Skip to main content
Top
Published in: BMC Health Services Research 1/2012

Open Access 01-12-2012 | Research article

An assessment of the Zimbabwe ministry of health and child welfare provider initiated HIV testing and counselling programme

Authors: Euphemia L Sibanda, Karin Hatzold, Owen Mugurungi, Getrude Ncube, Beatrice Dupwa, Pester Siraha, Lydia K Madyira, Alexio Mangwiro, Gaurav Bhattacharya, Frances M Cowan

Published in: BMC Health Services Research | Issue 1/2012

Login to get access

Abstract

Background

Provider-initiated HIV testing and counselling (PITC) is widely recommended to ensure timely treatment of HIV. The Zimbabwe Ministry of Health introduced PITC in 2007. We aimed to evaluate institutional capacity to implement PITC and investigate patient and health care worker (HCW) perceptions of the PITC programme.

Methods

Purposive selection of health care institutions was conducted among those providing PITC. Study procedures included 1) assessment of implementation procedures and institutional capacity using a semi-structured questionnaire; 2) in-depth interviews with patients who had been offered HIV testing to explore perceptions of PITC, 3) Focus group discussions with HCW to explore views on PITC. Qualitative data was analysed according to Framework Analysis.

Results

Sixteen health care institutions were selected (two central, two provincial, six district hospitals; and six primary care clinics). All institutions at least offered PITC in part. The main challenges which prevented optimum implementation were shortages of staff trained in PITC, HIV rapid testing and counselling; shortages of appropriate counselling space, and, at the time of assessment, shortages of HIV test kits. Both health care workers and patients embraced PITC because they had noticed that it had saved lives through early detection and treatment of HIV. Although health care workers reported an increase in workload as a result of PITC, they felt this was offset by the reduced number of HIV-related admissions and satisfaction of working with healthier clients.

Conclusion

PITC has been embraced by patients and health care workers as a life-saving intervention. There is need to address shortages in material, human and structural resources to ensure optimum implementation.
Appendix
Available only for authorised users
Literature
1.
go back to reference World Health Organisation: Guidance on provider-initiated HIV testing and counselling in health facilities. 2007, World Health Organisation, In. Switzerland World Health Organisation: Guidance on provider-initiated HIV testing and counselling in health facilities. 2007, World Health Organisation, In. Switzerland
2.
go back to reference Leon N, Naidoo P, Mathews C, Lewin S, Lombard C: The impact of provider-initiated (opt-out) HIV testing and counseling of patients with sexually transmitted infection in Cape Town, South Africa: a controlled trial. Implement Sci. 2010, 5: 8-10.1186/1748-5908-5-8.CrossRefPubMedPubMedCentral Leon N, Naidoo P, Mathews C, Lewin S, Lombard C: The impact of provider-initiated (opt-out) HIV testing and counseling of patients with sexually transmitted infection in Cape Town, South Africa: a controlled trial. Implement Sci. 2010, 5: 8-10.1186/1748-5908-5-8.CrossRefPubMedPubMedCentral
3.
go back to reference Pope DS, Deluca AN, Kali P, Hausler H, Sheard C, Hoosain E, Chaudhary MA, DD Celentano, Chaisson RE: A cluster-randomized trial of provider-initiated (opt-out) HIV counseling and testing of tuberculosis patients in South Africa. J Acquir Immune Defic Syndr. 1999, 48 (2): 190-195.CrossRef Pope DS, Deluca AN, Kali P, Hausler H, Sheard C, Hoosain E, Chaudhary MA, DD Celentano, Chaisson RE: A cluster-randomized trial of provider-initiated (opt-out) HIV counseling and testing of tuberculosis patients in South Africa. J Acquir Immune Defic Syndr. 1999, 48 (2): 190-195.CrossRef
4.
go back to reference Weigel R, Kamthunzi P, Mwansambo C, Phiri S, Kazembe PN: Effect of provider-initiated testing and counselling and integration of ART services on access to HIV diagnosis and treatment for children in Lilongwe, Malawi: a pre- post comparison. BMC Pediatr. 2009, 9: 80-10.1186/1471-2431-9-80.CrossRefPubMedPubMedCentral Weigel R, Kamthunzi P, Mwansambo C, Phiri S, Kazembe PN: Effect of provider-initiated testing and counselling and integration of ART services on access to HIV diagnosis and treatment for children in Lilongwe, Malawi: a pre- post comparison. BMC Pediatr. 2009, 9: 80-10.1186/1471-2431-9-80.CrossRefPubMedPubMedCentral
5.
go back to reference Kiene SM, Bateganya M, Wanyenze R, Lule H, Nantaba H, Stein MD: Initial outcomes of provider-initiated routine HIV testing and counseling during outpatient care at a rural Ugandan hospital: risky sexual behavior, partner HIV testing, disclosure, and HIV care seeking. AIDS Patient Care STDS. 2010, 24 (2): 117-126. 10.1089/apc.2009.0269.CrossRefPubMedPubMedCentral Kiene SM, Bateganya M, Wanyenze R, Lule H, Nantaba H, Stein MD: Initial outcomes of provider-initiated routine HIV testing and counseling during outpatient care at a rural Ugandan hospital: risky sexual behavior, partner HIV testing, disclosure, and HIV care seeking. AIDS Patient Care STDS. 2010, 24 (2): 117-126. 10.1089/apc.2009.0269.CrossRefPubMedPubMedCentral
6.
go back to reference Thomas BE, Dewan PK, Vijay S, Thomas A, Chauhan LS, Vedachalam C, Vaidyanathan P, Swaminathan S: Perceptions of tuberculosis patients on provider-initiated HIV testing and counseling–a study from south India. PLoS One. 2009, 4 (12): e8389-10.1371/journal.pone.0008389.CrossRefPubMedPubMedCentral Thomas BE, Dewan PK, Vijay S, Thomas A, Chauhan LS, Vedachalam C, Vaidyanathan P, Swaminathan S: Perceptions of tuberculosis patients on provider-initiated HIV testing and counseling–a study from south India. PLoS One. 2009, 4 (12): e8389-10.1371/journal.pone.0008389.CrossRefPubMedPubMedCentral
7.
go back to reference Vijay S, Swaminathan S, Vaidyanathan P, Thomas A, Chauhan LS, Kumar P, Chiddarwar S, Thomas B, Dewan PK: Feasibility of provider-initiated HIV testing and counselling of tuberculosis patients under the TB control programme in two districts of South India. PLoS One. 2009, 4 (11): e7899-10.1371/journal.pone.0007899.CrossRefPubMedPubMedCentral Vijay S, Swaminathan S, Vaidyanathan P, Thomas A, Chauhan LS, Kumar P, Chiddarwar S, Thomas B, Dewan PK: Feasibility of provider-initiated HIV testing and counselling of tuberculosis patients under the TB control programme in two districts of South India. PLoS One. 2009, 4 (11): e7899-10.1371/journal.pone.0007899.CrossRefPubMedPubMedCentral
8.
go back to reference Odhiambo J, Kizito W, Njoroge A, Wambua N, Nganga L, Mburu M, Mansoer J, Marum L, Phillips E, Chakaya J, et al: Provider-initiated HIV testing and counselling for TB patients and suspects in Nairobi, Kenya. Int J Tuberc Lung Dis. 2008, 12 (3 Suppl 1): 63-68.PubMed Odhiambo J, Kizito W, Njoroge A, Wambua N, Nganga L, Mburu M, Mansoer J, Marum L, Phillips E, Chakaya J, et al: Provider-initiated HIV testing and counselling for TB patients and suspects in Nairobi, Kenya. Int J Tuberc Lung Dis. 2008, 12 (3 Suppl 1): 63-68.PubMed
9.
go back to reference Ferrand RA, Trigg C, Bandason T, Ndhlovu CE, Mungofa S, Nathoo K, Gibb DM, Cowan FM, Corbett EL: Perception of risk of vertically acquired HIV infection and acceptability of provider-initiated testing and counseling among adolescents in Zimbabwe. Am J Public Health. 2011, 101 (12): 2325-2332. 10.2105/AJPH.2011.300250.CrossRefPubMedPubMedCentral Ferrand RA, Trigg C, Bandason T, Ndhlovu CE, Mungofa S, Nathoo K, Gibb DM, Cowan FM, Corbett EL: Perception of risk of vertically acquired HIV infection and acceptability of provider-initiated testing and counseling among adolescents in Zimbabwe. Am J Public Health. 2011, 101 (12): 2325-2332. 10.2105/AJPH.2011.300250.CrossRefPubMedPubMedCentral
10.
go back to reference Wanyenze RK, Nawavvu C, Ouma J, Namale A, Colebunders R, Kamya MR: Provider-initiated HIV testing for paediatric inpatients and their caretakers is feasible and acceptable. Trop Med Int Health. 2010, 15 (1): 113-119.PubMed Wanyenze RK, Nawavvu C, Ouma J, Namale A, Colebunders R, Kamya MR: Provider-initiated HIV testing for paediatric inpatients and their caretakers is feasible and acceptable. Trop Med Int Health. 2010, 15 (1): 113-119.PubMed
11.
go back to reference Dalal S, Lee CW, Farirai T, Schilsky A, Goldman T, Moore J, Bock NN: Provider-initiated HIV testing and counseling: increased uptake in two public community health centers in South Africa and implications for scale-up. PLoS One. 2011, 6 (11): e27293-10.1371/journal.pone.0027293.CrossRefPubMedPubMedCentral Dalal S, Lee CW, Farirai T, Schilsky A, Goldman T, Moore J, Bock NN: Provider-initiated HIV testing and counseling: increased uptake in two public community health centers in South Africa and implications for scale-up. PLoS One. 2011, 6 (11): e27293-10.1371/journal.pone.0027293.CrossRefPubMedPubMedCentral
12.
go back to reference Evans C, Ndirangu E: The nursing implications of routine provider-initiated HIV testing and counselling in sub-Saharan Africa: a critical review of new policy guidance from WHO/UNAIDS. Int J Nurs Stud. 2009, 46 (5): 723-731. 10.1016/j.ijnurstu.2008.11.003.CrossRefPubMed Evans C, Ndirangu E: The nursing implications of routine provider-initiated HIV testing and counselling in sub-Saharan Africa: a critical review of new policy guidance from WHO/UNAIDS. Int J Nurs Stud. 2009, 46 (5): 723-731. 10.1016/j.ijnurstu.2008.11.003.CrossRefPubMed
13.
go back to reference Medley AM, Kennedy CE: Provider challenges in implementing antenatal provider-initiated HIV testing and counseling programs in Uganda. AIDS Educ Prev. 2010, 22 (2): 87-99. 10.1521/aeap.2010.22.2.87.CrossRefPubMed Medley AM, Kennedy CE: Provider challenges in implementing antenatal provider-initiated HIV testing and counseling programs in Uganda. AIDS Educ Prev. 2010, 22 (2): 87-99. 10.1521/aeap.2010.22.2.87.CrossRefPubMed
14.
go back to reference Ntuli AK, Kabengula JS, Msuya SE: Perceived barriers and attitudes of health care providers towards provider-initiated HIV testing and counseling in Mbeya region, southern highland zone of Tanzania. Pan Afr Med J. 2011, 8: 17.PubMedPubMedCentral Ntuli AK, Kabengula JS, Msuya SE: Perceived barriers and attitudes of health care providers towards provider-initiated HIV testing and counseling in Mbeya region, southern highland zone of Tanzania. Pan Afr Med J. 2011, 8: 17.PubMedPubMedCentral
15.
go back to reference Mutanga JN, Raymond J, Towle MS, Mutembo S, Fubisha RC, Lule F, Muhe L: Institutionalizing provider-initiated HIV testing and counselling for children: an observational case study from Zambia. PLoS One. 2012, 7 (4): e29656-10.1371/journal.pone.0029656.CrossRefPubMedPubMedCentral Mutanga JN, Raymond J, Towle MS, Mutembo S, Fubisha RC, Lule F, Muhe L: Institutionalizing provider-initiated HIV testing and counselling for children: an observational case study from Zambia. PLoS One. 2012, 7 (4): e29656-10.1371/journal.pone.0029656.CrossRefPubMedPubMedCentral
16.
go back to reference Chandisarewa W, Stranix-Chibanda L, Chirapa E, Miller A, Simoyi M, Mahomva A, Maldonado Y, Shetty AK: Routine offer of antenatal HIV testing (“opt-out” approach) to prevent mother-to-child transmission of HIV in urban Zimbabwe. Bull World Health Organ. 2007, 85 (11): 843-850.CrossRefPubMedPubMedCentral Chandisarewa W, Stranix-Chibanda L, Chirapa E, Miller A, Simoyi M, Mahomva A, Maldonado Y, Shetty AK: Routine offer of antenatal HIV testing (“opt-out” approach) to prevent mother-to-child transmission of HIV in urban Zimbabwe. Bull World Health Organ. 2007, 85 (11): 843-850.CrossRefPubMedPubMedCentral
17.
go back to reference Topp SM, Chipukuma JM, Chiko MM, Wamulume CS, Bolton-Moore C, Reid SE: Opt-out provider-initiated HIV testing and counselling in primary care outpatient clinics in Zambia. Bull World Health Organ. 2011, 89 (5): 328-335A. 10.2471/BLT.10.084442.CrossRefPubMedPubMedCentral Topp SM, Chipukuma JM, Chiko MM, Wamulume CS, Bolton-Moore C, Reid SE: Opt-out provider-initiated HIV testing and counselling in primary care outpatient clinics in Zambia. Bull World Health Organ. 2011, 89 (5): 328-335A. 10.2471/BLT.10.084442.CrossRefPubMedPubMedCentral
18.
go back to reference Zimbabwe Ministry of Health and Child Welfare: Guidelines for implementation of Provider-Initiated HIV Testing and Counselling. , , In. Harare Zimbabwe Ministry of Health and Child Welfare: Guidelines for implementation of Provider-Initiated HIV Testing and Counselling. , , In. Harare
19.
20.
go back to reference Weiser SD, Heisler M, Leiter K, Percy-de Korte F, Tlou S, DeMonner S, Phaladze N, Bangsberg DR, Iacopino V: Routine HIV testing in Botswana: a population-based study on attitudes, practices, and human rights concerns. PLoS Med. 2006, 3 (7): e261-10.1371/journal.pmed.0030261.CrossRefPubMedPubMedCentral Weiser SD, Heisler M, Leiter K, Percy-de Korte F, Tlou S, DeMonner S, Phaladze N, Bangsberg DR, Iacopino V: Routine HIV testing in Botswana: a population-based study on attitudes, practices, and human rights concerns. PLoS Med. 2006, 3 (7): e261-10.1371/journal.pmed.0030261.CrossRefPubMedPubMedCentral
21.
go back to reference Ostermann J, Reddy EA, Shorter MM, Muiruri C, Mtalo A, Itemba DK, Njau B, Bartlett JA, Crump JA, Thielman NM: Who tests, who doesn’t, and why? Uptake of mobile HIV counseling and testing in the Kilimanjaro Region of Tanzania. PLoS One. 2011, 6 (1): e16488-10.1371/journal.pone.0016488.CrossRefPubMedPubMedCentral Ostermann J, Reddy EA, Shorter MM, Muiruri C, Mtalo A, Itemba DK, Njau B, Bartlett JA, Crump JA, Thielman NM: Who tests, who doesn’t, and why? Uptake of mobile HIV counseling and testing in the Kilimanjaro Region of Tanzania. PLoS One. 2011, 6 (1): e16488-10.1371/journal.pone.0016488.CrossRefPubMedPubMedCentral
22.
go back to reference de Wit JB, Adam PC: To test or not to test: psychosocial barriers to HIV testing in high-income countries. HIV Med. 2008, 9 (Suppl 2): 20-22.CrossRefPubMed de Wit JB, Adam PC: To test or not to test: psychosocial barriers to HIV testing in high-income countries. HIV Med. 2008, 9 (Suppl 2): 20-22.CrossRefPubMed
23.
go back to reference McCollum ED, Preidis GA, Kabue MM, Singogo EB, Mwansambo C, Kazembe PN, Kline MW: Task shifting routine inpatient pediatric HIV testing improves program outcomes in urban Malawi: a retrospective observational study. PLoS One. 2010, 5 (3): e9626-10.1371/journal.pone.0009626.CrossRefPubMedPubMedCentral McCollum ED, Preidis GA, Kabue MM, Singogo EB, Mwansambo C, Kazembe PN, Kline MW: Task shifting routine inpatient pediatric HIV testing improves program outcomes in urban Malawi: a retrospective observational study. PLoS One. 2010, 5 (3): e9626-10.1371/journal.pone.0009626.CrossRefPubMedPubMedCentral
24.
go back to reference Sanjana P, Torpey K, Schwarzwalder A, Simumba C, Kasonde P, Nyirenda L, Kapanda P, Kakungu-Simpungwe M, Kabaso M, Thompson C: Task-shifting HIV counselling and testing services in Zambia: the role of lay counsellors. Hum Resour Health. 2009, 7: 44-10.1186/1478-4491-7-44.CrossRefPubMedPubMedCentral Sanjana P, Torpey K, Schwarzwalder A, Simumba C, Kasonde P, Nyirenda L, Kapanda P, Kakungu-Simpungwe M, Kabaso M, Thompson C: Task-shifting HIV counselling and testing services in Zambia: the role of lay counsellors. Hum Resour Health. 2009, 7: 44-10.1186/1478-4491-7-44.CrossRefPubMedPubMedCentral
25.
go back to reference Callaghan M, Ford N, Schneider H: A systematic review of task- shifting for HIV treatment and care in Africa. Hum Resour Health. 2010, 8: 8-10.1186/1478-4491-8-8.CrossRefPubMedPubMedCentral Callaghan M, Ford N, Schneider H: A systematic review of task- shifting for HIV treatment and care in Africa. Hum Resour Health. 2010, 8: 8-10.1186/1478-4491-8-8.CrossRefPubMedPubMedCentral
26.
go back to reference Zimbabwe Ministry of Health and Child Welfare: Zimbabwe National HIV and AIDS Strategic Plan (ZNASP), 2011–2016. 2011, Ministry of Helath and Child Welfare, In. Harare Zimbabwe Ministry of Health and Child Welfare: Zimbabwe National HIV and AIDS Strategic Plan (ZNASP), 2011–2016. 2011, Ministry of Helath and Child Welfare, In. Harare
27.
go back to reference Zimbabwe Ministry of Health and Child Welfare: January 2009 ART Progress Report by Province. ART Progress Reports. 2009, Ministry of Health and Child Welfare, Harare Zimbabwe Ministry of Health and Child Welfare: January 2009 ART Progress Report by Province. ART Progress Reports. 2009, Ministry of Health and Child Welfare, Harare
28.
go back to reference Zimbabwe Ministry of Health and Child Welfare: December 2010 ART Progress Report by Province. ART Progress Reports. 2010, , Harare Zimbabwe Ministry of Health and Child Welfare: December 2010 ART Progress Report by Province. ART Progress Reports. 2010, , Harare
29.
go back to reference Van Rie A, Sabue M, Jarrett N, Westreich D, Behets F, Kokolomani J, Bahati ER: Counseling and testing TB patients for HIV: evaluation of three implementation models in Kinshasa, Congo. Int J Tuberc Lung Dis. 2008, 12 (3 Suppl 1): 73-78.PubMed Van Rie A, Sabue M, Jarrett N, Westreich D, Behets F, Kokolomani J, Bahati ER: Counseling and testing TB patients for HIV: evaluation of three implementation models in Kinshasa, Congo. Int J Tuberc Lung Dis. 2008, 12 (3 Suppl 1): 73-78.PubMed
30.
go back to reference Corneli A, Jarrett NM, Sabue M, Duvall S, Bahati E, Behets F, Van Rie A: Patient and provider perspectives on implementation models of HIV counseling and testing for patients with TB. Int J Tuberc Lung Dis. 2008, 12 (3 Suppl 1): 79-84.PubMed Corneli A, Jarrett NM, Sabue M, Duvall S, Bahati E, Behets F, Van Rie A: Patient and provider perspectives on implementation models of HIV counseling and testing for patients with TB. Int J Tuberc Lung Dis. 2008, 12 (3 Suppl 1): 79-84.PubMed
31.
go back to reference Amanyire G, Wanyenze R, Alamo S, Kwarisiima D, Sunday P, Sebikaari G, Kamya M, Wabwire-Mangen F, Wagner G: Client and provider perspectives of the efficiency and quality of care in the context of rapid scale-up of antiretroviral therapy. AIDS Patient Care STDS. 2010, 24 (11): 719-727. 10.1089/apc.2010.0108.CrossRefPubMedPubMedCentral Amanyire G, Wanyenze R, Alamo S, Kwarisiima D, Sunday P, Sebikaari G, Kamya M, Wabwire-Mangen F, Wagner G: Client and provider perspectives of the efficiency and quality of care in the context of rapid scale-up of antiretroviral therapy. AIDS Patient Care STDS. 2010, 24 (11): 719-727. 10.1089/apc.2010.0108.CrossRefPubMedPubMedCentral
32.
go back to reference Walsh A, Ndubani P, Simbaya J, Dicker P, Brugha R: Task sharing in Zambia: HIV service scale-up compounds the human resource crisis. BMC Health Serv Res. 2010, 10: 272-10.1186/1472-6963-10-272.CrossRefPubMedPubMedCentral Walsh A, Ndubani P, Simbaya J, Dicker P, Brugha R: Task sharing in Zambia: HIV service scale-up compounds the human resource crisis. BMC Health Serv Res. 2010, 10: 272-10.1186/1472-6963-10-272.CrossRefPubMedPubMedCentral
33.
go back to reference Muula AS, Chipeta J, Siziya S, Rudatsikira E, Mataya RH, Kataika E: Human resources requirements for highly active antiretroviral therapy scale-up in Malawi. BMC Health Serv Res. 2007, 7: 208-10.1186/1472-6963-7-208.CrossRefPubMedPubMedCentral Muula AS, Chipeta J, Siziya S, Rudatsikira E, Mataya RH, Kataika E: Human resources requirements for highly active antiretroviral therapy scale-up in Malawi. BMC Health Serv Res. 2007, 7: 208-10.1186/1472-6963-7-208.CrossRefPubMedPubMedCentral
34.
go back to reference Rosenstock I: Historical origins of the Health Belief Model. Health Education Monographs. 1974, , , Volume Volume 2 Number 4, edn Rosenstock I: Historical origins of the Health Belief Model. Health Education Monographs. 1974, , , Volume Volume 2 Number 4, edn
35.
go back to reference Glanz K, Rimer BK, Lewis FM: Health Behaviour and Health Education. Theory, Research and Practice. edn. 2002, Wiley, San Francisco Glanz K, Rimer BK, Lewis FM: Health Behaviour and Health Education. Theory, Research and Practice. edn. 2002, Wiley, San Francisco
36.
go back to reference Pettifor A, MacPhail C, Suchindran S, Delany-Moretlwe S: Factors associated with HIV testing among public sector clinic attendees in Johannesburg, South Africa. AIDS Behav. 2010, 14 (4): 913-921. 10.1007/s10461-008-9462-5.CrossRefPubMed Pettifor A, MacPhail C, Suchindran S, Delany-Moretlwe S: Factors associated with HIV testing among public sector clinic attendees in Johannesburg, South Africa. AIDS Behav. 2010, 14 (4): 913-921. 10.1007/s10461-008-9462-5.CrossRefPubMed
37.
go back to reference Bila B, Egrot M: Gender asymmetry in healthcare-facility attendance of people living with HIV/AIDS in Burkina Faso. Soc Sci Med. 2009, 69 (6): 854-861. 10.1016/j.socscimed.2009.05.035.CrossRefPubMed Bila B, Egrot M: Gender asymmetry in healthcare-facility attendance of people living with HIV/AIDS in Burkina Faso. Soc Sci Med. 2009, 69 (6): 854-861. 10.1016/j.socscimed.2009.05.035.CrossRefPubMed
Metadata
Title
An assessment of the Zimbabwe ministry of health and child welfare provider initiated HIV testing and counselling programme
Authors
Euphemia L Sibanda
Karin Hatzold
Owen Mugurungi
Getrude Ncube
Beatrice Dupwa
Pester Siraha
Lydia K Madyira
Alexio Mangwiro
Gaurav Bhattacharya
Frances M Cowan
Publication date
01-12-2012
Publisher
BioMed Central
Published in
BMC Health Services Research / Issue 1/2012
Electronic ISSN: 1472-6963
DOI
https://doi.org/10.1186/1472-6963-12-131

Other articles of this Issue 1/2012

BMC Health Services Research 1/2012 Go to the issue