Universal voluntary HIV testing in antenatal care settings: a review of the contribution of provider-initiated testing & counselling.
OBJECTIVE
To assess the contribution of provider-initiated testing and counselling (PITC) to achieving universal testing of pregnant women and, from available data on components of PITC, assess whether PITC adoption adheres to pre-test information, post-test counselling procedures and linkage to treatment.


METHODS
Systematic review of published literature. Findings were collated and data extracted on HIV testing uptake before and after the adoption of a PITC model. Data on pre- and post-test counselling uptake and linkage to anti-retrovirals, where available, were also extracted.


RESULTS
Ten eligible studies were identified. Pre-intervention testing uptake ranged from 5.5% to 78.7%. Following PITC introduction, testing uptake increased by a range of 9.9% to 65.6%, with testing uptake ≥85% in eight studies. Where reported, pre-test information was provided to between 91.5% and 100% and post-test counselling to between 82% and 99.8% of pregnant women. Linkage to ARVs for prevention of mother to child transmission (PMTCT) was reported in five studies and ranged from 53.7% to 77.2%. Where reported, PITC was considered acceptable by ANC attendees.


CONCLUSIONS
Our review provides evidence that the adoption of PITC within ANC can facilitate progress towards universal voluntary testing of pregnant women. This is necessary to increase the coverage of PMTCT services and facilitate access to treatment and prevention interventions. We found some evidence that PITC adoption does not undermine processes inherent to good conduct of testing, with high levels of pre-test information and post-test counselling, and two studies suggesting that PITC is acceptable to ANC attendees.
Faculty of Infectious Diseases, London School of Hygiene and Tropical Medicine, London, UK. bernadette.hensen@lshtm.ac.uk
Bernadette
B
Hensen
Rachel
R
Baggaley
Vincent J
VJ
Wong
Kristina L
KL
Grabbe
Nathan
N
Shaffer
Ying-Ru Jacqueline
YR
Lo
James
J
Hargreaves
D015492:AIDS Serodiagnosis; D022126:Access to Information; D019380:Anti-HIV Agents / Q000627:therapeutic use; D003376:Counseling; D005260:Female; D006678:HIV; D015658:HIV Infections / Q000175:diagnosis* / Q000517:prevention & control / Q000635:transmission; D006801:Humans; D018445:Infectious Disease Transmission, Vertical / Q000517:prevention & control*; D008403:Mass Screening; D010342:Patient Acceptance of Health Care; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000175:diagnosis*; D011295:Prenatal Care; D035141:Voluntary Programs
D019380:Anti-HIV Agents