title: Provider-initiated HIV testing and counselling in Rwanda: acceptability among clinic attendees and workers, reasons for testing and predictors of testing.
abstract: BACKGROUND
  Routine provider-initiated HIV testing and counselling (PITC) may increase HIV testing rates, but whether PITC is acceptable to health facility (HF) attendees is unclear. In the course of a PITC intervention study in Rwanda, we assessed the acceptability of PITC, reasons for being or not being tested and factors associated with HIV testing.
  
  
  METHODS
  Attendees were systematically interviewed in March 2009 as they left the HF, regarding knowledge and acceptability of PITC, history of testing and reasons for being tested or not. Subsequently, PITC was introduced in 6 of the 8 HFs and a second round of interviews was conducted. Independent factors associated with testing were analysed using logistic regression. Randomly selected health care workers (HCWs) were also interviewed.
  
  
  RESULTS
  1772 attendees were interviewed. Over 95% agreed with the PITC policy, both prior to and after implementation of PITC policy. The most common reasons for testing were the desire to know one's HIV status and having been offered an HIV test by an HCW. The most frequent reasons for not being tested were known HIV status and test not being offered. In multivariable analysis, PITC, age ≥15 years, and not having been previously tested were factors significantly associated with testing. Although workload was increased by PITC, HIV testing rates increased and HCWs overwhelmingly supported the policy.
  
  
  CONCLUSIONS
  Among attendees and HCWs in Rwandan clinics, the acceptability of PITC was very high. PITC appeared to increase testing rates and may be helpful in prevention and early access to treatment.
authors.affiliation: INTERACT, Kigali, Rwanda.
authors.forename: Felix R
authors.initials: FR
authors.lastname: Kayigamba
authors.affiliation: Royal Tropical Institute, KIT Biomedical Research, Amsterdam, The Netherlands.
authors.forename: Mirjam I
authors.initials: MI
authors.lastname: Bakker
authors.affiliation: Academic Medical Center (AMC), Amsterdam, The Netherlands.
authors.forename: Judith
authors.initials: J
authors.lastname: Lammers
authors.affiliation: ICAP, Mailman School of Public Health, Columbia University, Kigali, Rwanda.
authors.forename: Veronicah
authors.initials: V
authors.lastname: Mugisha
authors.affiliation: Ruhengeri hospital, Ministry of Health, Kigali, Rwanda.
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Bagiruwigize
authors.affiliation: Ministry of Health, Kigali, Rwanda.
authors.forename: Anita
authors.initials: A
authors.lastname: Asiimwe
authors.affiliation: Amsterdam Institute of Global Health and Development (AIGHD), Academic Medical Center (AMC), Amsterdam, The Netherlands; Center for Infection and Immunity Amsterdam (CINIMA), AMC, Amsterdam, The Netherlands; Public Health Service of Amsterdam (GGD), Amsterdam, The Netherlands.
authors.forename: Maarten F Schim
authors.initials: MF
authors.lastname: van der Loeff
mesh_terms: D000328:Adult; D003376:Counseling / Q000706:statistics & numerical data; D005260:Female; D015658:HIV Infections / Q000175:diagnosis*; D006282:Health Personnel; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000706:statistics & numerical data; D012432:Rwanda; D055815:Young Adult
references.citation: Am J Public Health. 2007 Oct;97(10):1762-74
references.pmid: 17761565
references.citation: J Acquir Immune Defic Syndr. 2008 Jun 1;48(2):190-5
references.pmid: 18520677
references.citation: BMC Health Serv Res. 2011 Apr 21;11:87
references.pmid: 21507273
references.citation: J Acquir Immune Defic Syndr. 2007 Oct 1;46(2):181-6
references.pmid: 17667332
references.citation: Int J Tuberc Lung Dis. 2008 Mar;12(3 Suppl 1):63-8
references.pmid: 18302825
references.citation: Clin Infect Dis. 2010 May 15;50 Suppl 3:S77-84
references.pmid: 20397960
references.citation: Int J Tuberc Lung Dis. 2008 Mar;12(3 Suppl 1):73-8
references.pmid: 18302827
references.citation: BMC Public Health. 2011 Mar 08;11:151
references.pmid: 21385423
references.citation: MMWR Recomm Rep. 2006 Sep 22;55(RR-14):1-17; quiz CE1-4
references.pmid: 16988643
references.citation: Bull World Health Organ. 2008 Apr;86(4):302-9
references.pmid: 18438519
references.citation: Bull World Health Organ. 2010 Sep 1;88(9):703-8
references.pmid: 20865076
references.citation: PLoS Med. 2006 Jul;3(7):e261
references.pmid: 16834458
references.citation: J Acquir Immune Defic Syndr. 2007 May 1;45(1):102-7
references.pmid: 17460473
references.citation: N Engl J Med. 2011 Oct 6;365(14):1265-8
references.pmid: 21991946
references.citation: Med Anthropol. 2011 Mar;30(2):183-201
references.pmid: 21400352
references.citation: AIDS Behav. 2007 Sep;11(5):753-8
references.pmid: 17096199
references.citation: AIDS Care. 2010 Feb;22(2):238-45
references.pmid: 20390502
references.citation: AIDS Care. 2010 May;22(5):533-7
references.pmid: 20397075
references.citation: AIDS. 2013 Feb 20;27(4):617-26
references.pmid: 23364442
references.citation: Int J Tuberc Lung Dis. 2008 Mar;12(3 Suppl 1):69-72
references.pmid: 18302826
references.citation: J Acquir Immune Defic Syndr. 2011 Jan 1;56(1):e9-32
references.pmid: 21189483
references.citation: BMC Int Health Hum Rights. 2007 Jun 08;7:5
references.pmid: 17559678
references.citation: Int J Gynaecol Obstet. 2009 Aug;106(2):137-40
references.pmid: 19539931
references.citation: Pan Afr Med J. 2009 Sep 04;3:4
references.pmid: 21532713
references.citation: Bull World Health Organ. 2011 May 1;89(5):328-335A
references.pmid: 21556300
references.citation: AIDS Patient Care STDS. 2007 Dec;21(12):981-6
references.pmid: 18154494
references.citation: Int J Nurs Stud. 2009 May;46(5):723-31
references.pmid: 19159879
references.citation: Trop Med Int Health. 2007 Nov;12(11):1315-22
references.pmid: 17949401
references.citation: PLoS One. 2010 Jul 13;5(7):e11522
references.pmid: 20644629
references.citation: J Acquir Immune Defic Syndr. 2007 Apr 1;44(4):484-8
references.pmid: 17211281
references.citation: Int J Tuberc Lung Dis. 2008 Mar;12(3 Suppl 1):79-84
references.pmid: 18302828