Counsellor-initiated testing doubles the proportion of people in hospital knowing their HIV status

Implementation of routine counselor-initiated opt-out HIV testing on the adult medical ward at Kamuzu Central Hospital, Lilongwe, Malawi.

LaCourse SM, Chester FM, Matoga M, Munthali C, Nsona D, Haac B, Hoffman IF, Hosseinipour MC. J Acquir Immune Defic Syndr. 2015 Jan 23. [Epub ahead of print]

The optimal approach of provider-initiated HIV testing and counseling (PITC) for inpatients in high-burden settings is unknown. We prospectively evaluated the implementation of task-shifting from clinician-referral to counselor-initiated PITC on the medical wards of Kamuzu Central Hospital, Malawi. The majority of patients (1905/3154, 60.4%) had an unknown admission HIV status. Counselors offered testing to 66.6% (1268/1905). HIV prevalence was 39.3%. Counselor-initiated PITC significantly increased HIV testing by 85% (643/2957 vs. 1268/3154), resulting in an almost 2-fold increase in patients with known HIV status (2447/3154 vs. 1249/3154) (both p<.0001), with 17.9% of those tested receiving a new diagnosis of HIV.

Abstract access [1]

Editor’s notes: UNAIDS estimates that in sub-Saharan Africa more than half of all people living with HIV remain unaware of their status and thus have no opportunity to access HIV care. Provider-initiated testing and counselling has been successful in increasing coverage of HIV testing in antenatal and tuberculosis clinics. In in-patient settings, it is most often the responsibility of a clinician to initiate the offer of HIV testing. Even when the universal offer of HIV testing is policy, many people may be missed.

In this study from a tertiary referral hospital in Malawi, counsellors were given responsibility for offering testing to all in-patients in the short-stay and medical wards. Prior to this programme, only 22% of people in these wards had an HIV test, and 31% of people tested were HIV-positive. During the programme period, some 60% of people admitted had unknown HIV status, of whom 67% were tested by counsellors. The refusal rate was very low, 3.2%. Some 39% of people tested were HIV positive. This seems a very effective way to maximise the number of medical in-patients who know their HIV status, thus allowing people to access appropriate care. Similar task-shifting activities have been undertaken to identify in-patients who are coughing and to ensure that their sputum is tested for tuberculosis. In settings where both HIV and tuberculosis are common, a programme combining counsellor-initiated HIV testing and cough screening could maximise case finding for both diseases. This would enable earlier initiation of treatment and reduce the risk of nosocomial transmission of tuberculosis.

HIV testing [4]
Africa [5]
Malawi [6]
  • [7]