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

Full article at:   http://goo.gl/uXYkdc

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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Association of Sexual Risk Behavior with Previous HIV Testing among VCT Clients in Kigali, Rwanda

With increased coverage of voluntary HIV counselling and testing (VCT) in Rwanda and a greater focus on repeat testing of key populations, it is important to understand whether the right clients are returning for repeat testing and if repeat testing is effective at reducing risk. 

We assessed the association between repeat testing and recent sexual risk behaviours among 1852 first time or repeat HIV testing clients in Kigali who had had sex, using data from a cross-sectional survey. Repeat testing was associated with being female, older and type of occupation. Multivariable analyses indicate that individuals who tested for HIV 1-2 times and 3+ times previously were more likely to have recent unprotected sex. Those with 3+ previous tests were more likely to have recently had multiple sexual partners. However, a significant decrease in HIV prevalence is shown as individuals receive more HIV tests in their lifetime (p < 0.001). 

These findings show that individuals who report high-risk behaviours are returning for repeat tests. However, VCT may not be successful at addressing certain sexual risk behaviours. Therefore more intensive counselling or additional HIV prevention services may be needed.

Purchase full article at:  http://goo.gl/LFuZqI

By:  Stalter R1, Chen M2, Uwizeye G3, Mutunge E4, Ahayo A4, Mugwaneza P4, Shumbusho F5, Wesson J6.

• 1FHI 360, Durham, North Carolina, USA rstalter@fhi360.org.
• 2FHI 360, Durham, North Carolina, USA.
• 3FHI 360, Kigali, Rwanda Human Resources for Health (HRH) Program, Ministry of Health, Kigali, Rwanda.
• 4Institute of HIV/AIDS, Disease Prevention and Control, Rwanda Biomedical Center, Kigali, Rwanda.
• 5FHI 360, Kigali, Rwanda Rwanda Healthcare Federation (RHF), Kigali, Rwanda.
• 6FHI 360, Kigali, Rwanda IntraHealth International, Chapel Hill, North Carolina, USA. 

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