title: Provider-initiated HIV testing and counseling: increased uptake in two public community health centers in South Africa and implications for scale-up.
abstract: BACKGROUND
  International guidance recommends the scale up of routinely recommended, offered, and delivered health care provider-initiated HIV testing and counseling (PITC) to increase the proportion of persons who know their HIV status. We compared HIV test uptake under PITC to provider-referral to voluntary counseling and testing (VCT referral) in two primary health centers in South Africa.
  
  
  METHODS
  Prior to introducing PITC, clinical providers were instructed to refer systematically selected study participants to VCT. After PITC and HIV rapid test training, providers were asked to recommend, offer and provide HIV testing to study participants during the clinical consultation. Participants were interviewed before and after their consultation to assess their HIV testing experiences.
  
  
  RESULTS
  HIV test uptake increased under PITC (OR 2.85, 95% CI 1.71, 4.76), and more patients felt providers answered their questions on HIV (104/141 [74%] versus 73/118 [62%] for VCT referral; p 0.04). After three months, only 4/106 (3.8%) HIV-positive patients had registered for onsite HIV treatment. Providers found PITC useful, but tested very few patients (range 0-15).
  
  
  CONCLUSIONS
  PITC increased the uptake of HIV testing compared with referral to onsite VCT, and patients reported a positive response to PITC. However, providing universal PITC will require strong leadership to train and motivate providers, and interventions to link HIV-positive persons to HIV treatment centers.
authors: Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America. sdalal@cdc.gov
authors: Shona
authors: S
authors: Dalal
authors: Chung-won
authors: CW
authors: Lee
authors: Thato
authors: T
authors: Farirai
authors: Allison
authors: A
authors: Schilsky
authors: Thurma
authors: T
authors: Goldman
authors: Janet
authors: J
authors: Moore
authors: Naomi N
authors: NN
authors: Bock
mesh_terms: D015492:AIDS Serodiagnosis / Q000706:statistics & numerical data*; D000293:Adolescent; D000328:Adult; D003151:Community Health Centers / Q000458:organization & administration*; D003376:Counseling; D005260:Female; D006678:HIV / Q000472:pathogenicity; D015658:HIV Infections / Q000175:diagnosis* / Q000821:virology; D006282:Health Personnel; D006291:Health Policy; D006801:Humans; D008297:Male; D008403:Mass Screening; D008875:Middle Aged; D013019:South Africa; D055815:Young Adult