title: Implementation and Operational Research: Implementation of Routine Counselor-Initiated Opt-Out HIV Testing on the Adult Medical Ward at Kamuzu Central Hospital, Lilongwe, Malawi.
abstract: The optimal approach of provider-initiated HIV testing and counseling (PITC) for inpatients in high-burden settings is unknown. We prospectively evaluated the implementation of task shifting from clinician-referral to counselor-initiated PITC on the medical wards of Kamuzu Central Hospital, Malawi. Most of patients (1905/3154, 60.4%) had an unknown admission HIV status. Counselors offered testing to 66.6% (1268/1905). HIV prevalence was 39.3%. Counselor-initiated PITC significantly increased HIV testing by 79% (643/2957 vs. 1228/3154), resulting in an almost 2-fold increase in patients with known HIV status (2447/3154 vs. 1249/3154) (both P < 0.0001), with 18.4% of those tested receiving a new diagnosis of HIV.
authors.affiliation: *Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington, Seattle, WA; †UNC Project, Lilongwe, Malawi; ‡Department of Medicine, Kamuzu Central Hospital, Lilongwe, Malawi; §Lighthouse Trust Clinic, Lilongwe, Malawi; ‖Department of Surgery, University of Maryland Medical Center, Baltimore, MD; and ¶Division of Infectious Diseases, Department of Medicine, University of North Carolina, Chapel Hill, NC.
authors.forename: Sylvia M
authors.initials: SM
authors.lastname: LaCourse
authors.forename: Frances M
authors.initials: FM
authors.lastname: Chester
authors.forename: Mitch
authors.initials: M
authors.lastname: Matoga
authors.forename: Charles
authors.initials: C
authors.lastname: Munthali
authors.forename: Dominic
authors.initials: D
authors.lastname: Nsona
authors.forename: Bryce
authors.initials: B
authors.lastname: Haac
authors.forename: Irving F
authors.initials: IF
authors.lastname: Hoffman
authors.forename: Mina C
authors.initials: MC
authors.lastname: Hosseinipour
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D003376:Counseling; D005260:Female; D015658:HIV Infections / Q000175:diagnosis*; D006302:Health Services Research; D006761:Hospitals; D006801:Humans; D008295:Malawi; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D055815:Young Adult