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Atlaw D, Sahiledengle B, Degno S, Mamo A, Gudisa Z, Zenbaba D, Shiferaw Z, Gezahegn H. Utilization of provider-initiated HIV testing and counselling in Ethiopia: a systematic review and meta-analysis. Trop Med Health 2022; 50:29. [PMID: 35436943 PMCID: PMC9016945 DOI: 10.1186/s41182-022-00420-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Accepted: 04/08/2022] [Indexed: 11/17/2022] Open
Abstract
Background Provider-initiated HIV testing, and counseling (PITC) is a service in which health professionals provide HIV testing to all patients in health facilities. Provider-initiated HIV testing, and counseling is an important opportunity for early screening of individuals, and it is fundamental for both HIV treatment and prevention. Although there are studies conducted in different parts of Ethiopia, their findings are variable. Therefore, this systematic review and meta-analysis aimed to summarize the pooled utilization of PITC in Ethiopia. Method All studies conducted on utilization of provider-initiated HIV testing and counseling at outpatient departments (OPD), inpatient departments (IPD), antenatal clinic care (ANC), and tuberculosis (TB) clinics in Ethiopia are eligible for these meta-analyses. A systematic search of the literature was conducted by the authors to identify all relevant primary studies. The databases used to search for studies were PubMed, Science Direct, POPLINE, HENARI, Google Scholar, and Scopus. The extracted data were imported into STATA version 14 software for statistical analysis. The risk of bias was assessed using the Joana Briggs Institute (JBI) criteria for prevalence studies. The heterogeneity among all included studies was assessed by I2 statistics and the Cochran’s Q test. Pooled utilization along with its corresponding 95% CI was presented using a forest plot. Result About 1738 studies were retrieved from initial electronic searches using international databases and Google, and a total of 10,676 individual clients were included in the meta-analysis. The pooled utilization of PITC in Ethiopia using the random effects model was estimated to be 78.9% (95% CI 73.87–83.85) with a significant level of heterogeneity (I2 = 98.5%; P < 0.001). Subgroup analysis conducted on PITC showed the highest percentage among studies conducted in Addis Ababa (93.5%), while lower utilization was identified from a study conducted in the Tigray Region (35%). Limitation of the study The drawbacks of this review and meta-analysis were being reported with significant heterogeneity, and the protocol was not registered. Conclusion About 21% of health facility clients missed opportunities for PITC in Ethiopia. Supplementary Information The online version contains supplementary material available at 10.1186/s41182-022-00420-9.
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Martelli G, Van Duffel L, Kwezi EC, Cavallin F, Salehe IA, Torelli GF, Putoto G, Hermans S, Rinke de Wit TF, Pozniak A. Community- and facility-based HIV testing interventions in northern Tanzania: Midterm results of Test & Treat Project. PLoS One 2022; 17:e0266870. [PMID: 35413074 PMCID: PMC9004748 DOI: 10.1371/journal.pone.0266870] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Accepted: 03/29/2022] [Indexed: 11/18/2022] Open
Abstract
Test & Treat Project offers universal HIV testing and access to antiretroviral treatment in Northern Tanzania. The current cross-sectional study provides midterm results on HIV testing and counseling activities through community outreaches and facility-based services. A total 255,329 HIV tests were performed: 198,451 (77.7%) during testing campaigns in the villages, 12,592 (4.9%) during special events outreach and 44,286 (17.4%) in the health facilities. Females represented 53.8% (23,809) among those tested in the health facilities, while males were the majority in the community (54.4%, 114,835). Over one third of tests (n = 104,605, 41%) were performed among first-time testers. The overall HIV positivity rate was 1.2%, ranging from 0.7% in the community to 3.8% in the health facilities and decreased over time. Using a multivariable analysis, a positive test result was associated with age ≥ 50 years (PR 1.22, 95% CI 1.11 to 1.34), with female gender (PR 1.61, 95% CI 1.50 to 1.73), being tested in health facilities (PR 5.00, 95% CI 4.65 to 5.36) and for the first time (PR 1.86, 95% CI 1.73 to 2.00). The estimated proportion of PLHIV who knew their status of the project area increased by 28.6% (from 35.7% to 64.3%) and 11.1% (from 57.7% to 68.8%) in the project areas of Shinyanga and Simiyu regions respectively. Reaching the first UNAIDS 90 target by the end of this project seems possible. Future strategies should focus on improving PITC coverage, implementing more targeted testing modalities, together with current universal community-based approach.
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Affiliation(s)
| | | | | | | | | | | | | | - Sabine Hermans
- Department of Global Health, Amsterdam Institute for Global Health and Development, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Tobias F. Rinke de Wit
- Department of Global Health, Amsterdam Institute for Global Health and Development, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Anton Pozniak
- HIV and Sexual Health Clinic, Chelsea and Westminster Hospital NHS Foundation Trust London, London, United Kingdom
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Agutu CA, Oduor TH, Kombo BK, Mugo PM, Chira SM, Ogada FW, Rinke de Wit TF, Chege W, van der Elst EM, Graham SM, Sanders EJ. High patient acceptability but low coverage of provider-initiated HIV testing among adult outpatients with symptoms of acute infectious illness in coastal Kenya. PLoS One 2021; 16:e0246444. [PMID: 33544736 PMCID: PMC7864413 DOI: 10.1371/journal.pone.0246444] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Accepted: 01/19/2021] [Indexed: 11/28/2022] Open
Abstract
Background Only approximately one in five adults are offered HIV testing by providers when seeking care for symptoms of acute illness in Sub-Saharan Africa. Our aims were to estimate testing coverage and identify predictors of provider-initiated testing and counselling (PITC) and barriers to PITC implementation in this population. Methods We assessed HIV testing coverage among adult outpatients 18–39 years of age at four public and two private health facilities in coastal Kenya, during a 3- to 6-month surveillance period at each facility. A subset of patients who reported symptoms including fever, diarrhoea, fatigue, body aches, sore throat or genital ulcers were enrolled to complete a questionnaire independently of PITC offer. We assessed predictors of PITC in this population using generalised estimating equations and identified barriers to offering PITC through focus group discussion with healthcare workers (HCW) at each facility. Results Overall PITC coverage was 13.7% (1600 of 11,637 adults tested), with 1.9% (30) testing positive. Among 1,374 participants enrolled due to symptoms, 378 (27.5%) were offered PITC and 352 (25.6%) were tested, of whom 3.7% (13) tested positive. Among participants offered HIV testing, 93.1% accepted it; among participants not offered testing, 92.8% would have taken an HIV test if offered. The odds of completed PITC were increased among older participants (adjusted odds ratio [aOR] 1.7, 95% confidence interval [CI] 1.4–2.1 for 30–39 years, relative to 18–24 years), men (aOR 1.3, 95% CI 1.1–1.7); casual labourers (aOR 1.3, 95% CI 1.0–1.7); those paying by cash (aOR 1.2, 95% CI 1.0–1.4) or insurance (aOR 3.0, 95% CI 1.5–5.8); participants with fever (aOR 1.5, 95% CI 1.2–1.8) or genital ulcers (aOR 4.0, 95% CI 2.7–6.0); and who had tested for HIV >1 year ago (aOR 1.4, 95% CI 1.0–2.0) or had never tested (aOR 2.2, 95% CI 1.5–3.1). Provider barriers to PITC implementation included lack of HCW knowledge and confidence implementing guidelines, limited capacity and health systems constraints. Conclusion PITC coverage was low, though most patients would accept testing if offered. Missed opportunities to promote testing during care-seeking were common and innovative solutions are needed.
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Affiliation(s)
- Clara A. Agutu
- Kenya Medical Research Institute-Wellcome Trust Research Programme, Kilifi, Kenya
- * E-mail:
| | - Tony H. Oduor
- Kenya Medical Research Institute-Wellcome Trust Research Programme, Kilifi, Kenya
| | - Bernadette K. Kombo
- Kenya Medical Research Institute-Wellcome Trust Research Programme, Kilifi, Kenya
| | - Peter M. Mugo
- Kenya Medical Research Institute-Wellcome Trust Research Programme, Kilifi, Kenya
| | - Salome M. Chira
- Kenya Medical Research Institute-Wellcome Trust Research Programme, Kilifi, Kenya
| | - Fred W. Ogada
- Kenya Medical Research Institute-Wellcome Trust Research Programme, Kilifi, Kenya
| | - Tobias F. Rinke de Wit
- Department of Global Health, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - Wairimu Chege
- Prevention Sciences Program, Division of AIDS (DAIDS), National Institute of Allergy and Infectious Diseases (NIAID), National Institutes of Health (NIH), Rockville, Maryland, United States of America
| | | | - Susan M. Graham
- Kenya Medical Research Institute-Wellcome Trust Research Programme, Kilifi, Kenya
- Departments of Global Health, Medicine, and Epidemiology, University of Washington, Seattle, Washington, United States of America
| | - Eduard J. Sanders
- Kenya Medical Research Institute-Wellcome Trust Research Programme, Kilifi, Kenya
- Department of Global Health, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
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Inghels M, Kouassi AK, Niangoran S, Bekelynck A, Carillon S, Sika L, Danel C, Kone M, Desgrees du Lou A, Larmarange J. Practices and Obstacles to Provider-Initiated HIV Testing and Counseling (PITC) Among Healthcare Providers in Côte d'Ivoire. AIDS Behav 2020; 24:3491-3500. [PMID: 32449115 PMCID: PMC7667140 DOI: 10.1007/s10461-020-02923-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
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.
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Affiliation(s)
- Maxime Inghels
- Lincoln International Institute for Rural Health (LIIRH), University of Lincoln, Brayford Pool, Lincoln, Lincolnshire, LN6 7TS, UK.
- Centre Population et Développement (UMR 196 Paris Descartes - IRD), SageSud (ERL INSERM 1244), Institut de Recherche Pour Le Développement, Paris, France.
| | - Arsène Kra Kouassi
- Programme PAC-CI/ANRS, Centre Hospitalier Universitaire de Treichville, Abidjan, Ivory Coast
| | - Serge Niangoran
- Programme PAC-CI/ANRS, Centre Hospitalier Universitaire de Treichville, Abidjan, Ivory Coast
| | - Anne Bekelynck
- Centre Population et Développement (UMR 196 Paris Descartes - IRD), SageSud (ERL INSERM 1244), Institut de Recherche Pour Le Développement, Paris, France
- Programme PAC-CI/ANRS, Centre Hospitalier Universitaire de Treichville, Abidjan, Ivory Coast
| | - Séverine Carillon
- Centre Population et Développement (UMR 196 Paris Descartes - IRD), SageSud (ERL INSERM 1244), Institut de Recherche Pour Le Développement, Paris, France
| | - Lazare Sika
- École Nationale Supérieure de Statistique et d'Economie Appliquée (ENSEA), Abidjan, Ivory Coast
| | - Christine Danel
- Programme PAC-CI/ANRS, Centre Hospitalier Universitaire de Treichville, Abidjan, Ivory Coast
- Centre Inserm 1219, Université de Bordeaux, Bordeaux, France
| | - Mariatou Kone
- Institut D'Ethno-Sociologie (IES), Abidjan, Ivory Coast
| | - Annabel Desgrees du Lou
- Centre Population et Développement (UMR 196 Paris Descartes - IRD), SageSud (ERL INSERM 1244), Institut de Recherche Pour Le Développement, Paris, France
| | - Joseph Larmarange
- Centre Population et Développement (UMR 196 Paris Descartes - IRD), SageSud (ERL INSERM 1244), Institut de Recherche Pour Le Développement, Paris, France
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