From caution to urgency: the evolution of HIV testing and counselling in Africa
R Baggaley, B Hensen, O Ajose, KL Grabbe, VJ Wong, A Schilsky, Y-R Lo, F Lule, R Granich & J Hargreaves
Volume 90, Number 9, September 2012, 652-658B
Table 3. Users’ experiences of provider-initiated HIV testing and counselling, Africa, 1999–2009
| Publication (Author, year) |
Country | Primary objective | Sample size | Population group | Experience |
|---|---|---|---|---|---|
| Etiebet, 2004 |
South Africa | Knowledge, attitude and practices survey of women receiving prenatal or postnatal care | 264 | Pregnant women | (i) 94% were satisfied with the counselling services offered to them; (ii) 0.34% felt pressured by nurses to accept testing (45% believed that women who accepted testing receive better care); (iii) 8% of women tested did not remember receiving post-test counselling |
| Chandisarewa, 2007 |
Zimbabwe | To assess the impact of routine ANC testing for PMTCT | 2011 | Exist survey with pregnant women | 98% stated that the information provided by counsellors on routine testing had “adequately prepared” them for the result |
| Corneli, 2008 |
Democratic Republic of the Congo | To identify an acceptable approach to HIV testing for tuberculosis patients based on the views of patients and health-care workers | 88 | Tuberculosis patients | (i) The majority (71%) felt confident they had the right to choose whether or not to be tested; (ii) 29% believed it would be difficult to decline a routine offer of testing from a nurse and some said this was because of the power relationship whereas others felt it was because health-care workers know what is best for them |
| Mugore, 2008 |
Zimbabwe | To assess understanding of a routine offer of HTC among women attending ANC | 146 | Pregnant women | (i) 95% stated that the information they received during group education was sufficient to make a decision about whether or not to test for HIV; (ii) 94.1% knew their blood was being drawn for HTC; (iii) 77.8% of those who declined HTC said it would not deter them from seeking ANC at the health facility |
| Byamugisha, 2009 |
Uganda | To assess attitudes towards routine HIV testing among new ANC attendees | 388 | First time ANC attendees | (i) 90.2% had a “good” or “very good” experience with or opinion of the health education talk, whereas 9.8% had a “fair”, “bad” or “very bad” experience; (ii) 86.3% had a “good” or “very good” experience with or opinion of pretest counselling, whereas 13.7% had a “fair”, “bad” or “very bad” experience; (iii) 95.1% had a “good” or “very good” experience with or opinion of post-test counselling, whereas 4.9% had a “fair”, “bad” or “very bad” experience |
| Groves, 2010 |
South Africa | To evaluate women’s experiences with HTC | 25 | Women who had been tested for HIV during their most recent pregnancy | (i) 52% believed they had clearly consented to testing and had a positive experience of group and individual education sessions; (ii) 28% said their choice was “less clear” and were less positive about the education sessions; (iii) 20% felt their choice had been compromised (48% of these women expressed the view that they experienced less autonomy in deciding whether to be tested for HIV) |
| Angotti, 2010 |
Malawi | To determine local perceptions of routine HIV testing and the potential consequences | 18 (12 from an ANC attendee sample) | Women that had been offered HTC in an ANC and accepted the offer | (i) 22.2% stated that refusing the offer of a test was an option and believed that women could still receive services if they opted out of testing; (ii) the majority who underwent HIV testing stated they were not given the option of refusing in the ANC; (iii) HTC was considered a precondition for receiving care |
| Larsson, 2011 |
Uganda | To explore women’s experiences of, and views on, the opt-out testing policy and associated HIV testing in an ANC | 18 | Pregnant women attending an ANC | (i) Pregnant women recruited from facilities that offered testing on site perceived HIV testing as compulsory, despite pretest group counselling; (ii) generally women thought they could not receive any other ANC service if they declined testing; (iii) women felt obligated to attempt to persuade their partners to attend the ANC for HIV testing and felt anxious about asking their male partners to participate in couples testing; (iv) women highlighted the power asymmetry between themselves and health-care providers |
| Ujiji, 2011 |
Kenya | To identify factors associated with consent to opt-out of HTC | 900 | Pregnant women | (i) 17% understood that HIV testing was optional, whereas 83% did not; (ii) when asked: “If you could choose to HIV test or not, would you decline?”, 80% responded “no” and 20% responded “yes” |
ANC, antenatal clinic; HIV, human immunodeficiency virus; HTC, HIV testing and counselling; PMTCT, prevention of mother-to-child HIV transmission.