Lost opportunities to identify and treat HIV-positive patients: results from a baseline assessment of provider-initiated HIV testing and counselling (PITC) in Malawi.
Trop Med Int Health
; 21(4): 479-85, 2016 Apr.
Article
en En
| MEDLINE
| ID: mdl-26806378
ABSTRACT
OBJECTIVE:
To assess implementation of provider-initiated testing and counselling (PITC) for HIV in Malawi.METHODS:
A review of PITC practices within 118 departments in 12 Ministry of Health (MoH) facilities across Malawi was conducted. Information on PITC practices was collected via a health facility survey. Data describing patient visits and HIV tests were abstracted from routinely collected programme data.RESULTS:
Reported PITC practices were highly variable. Most providers practiced symptom-based PITC. Antenatal clinics and maternity wards reported widespread use of routine opt-out PITC. In 2014, there was approximately 1 HIV test for every 15 clinic visits. HIV status was ascertained in 94.3% (5293/5615) of patients at tuberculosis clinics, 92.6% (30,675/33,142) of patients at antenatal clinics and 49.4% (6871/13,914) of patients at sexually transmitted infection clinics. Reported challenges to delivering PITC included test kit shortages (71/71 providers), insufficient physical space (58/71) and inadequate number of HIV counsellors (32/71) while providers from inpatient units cited the inability to test on weekends.CONCLUSIONS:
Various models of PITC currently exist at MoH facilities in Malawi. Only antenatal and maternity clinics demonstrated high rates of routine opt-out PITC. The low ratio of facility visits to HIV tests suggests missed opportunities for HIV testing. However, the high proportion of patients at TB and antenatal clinics with known HIV status suggests that routine PITC is feasible. These results underscore the need to develop clear, standardised PITC policy and protocols, and to address obstacles of limited health commodities, infrastructure and human resources.Palabras clave
Texto completo:
1
Colección:
01-internacional
Asunto principal:
Calidad de la Atención de Salud
/
Infecciones por VIH
/
Tamizaje Masivo
/
Consejo
/
Instituciones de Atención Ambulatoria
Tipo de estudio:
Evaluation_studies
/
Guideline
/
Prognostic_studies
/
Screening_studies
Límite:
Humans
País/Región como asunto:
Africa
Idioma:
En
Revista:
Trop Med Int Health
Asunto de la revista:
MEDICINA TROPICAL
/
SAUDE PUBLICA
Año:
2016
Tipo del documento:
Article
País de afiliación:
Malawi