title: From caution to urgency: the evolution of HIV testing and counselling in Africa.
abstract: OBJECTIVE
  To describe recent changes in policy on provider-initiated testing and counselling (PITC) for human immunodeficiency virus (HIV) infection in African countries and to investigate patients' experiences of and views about PITC.
  
  
  METHODS
  A review of the published literature and of national HIV testing policies, strategic frameworks, plans and other relevant documents was carried out.
  
  
  RESULTS
  Of the African countries reviewed, 42 (79.2%) had adopted a PITC policy. Of the 42, all recommended PITC for the prevention of mother-to-child HIV transmission, 66.7% recommended it for tuberculosis clinics and patients, and 45.2% for sexually transmitted infection clinics. Moreover, 43.6% adopted PITC in 2005 or 2006. The literature search identified 11 studies on patients' experiences of and views about PITC in clinical settings in Africa. The clear majority regarded PITC as acceptable. However, women in antenatal clinics were not always aware that they had the right to decline an HIV test.
  
  
  CONCLUSIONS
  Policy and practice on HIV testing and counselling in Africa has shifted from a cautious approach that emphasizes confidentiality to greater acceptance of the routine offer of HIV testing. The introduction of PITC in clinical settings has contributed to increased HIV testing in several of these settings. Most patients regard PITC as acceptable. However, other approaches are needed to reach people who do not consult health-care services.
authors.affiliation: HIV/AIDS Department, World Health Organization, Geneva, Switzerland.
authors.forename: R
authors.initials: R
authors.lastname: Baggaley
authors.forename: B
authors.initials: B
authors.lastname: Hensen
authors.forename: O
authors.initials: O
authors.lastname: Ajose
authors.forename: K L
authors.initials: KL
authors.lastname: Grabbe
authors.forename: V J
authors.initials: VJ
authors.lastname: Wong
authors.forename: A
authors.initials: A
authors.lastname: Schilsky
authors.forename: Y-R
authors.initials: YR
authors.lastname: Lo
authors.forename: F
authors.initials: F
authors.lastname: Lule
authors.forename: R
authors.initials: R
authors.lastname: Granich
authors.forename: J
authors.initials: J
authors.lastname: Hargreaves
mesh_terms: D015492:AIDS Serodiagnosis / Q000639:trends*; D000349:Africa / Q000453:epidemiology; D037001:Directive Counseling / Q000379:methods*; D005260:Female; D015658:HIV Infections / Q000175:diagnosis* / Q000453:epidemiology / Q000523:psychology; D006266:Health Education / Q000379:methods*; D006293:Health Promotion / Q000379:methods; D006801:Humans; D018445:Infectious Disease Transmission, Vertical / Q000517:prevention & control; D011247:Pregnancy; D011634:Public Health / Q000379:methods