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CSU 178/2011: PROVIDER INITIATED HIV TESTING, AN ALTERNATIVE TO CONVENTIONAL VCT

Thursday, 12th of May 2011

‘The introduction of routine PITC using lay counsellors into health-care clinics in Lusaka, Zambia, dramatically increased the uptake and acceptability of HIV testing.’ 

Full text, with figures, is at http://www.who.int/bulletin/volumes/89/5/10-084442.pdf

Readers of this update should also consult 'Game Changer in HIV Prevention,' available at  http://www.childsurvival.net/?content=com_articles&artid=534


 Opt-out provider-initiated HIV testing and counselling in primary care outpatient clinics in Zambia

Stephanie M Topp,a Julien M Chipukuma,a Matimba M Chiko,b Chibesa S Wamulume,b Carolyn Bolton-Moorea & Stewart E Reida

 

 

Objective To increase case-finding of infection with human immunodeficiency virus (HIV) in Zambia and their referral to HIV care and treatment by supplementing existing client-initiated voluntary counselling and testing (VCT), the dominant mode of HIV testing in the country.

 

Methods Lay counsellors offered provider-initiated HIV testing and counselling (PITC) to all outpatients who attended primary clinics and did not know their HIV serostatus. Data on counselling and testing were collected in registers. Outcomes of interest included HIV testing coverage, the acceptability of testing, the proportion testing HIV-positive (HIV+), the proportion enrolling in HIV care and treatment and the time between testing and enrolment.

 

Findings After the addition of PITC to VCT, the number tested for HIV infection in the nine clinics was twice the number undergoing VCT alone. Over 30 months, 44 420 patients were counselled under PITC and 31 197 patients, 44% of them men, accepted testing. Of those tested, 21% (6572) were HIV+; 38% of these HIV+ patients (2515) enrolled in HIV care and treatment. The median time between testing and enrolment was 6 days. The acceptability of testing rose over time.

 

Conclusion The introduction of routine PITC using lay counsellors into health-care clinics in Lusaka, Zambia, dramatically increased the uptake and acceptability of HIV testing. Moreover, PITC was incorporated rapidly into primary care outpatient departments. Maximizing the number of patients who proceed to HIV care and treatment remains a challenge and warrants further research.’