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Provider-Initiated HIV Testing and Counseling in Low- and Middle-Income Countries: A Systematic Review

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Abstract

Provider-initiated HIV testing and counseling (PITC) has expanded since 2007 WHO guidelines were established. We conducted a systematic review of PITC in low- and middle-income countries. Peer-reviewed studies were included if they measured pre-post or multi-arm outcomes. Two coders abstracted data using standardized forms. Nineteen studies were included, all from sub-Saharan Africa (N = 15) or Asia (N = 4). Studies were conducted in clinics for antenatal/family planning/child health (N = 12), tuberculosis (N = 4), outpatient (N = 1), sexually transmitted diseases (N = 1), and methadone maintenance (N = 1). HIV testing uptake increased after PITC. Condom use also increased following PITC in most studies; nevirapine uptake and other outcomes were mixed. Few negative outcomes were identified. Findings support PITC as an important intervention to increase HIV testing. PITC’s impact on other outcomes is mixed, but does not appear to be worse than voluntary counseling and testing. PITC should continue to be expanded and rigorously evaluated across settings and outcomes.

Resumen

Los servicios de pruebas de VIH y asesoramiento (PITC por sus siglas en inglés) se ha ampliado desde que las directrices del 2007 de la OMS fueron establecidas. Llevamos a cabo una revisión sistemática del PITC en países de bajos y medianos ingresos. Estudios revisados se incluyeron si medían resultados antes-despues o múltiple brazo. Dos codificadores obtuvieron los datos mediante formularios estandarizados. Se incluyen diecinueve estudios, todos ellos de África subsahariana (N = 15) o de Asia (N = 4). Los estudios se llevaron a cabo en las clínicas de atención prenatal / planificación familiar / salud infantil (N = 12), tuberculosis (N = 4), para pacientes ambulatorios (N = 1), enfermedades de transmisión sexual (N = 1), y de mantenimiento con metadona (N = 1). La captación de las pruebas del VIH aumentó después de PITC. El uso de condones también aumentó después de PITC en la mayoría de los estudios, la utilización de nevirapina y otros resultados fueron variados. Se identificaron pocos resultados negativos. Los resultados apoyan la premisa de que el PITC es una intervención importante para aumentar las pruebas de VIH. El impacto del PITC en otros resultados es variado, pero no demuestra menor eficiencia que el asesoramiento y pruebas voluntarias. El PITC debe seguir ampliándose y evaluándose rigurosamente en todos los entornos y los resultados.

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Acknowledgments

This research was supported by the US National Institute of Mental Health, grant number 1R01MH090173. We wish to thank Samantha Dovey, Jewel Gausman, Alexandria Smith, Eugenia Pyntikova, Hieu Pham, Tina Dickenson, Erica Layer, Jeremy Lapedis, Aisha Yansaneh, and Lindsay Litwin for their screening and coding work on this review.

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Authors and Affiliations

  1. Social and Behavioral Interventions Program, Department of International Health, Room E5033, Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe Street, Baltimore, MD, 21205, USA

    Caitlin E. Kennedy & Virginia A. Fonner

  2. The Medical University of South Carolina, Charleston, SC, USA

    Michael D. Sweat

  3. World Health Organization, Geneva, Switzerland

    F. Amolo Okero, Rachel Baggaley & Kevin R. O’Reilly

Authors
  1. Caitlin E. Kennedy
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  2. Virginia A. Fonner
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  3. Michael D. Sweat
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  4. F. Amolo Okero
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  5. Rachel Baggaley
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  6. Kevin R. O’Reilly
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Correspondence to Caitlin E. Kennedy.

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Kennedy, C.E., Fonner, V.A., Sweat, M.D. et al. Provider-Initiated HIV Testing and Counseling in Low- and Middle-Income Countries: A Systematic Review. AIDS Behav 17, 1571–1590 (2013). https://doi.org/10.1007/s10461-012-0241-y

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  • DOI: https://doi.org/10.1007/s10461-012-0241-y

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