A comparison of HIV detection rates using routine opt-out provider-initiated HIV testing and counseling versus a standard of care approach in a rural African setting.

Silvestri DM, Modjarrad K, Blevins ML, Halale E, Vermund SH, McKinzie JP
J Acquir Immune Defic Syndr. 2011 56 (1): e9-32

PMID: 21189483 · PMCID: PMC3016940 · DOI:10.1097/qai.0b013e3181fdb629

BACKGROUND - Routine opt-out provider-initiated HIV testing and counseling (PITC) remains underutilized in sub-Saharan Africa. By selectively targeting clients who either volunteer or have clinical indications of HIV disease, standard approaches to HIV counseling and testing are presumed more cost-efficient than PITC.

METHODS - One thousand two hundred twenty-one patients aged 15– 49 years were seen by 22 practitioners in a mobile clinic in southern Zambia. A random sample of physicians was assigned to administer PITC, whereas the remaining practitioners offered standard non- PITC (ie, voluntary or diagnostic). Questionnaires assessed patient demographics and attitudes toward HIV. HIV detection rates were stratified by referral type, demographics, and HIV-related knowledge and attitudes.

RESULTS - HIV prevalence was 10.6%. Infection rates detected using PITC [11.1%; 95% confidence interval (CI): 8.8% to 13.5%] and standard non-PITC (10.0%; 95% CI: 7.5% to 12.5%) did not significantly differ (odds ratio = 1.01; 95% CI: 0.67 to 1.52; P = 0.95). Patients who did not request testing or demonstrate clinical indicators of HIV did not have significantly higher HIV prevalence than those who did (odds ratio = 0.83; 95% CI: 0.55 to 1.24; P = 0.36). Implementation of PITC was highly acceptable and produced a 3-fold increase in patients tested per practitioner compared with standard non-PITC (114 vs. 34 patients per practitioner, respectively).

CONCLUSIONS - PITC detected a comparable HIV infection rate as a standard non-PITC approach among rural adults seeking primary care services. Widespread implementation of PITC may therefore lead to significantly more cases of HIV detected.

MeSH Terms (21)

Adolescent Adult AIDS Serodiagnosis Attitude to Health Chi-Square Distribution Confidence Intervals Counseling Female Health Knowledge, Attitudes, Practice HIV Infections HIV Seropositivity Humans Male Middle Aged Odds Ratio Rural Population Standard of Care Surveys and Questionnaires Voluntary Programs Young Adult Zambia

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