Provider-initiated testing and counselling programmes in sub-Saharan Africa:  a systematic review of their operational implementation.
OBJECTIVE
The routine offer of an HIV test during patient-provider encounters is gaining momentum within HIV treatment and prevention programmes. This review examined the operational implementation of provider-initiated testing and counselling (PITC) programmes in sub-Saharan Africa.


METHODS
PUBMED, EMBASE, Global Health, COCHRANE Library and JSTOR databases were searched systematically for articles published in English between January 2000 and November 2010. Grey literature was explored through the websites of international and nongovernmental organizations. Eligibility of studies was based on predetermined criteria applied during independent screening by two researchers.


RESULTS
We retained 44 studies out of 5088 references screened. PITC polices have been effective at identifying large numbers of previously undiagnosed individuals. However, the translation of policy guidance into practice has had mixed results, and in several studies of routine programmes the proportion of patients offered an HIV test was disappointingly low. There were wide variations in the rates of acceptance of the test and poor linkage of those testing positive to follow-up assessments and antiretroviral treatment. The challenges encountered encompass a range of areas from logistics, to data systems, human resources and management, reflecting some of the weaknesses of health systems in the region.


CONCLUSIONS
The widespread adoption of PITC provides an unprecedented opportunity for identifying HIV-positive individuals who are already in contact with health services and should be accompanied by measures aimed at strengthening health systems and fostering the normalization of HIV at community level. The resources and effort needed to do this successfully should not be underestimated.
London School of Hygiene and Tropical Medicine, London, UK. maria.roura@lshtm.ac.uk
Maria
M
Roura
Deborah
D
Watson-Jones
Tanya M
TM
Kahawita
Laura
L
Ferguson
David A
DA
Ross
D015492:AIDS Serodiagnosis / Q000379:methods*; D017954:Africa South of the Sahara; D000554:Ambulatory Care Facilities / Q000458:organization & administration; D003376:Counseling / Q000458:organization & administration*; D005260:Female; D006679:HIV Seropositivity / Q000175:diagnosis*; D006302:Health Services Research; D006801:Humans; D008297:Male; D008403:Mass Screening; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data; D011320:Primary Health Care / Q000458:organization & administration*