355-z) contains supplementary material, which is available to authorized users.