Provider-initiated HIV testing in health care settings: Should it include client-centered counselling?

Abstract

To increase access to HIV testing, the WHO and CDC have recommended implementing provider-initiated HIV testing (PITC). To address the resource limitations of the PITC setting, WHO and CDC suggest that patient-provider interactions during PITC may need to focus on providing information and referrals, instead of engaging patients in client-centered counselling, as is recommended during client-initiated HIV testing. Providing HIV prevention information has been shown to be less effective than client-centered counselling in reducing HIV-risk behaviour and STI incidence. Therefore, concerns exist about the efficacy of PITC as an HIV prevention approach. However, reductions in HIV incidence may be greater if more people know their HIV status through expanded availability of PITC, even if PITC is a less effective prevention intervention than is client-initiated HIV testing for individual patients. In the absence of an answer to this public health question, adaptation of effective brief client-centered counselling approaches to PITC should be explored along with research assessing the efficacy of PITC.

Pour augmenter l'accès au dépistage du VIH, l'OMS et le CDC ont recommandé la mise en oeuvre d'un dépistage du VIH initié par les fournisseurs (DVIF). Pour répondre aux limites du cadre du DVIF en matière de ressources, l'OMS et le CDC ont suggéré que les interactions patient-fournisseur au cours du DVIF se concentrent sur la fourniture d'informations et de références au lieu d'entraîner les patients vers une assistance psychosociale centrée sur le client comme cela est recommandé au cours d'un dépistage du VIH initié par le client. Il est apparu que les informations sur la prévention du VIH étaient moins efficaces que l'assistance psychosociale centrée sur le client pour réduire les comportements à risque quant au VIH et l'incidence de MST. Par conséquent, des préoccupations existent quant à l'efficacité du DVIF en tant qu'approche de prévention du VIH. Il est cependant apparu que les réductions de l'incidence du VIH pourraient être supérieures si davantage de personnes connaissaient leur statut sérologique par la plus grande disponibilité du DVID, même si le DVID reste une mesure de prévention moins efficace que ne l'est le dépistage du VIH initié par le client pour les patients individuels. En l'absence de réponse à cette question de santé publique, l'adaptation des approches efficaces d'assitance psychosociale centrée sur le client au DVID devrait être étudiée pendant que des études visant à évaluer l'efficacité du DVID sont réalisées.

Keywords:

• Provider-initiated HIV testing
• client-centered counselling
• HIV prevention
• developing countries

Mots clés:

• Dépistage du VIH initié par les fournisseurs
• asisstance psychosociale centrée sur le client
• prévention du VIH
• pays en développement

Additional information

Notes on contributors

Susan M Kiene

Susan M Kiene (PhD) is an Assistant Professor of Medicine and Community Health (Research) at Brown University in Providence, Rhode Island, where she is also a Research Associate at Rhode Island Hospital. Dr Kiene also holds an appointment as a Visiting Professor at Makerere University School of Public Health in Uganda. She received her doctoral training in Social Psychology at the University of Connecticut. During the final 3 years of her doctoral training she was supported by a Ruth L Kirschstein National Research Service Award (NRSA), Individual Pre-doctoral Fellowship from the National Institutes of Health (NIH) for HIV prevention research in South Africa. Upon arriving at Brown University, Dr Kiene launched her research programme in Uganda for which she received support from a K01 Research Scientist Career Development award from NIH, a grant from the Rhode Island Foundation, and a grant from the Brown University National Center for Excellence in Women's Health. As part of her K01 Research Scientist Career Development award she is pursuing an MPH in Global Health at the Harvard School of Public Health. Dr Kiene is also part of a research team that is conducting a multisite cluster randomised trial of an HIV prevention intervention for HIV-positive patients delivered in the context of ongoing clinical care in public health clinics in KwaZulu-Natal, South Africa. In Uganda, Dr Kiene and her team are studying ways to improve counselling during provider-initiated routine HIV counselling and testing.

Michael Stein

Michael Stein (MD) is Professor of Medicine and Community Health at Brown University in Providence, RI, USA. He has directed HIV services at Rhode Island Hospital for 20 years, and also directs a large HIV clinic in Santiago, Dominican Republic. He has twice been awarded a National Institute on Drug Abuse Mid-Career Research and Mentoring award. Visit his website at www.michaelsteinbooks.com

Moses Bateganya

Moses Bateganya (MB ChB, MMed, MPH) is a Ugandan physician, a graduate of Makerere University (Internal Medicine) and the University of Washington (Public Health). He currently works at the International Training and Education Center (I-TECH) in the Department of Global Health at the University of Washington. He has worked in HIV clinical care and treatment and research in Uganda and Guyana, and currently has ongoing research in Uganda (non-Hodgkin's lymphoma and HIV testing).

Rhoda Wanyenze

Rhoda Wanyenze (MB ChB, MPH) is the programme manager for the Makerere University School of Public Health-CDC HIV Fellowship Programme in Kampala, Uganda. She earned her medical degree (MB ChB) and Masters in Public Health from Makerere University. Dr Wanyenze piloted the first provider-initiated HIV counselling and testing programme in Uganda in 2003 and has been involved in research as well as implementation of HIV counselling and testing programmes, and policy development for over 7 years.

Kenneth Mayer

Kenneth Mayer (MD) is Medical Director of Research at The Fenway Institute/Fenway Health, Professor of Medicine and Community Health at Brown University, Director of the Brown University AIDS International Training and Research Programme, and Brown's AIDS programme and part of the Consulting and Attending Staff at Miriam Hospital of Rhode Island in the USA. He has been the Principal Investigator of one of the first National Institute of Allergy and Infectious Disease-funded studies of heterosexual transmission of HIV in Southeastern New England (beginning in 1987). He has also been a co-principal investigator of the Centers for Disease Control-funded HIV Epidemiology Research Study of the natural history of HIV in women. He is the principal investigator of the New England Vaccine Preparedness Cohort Studies of the National Institute of Health's (NIH) national HIV vaccine field trial effort. He is the principal investigator of a new NIH-funded HIV prevention trials network which funds studies of HIV prevention at Fenway, Brown University, and a collaborating site in Chennai, India. Most recently, he is the principal investigator of two investigator-initiated studies looking at the effectiveness of a behavioural secondary prevention intervention among HIV-infected MSM who receive primary care services. He is coprincipal investigator of the first study on the acceptability of rectal microbicides. Dr Mayer servers on the National Board of Directors of the American Foundation for AIDS Research (AMFAR), and served on the Data Safety and Monitoring Board of the National Institute of Health's AIDS Clinical Trials Group. He is on several editorial boards and has published extensively on AIDS, particularly in the areas of natural history, behavioural epidemiology, transmission variables, microbicides, and public policy aspects of the epidemic.

Haruna Lule

Haruna Lule (MB ChB, MHSM) is the principal medical officer and medical superintendent at Gombe Hospital in Uganda. He is also the medical officer in charge of Butumbala Health sub-district. Dr Lule earned his medical degree (MBChB) from Makerere University in Uganda and a Masters in Health Services Management from Uganda Martyrs University. He also has certificates in Community Health Management, Epidemiology, Health Services Planning and Management and Administrative Law. He has served at Gombe Hospital for over 14 years, starting as a medical officer to his current designation.