Quality, not just quantity: Lessons learned from HIV testing in Salvador, Brazil

Abstract

Studies have demonstrated that an early HIV diagnosis is a critical first step towards continued engagement in care. We examined HIV testing experiences in Salvador, Brazil, to understand how a focus on quality services can inform service provision more generally in the post–2015 global health agenda. Seventeen semi-structured interviews were conducted with HIV-positive pregnant women in Salvador, a large urban centre of north-east Brazil. Interviews were transcribed, translated and coded for analysis. Deductive codes confirmed factors identified in the literature review. Inductive codes highlighted new factors emerging from the initial coding. ‘Quality’ was defined according to global and national guidelines as HIV testing with informed and voluntary consent, counselling and confidentiality (3Cs). No pregnant woman experienced all elements of the 3Cs. Three women did not experience any informed and voluntary consent, counselling or confidentiality. Few women provided consent overall and none received pre-test counselling. Post-test counselling and confidentiality of services were more consistently provided. This study suggests that testing in Salvador – the third-largest city in the country – is not of the quality called for by global and national guidelines, despite the fact that HIV testing is being routinely provided for HIV-positive pregnant women in Brazil. Going forward, additional clarity around the 3Cs is necessary to improve how the quality, not just the quantity, of HIV services is measured.

Keywords:

• HIV/AIDS
• HIV testing and counselling
• human rights
• Brazil
• linkage to care

Acknowledgements

We are grateful for the support of the Joint United Nations Programme on HIV/AIDS, the United Nations Development Fund for Women, Brazilian National Department of STD/AIDS and Viral Hepatitis/Ministry of Health, the Foundation for Research Support of the State of Bahia (FAPESB), The HIV/AIDS Reference Center of the Bahia Department of Health (CEDAP/SESAB) and the Pathfinder Foundation. Finally, we appreciate the careful assistance of Ashley Batson in finalising this article for submission. The study was approved by an Ethics Committee at the State Secretary of Health in Salvador, Brazil, and by the Harvard School of Public Health in Boston, MA, USA.

Funding

This article was made possible with the support of ‘HIV and Other Infectious Consequences of Substance Abuse’ [T32DA13911-12]; the Lifespan/Tufts/Brown Center for AIDS Research [P30AI042853] and the National Institute of Allergy and Infectious Diseases.

Additional information

Funding

Funding: This article was made possible with the support of ‘HIV and Other Infectious Consequences of Substance Abuse’ [T32DA13911-12]; the Lifespan/Tufts/Brown Center for AIDS Research [P30AI042853] and the National Institute of Allergy and Infectious Diseases.