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Does provider-initiated HIV testing and counselling lead to higher HIV testing rate and HIV case finding in Rwandan clinics

Kayigamba, Felix R.; Van Santen, Daniela; Bakker, Mirjam I.; Lammers, Judith; Mugisha, Veronicah; Bagiruwigize, Emmanuel; De Naeyer, Ludwig; Asiimwe, Anita; Schim Van Der Loeff, Maarten F.

Background
Provider initiated HIV testing and counselling PITC is promoted as a means to increase HIV case finding. We assessed the effectiveness of PITC to increase HIV testing rate and HIV case finding among outpatients in Rwandan health facilities HF..

Methods
PITC was introduced in six HFs in 2009-2010. HIV testing rate and case finding were compared between phase 1 pre-PITC and phase 3 PITC period for outpatient-department OPD attendees only, and for OPD and voluntary counseling & testing VCT departments combined.

Results
Out of 26,367 adult OPD attendees in phase 1, 4.7 % were tested and out of 29,864 attendees in phase 3, 17.0 % were tested (p < 0.001). The proportion of HIV cases diagnosed was 0.25 % (67/26,367) in phase 1 and 0.46 % (136/29864) in phase 3 (p < 0.001). In multivariable analysis, both testing rate and case finding were significantly higher in phase 3 for OPD attendees. In phase 1 most of the HIV testing was done in VCT departments rather than at the OPD (78.6 % vs 21.4 % respectively); in phase 3 this was reversed (40.0 % vs 60.0 %; p < 0.001). In a combined analysis of VCT and OPD attendees, testing rate increased from 18.7 % in phase 1 to 25.4 % in phase 3, but case finding did not increase. In multivariable analysis, testing rate was significantly higher in phase 3 (OR 1.67; 95 % CI 1.60-1.73), but case finding remained stable (OR 1.09; 95 % CI 0.93-1.27).

Conclusion
PITC led to a shift of HIV testing from VCT department to the OPD, a higher testing rate, but no additional HIV case finding.

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Also Published In

Title
BMC Infectious Diseases
DOI
https://doi.org/10.1186/s12879-016-1355-z

More About This Work

Academic Units
International Center for AIDS Care and Treatment Programs
Published Here
February 1, 2017
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