Associations between mode of HIV testing and consent, confidentiality, and referral: a comparative analysis in four African countries.

<h4>Background</h4>Recommendations about scaling up HIV testing and counseling highlight the need to provide key services and to protect clients' rights, but it is unclear to what extent different modes of testing differ in this respect. This paper examines whether practices regardi...

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Autores principales:	Carla Makhlouf Obermeyer, Melissa Neuman, Alice Desclaux, Rhoda Wanyenze, Odette Ky-Zerbo, Peter Cherutich, Ireen Namakhoma, Anita Hardon
Formato:	article
Lenguaje:	EN
Publicado:	Public Library of Science (PLoS) 2012
Materias:	Medicine R
Acceso en línea:	https://doaj.org/article/d3c2a538d64c4b36b593348585b438a0
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spelling	oai:doaj.org-article:d3c2a538d64c4b36b593348585b438a02021-11-18T05:42:50ZAssociations between mode of HIV testing and consent, confidentiality, and referral: a comparative analysis in four African countries.1549-12771549-167610.1371/journal.pmed.1001329https://doaj.org/article/d3c2a538d64c4b36b593348585b438a02012-01-01T00:00:00Zhttps://www.ncbi.nlm.nih.gov/pmc/articles/pmid/23109914/?tool=EBIhttps://doaj.org/toc/1549-1277https://doaj.org/toc/1549-1676<h4>Background</h4>Recommendations about scaling up HIV testing and counseling highlight the need to provide key services and to protect clients' rights, but it is unclear to what extent different modes of testing differ in this respect. This paper examines whether practices regarding consent, confidentiality, and referral vary depending on whether testing is provided through voluntary counseling and testing (VCT) or provider-initiated testing.<h4>Methods and findings</h4>The MATCH (Multi-Country African Testing and Counseling for HIV) study was carried out in Burkina Faso, Kenya, Malawi, and Uganda. Surveys were conducted at selected facilities. We defined eight outcome measures related to pre- and post-test counseling, consent, confidentiality, satisfactory interactions with providers, and (for HIV-positive respondents) referral for care. These were compared across three types of facilities: integrated facilities, where testing is provided along with medical care; stand-alone VCT facilities; and prevention of mother-to-child transmission (PMTCT) facilities, where testing is part of PMTCT services. Tests of bivariate associations and modified Poisson regression were used to assess significance and estimate the unadjusted and adjusted associations between modes of testing and outcome measures. In total, 2,116 respondents tested in 2007 or later reported on their testing experience. High percentages of clients across countries and modes of testing reported receiving recommended services and being satisfied. In the unadjusted analyses, integrated testers were less likely to meet with a counselor before testing (83% compared with 95% of VCT testers; p<0.001), but those who had a pre-test meeting were more likely to have completed consent procedures (89% compared with 83% among VCT testers; p<0.001) and pre-test counseling (78% compared with 73% among VCT testers; p = 0.015). Both integrated and PMTCT testers were more likely to receive complete post-test counseling than were VCT testers (59% among both PMTCT and integrated testers compared with 36% among VCT testers; p<0.001). Adjusted analyses by country show few significant differences by mode of testing: only lower satisfaction among integrated testers in Burkina Faso and Uganda, and lower frequency of referral among PMTCT testers in Malawi. Adjusted analyses of pooled data across countries show a higher likelihood of pre-test meeting for those testing at VCT facilities (adjusted prevalence ratio: 1.22, 95% CI: 1.07-1.38) and higher satisfaction for stand-alone VCT facilities (adjusted prevalence ratio: 1.15; 95% CI: 1.06-1.25), compared to integrated testing, but no other associations were statistically significant.<h4>Conclusions</h4>Overall, in this study most respondents reported favorable outcomes for consent, confidentiality, and referral. Provider-initiated ways of delivering testing and counseling do not appear to be associated with less favorable outcomes for clients than traditional, client-initiated VCT, suggesting that testing can be scaled up through multiple modes without detriment to clients' rights. Please see later in the article for the Editors' Summary.Carla Makhlouf ObermeyerMelissa NeumanAlice DesclauxRhoda WanyenzeOdette Ky-ZerboPeter CherutichIreen NamakhomaAnita HardonPublic Library of Science (PLoS)articleMedicineRENPLoS Medicine, Vol 9, Iss 10, p e1001329 (2012)
institution	DOAJ
collection	DOAJ
language	EN
topic	Medicine R
spellingShingle	Medicine R Carla Makhlouf Obermeyer Melissa Neuman Alice Desclaux Rhoda Wanyenze Odette Ky-Zerbo Peter Cherutich Ireen Namakhoma Anita Hardon Associations between mode of HIV testing and consent, confidentiality, and referral: a comparative analysis in four African countries.
description	<h4>Background</h4>Recommendations about scaling up HIV testing and counseling highlight the need to provide key services and to protect clients' rights, but it is unclear to what extent different modes of testing differ in this respect. This paper examines whether practices regarding consent, confidentiality, and referral vary depending on whether testing is provided through voluntary counseling and testing (VCT) or provider-initiated testing.<h4>Methods and findings</h4>The MATCH (Multi-Country African Testing and Counseling for HIV) study was carried out in Burkina Faso, Kenya, Malawi, and Uganda. Surveys were conducted at selected facilities. We defined eight outcome measures related to pre- and post-test counseling, consent, confidentiality, satisfactory interactions with providers, and (for HIV-positive respondents) referral for care. These were compared across three types of facilities: integrated facilities, where testing is provided along with medical care; stand-alone VCT facilities; and prevention of mother-to-child transmission (PMTCT) facilities, where testing is part of PMTCT services. Tests of bivariate associations and modified Poisson regression were used to assess significance and estimate the unadjusted and adjusted associations between modes of testing and outcome measures. In total, 2,116 respondents tested in 2007 or later reported on their testing experience. High percentages of clients across countries and modes of testing reported receiving recommended services and being satisfied. In the unadjusted analyses, integrated testers were less likely to meet with a counselor before testing (83% compared with 95% of VCT testers; p<0.001), but those who had a pre-test meeting were more likely to have completed consent procedures (89% compared with 83% among VCT testers; p<0.001) and pre-test counseling (78% compared with 73% among VCT testers; p = 0.015). Both integrated and PMTCT testers were more likely to receive complete post-test counseling than were VCT testers (59% among both PMTCT and integrated testers compared with 36% among VCT testers; p<0.001). Adjusted analyses by country show few significant differences by mode of testing: only lower satisfaction among integrated testers in Burkina Faso and Uganda, and lower frequency of referral among PMTCT testers in Malawi. Adjusted analyses of pooled data across countries show a higher likelihood of pre-test meeting for those testing at VCT facilities (adjusted prevalence ratio: 1.22, 95% CI: 1.07-1.38) and higher satisfaction for stand-alone VCT facilities (adjusted prevalence ratio: 1.15; 95% CI: 1.06-1.25), compared to integrated testing, but no other associations were statistically significant.<h4>Conclusions</h4>Overall, in this study most respondents reported favorable outcomes for consent, confidentiality, and referral. Provider-initiated ways of delivering testing and counseling do not appear to be associated with less favorable outcomes for clients than traditional, client-initiated VCT, suggesting that testing can be scaled up through multiple modes without detriment to clients' rights. Please see later in the article for the Editors' Summary.
format	article
author	Carla Makhlouf Obermeyer Melissa Neuman Alice Desclaux Rhoda Wanyenze Odette Ky-Zerbo Peter Cherutich Ireen Namakhoma Anita Hardon
author_facet	Carla Makhlouf Obermeyer Melissa Neuman Alice Desclaux Rhoda Wanyenze Odette Ky-Zerbo Peter Cherutich Ireen Namakhoma Anita Hardon
author_sort	Carla Makhlouf Obermeyer
title	Associations between mode of HIV testing and consent, confidentiality, and referral: a comparative analysis in four African countries.
title_short	Associations between mode of HIV testing and consent, confidentiality, and referral: a comparative analysis in four African countries.
title_full	Associations between mode of HIV testing and consent, confidentiality, and referral: a comparative analysis in four African countries.
title_fullStr	Associations between mode of HIV testing and consent, confidentiality, and referral: a comparative analysis in four African countries.
title_full_unstemmed	Associations between mode of HIV testing and consent, confidentiality, and referral: a comparative analysis in four African countries.
title_sort	associations between mode of hiv testing and consent, confidentiality, and referral: a comparative analysis in four african countries.
publisher	Public Library of Science (PLoS)
publishDate	2012
url	https://doaj.org/article/d3c2a538d64c4b36b593348585b438a0
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Associations between mode of HIV testing and consent, confidentiality, and referral: a comparative analysis in four African countries.

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