Background
With
new testing technologies, task-shifting and rapid scale-up of HIV testing
services in high HIV prevalence countries, assuring quality of HIV testing is
paramount. This study aimed to explore various cadres of providers’ experiences
in providing HIV testing services and their understanding of elements that
impact on quality of service in Zambia.
Methods
Sixteen
in-depth interviews and two focus group discussions were conducted with HIV
testing service providers including lay counselors, nurses and laboratory
personnel at purposively selected HIV testing sites at a national reference
hospital in Lusaka. Qualitative content analysis was adopted for data analysis.
Results
Lay
counselors and nurses reported confidentiality and privacy to be greatly
compromised due to limited space in both in- and out-patient settings.
Difficulties in upholding consent were reported in provider-initiated testing
in in-patient settings. The providers identified non-adherence to testing
procedures, high workload and inadequate training and supervision as key
elements impacting on quality of testing. Difficulties related to testing
varied by sub-groups of providers: lay counselors, in finger pricking and
obtaining adequate volumes of specimen; non-laboratory providers in general, in
interpreting invalid, false-negative and false-positive results. The providers
had been participating in a recently established national HIV quality assurance
program, i.e. proficiency testing, but rarely received site supervisory visits.
Conclusion
Task-shifting coupled with policy shifts in service
provision has seriously challenged HIV testing quality, protection of
confidentiality and the process of informed consent. Ways to better protect
confidentiality and informed consent need careful attention. Training,
supervision and quality assurance need strengthening tailored to the needs of
the different cadres of providers.
Below: Providers’ experiences in HIV testing service provision and their understanding of elements impacting on quality
Full article at:
By:
Sheila Mwangala, Hope C. Nkamba, Kunda G. Musonda, Mwaka
Monze, Katoba K. Musukwa
Virology Laboratory, Department
of Pathology and Microbiology, University Teaching Hospital, Lusaka, Zambia
Sheila Mwangala, Karen M. Moland, Knut Fylkesnes
Centre for International Health,
Department of Global Public Health and Primary Care, University of Bergen,
Bergen, Norway
Kunda G. Musonda
Pathogen Molecular Biology
Department, London School of Hygiene and Tropical Medicine, University of
London, London, United Kingdom
Knut Fylkesnes
Department of Public Health,
School of Medicine, University of Zambia, Lusaka, Zambia
More at: https://twitter.com/hiv_insight
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