Does Provider-Initiated HIV Testing & Counselling Lead to Higher HIV Testing Rate & HIV Case Finding in Rwandan Clinics?
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.
Below: a. HIV testing rate at OPD. b. HIV case finding at OPD
By: Kayigamba FR1, Van Santen D2,3, Bakker MI4, Lammers J5, Mugisha V6, Bagiruwigize E7, De Naeyer L8, Asiimwe A9, Schim Van Der Loeff MF10,11,12.
- 1INTERACT, Kigali, Rwanda. fkaigamba@gmail.com.
- 2KIT Biomedical Research, Royal Tropical Institute (KIT), Amsterdam, The Netherlands. dvsanten@ggd.amsterdam.nl.
- 3Public Health Service of Amsterdam (GGD), Amsterdam, The Netherlands. dvsanten@ggd.amsterdam.nl.
- 4KIT Biomedical Research, Royal Tropical Institute (KIT), Amsterdam, The Netherlands. M.Bakker@kit.nl.
- 5Academic Medical Center (AMC), Amsterdam, The Netherlands. judith.lammers@amc.uva.nl.
- 6ICAP, Mailman School of Public Health, Columbia University, Kigali, Rwanda. vm2208@columbia.edu.
- 7Ruhengeri hospital, Ministry of Health, Kigali, Rwanda. emmanuelb@theaccessproject.com.
- 8INTERACT, Kigali, Rwanda. ldnaeyer@yahoo.com.
- 9University of Rwanda, Kigali, Rwanda. anita.asiimwe@gmail.com.
- 10Amsterdam Institute of Global Health and Development (AIGHD), Academic Medical Center (AMC), Amsterdam, The Netherlands. mschimvdloeff@ggd.amsterdam.nl.
- 11Center for Infection and Immunity Amsterdam (CINIMA), AMC, Amsterdam, The Netherlands. mschimvdloeff@ggd.amsterdam.nl.
- 12Public Health Service of Amsterdam (GGD), Amsterdam, The Netherlands. mschimvdloeff@ggd.amsterdam.nl.
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