Lost opportunities to identify and treat HIV-positive patients: results from a baseline assessment of provider-initiated HIV testing and counselling (PITC) in Malawi

• Published in: Tropical medicine & international health 2016-04, Vol.21 (4), p.479
• Main Authors: Ahmed, Saeed, Schwarz, Monica, Flick, Robert J, Rees, Chris A, Harawa, Mwelura, Simon, Katie, Robison, Jeff A, Kazembe, Peter N, Kim, Maria H
• Format: Article
• Language: English
• Subjects: Counseling; HIV; Human immunodeficiency virus; Patients
• ISSN: 1360-2276; 1365-3156
• DOI: 10.1111/tmi.12671

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. Objectif Evaluer l'implémentation du conseil et dépistage à l'initiative du soignant (CDIS) pour le VIH au Malawi. Méthodes Une analyse des pratiques de CDIS a été effectuée dans 118 départements de 12 établissements du Ministère de la Santé à travers le Malawi. Les informations sur les pratiques de CDIS ont été recueillies via une enquête sur les établissements de santé. Les données décrivant les visites des patients et les tests VIH ont été extraites des données du programme recueillies en routine. Résultats Les pratiques rapportées de CDIS étaient très variables. La plupart des soignants pratiquaient le CDIS en se basant sur les symptômes. Les consultations prénatales et les maternités ont rapporté l'utilisation généralisée du CDIS en routine sur base volontaire. En 2014, il