title: Opportunities for strengthening provider-initiated testing and counselling for HIV in Namibia.
abstract: This short report identifies enablers and barriers to the uptake of provider-initiated testing and counselling for HIV (PITC) in Namibia and identifies key opportunities for strengthening this vital aspect of the national HIV response. We explored this through facility mapping, register reviews and qualitative methods including focus group discussions and in-depth interviews. Four health facilities (clinics and hospitals) in two regions were included in the study. We identified that PITC in Namibia was largely delivered by lay counsellors operating in designated rapid testing rooms located in health facilities and found a large number of missed opportunities for HIV testing through this model. Nurses did not see it as an integral part of their role, were not aware of HIV testing and counselling policy, felt inadequately trained and supported, and experienced staffing shortages. Institutional issues also acted as barriers to nurses performing or initiating discussions about PITC. Wider dissemination and implementation of policy, increasing privacy of consultation spaces and community sensitisation are simple measures that represent opportunities for strengthening this response and ensuring that symptomatic individuals who are unaware of their HIV status do not fall through the net.
authors.affiliation: a Liverpool School of Tropical Medicine , Liverpool , UK.
authors.forename: Tracy
authors.initials: T
authors.lastname: Davyduke
authors.forename: Ismelda
authors.initials: I
authors.lastname: Pietersen
authors.forename: David
authors.initials: D
authors.lastname: Lowrance
authors.forename: Selma
authors.initials: S
authors.lastname: Amwaama
authors.forename: Miriam
authors.initials: M
authors.lastname: Taegtmeyer
mesh_terms: D000554:Ambulatory Care Facilities / Q000458:organization & administration; D019380:Anti-HIV Agents / Q000627:therapeutic use; D001291:Attitude of Health Personnel; D003376:Counseling / Q000379:methods / Q000458:organization & administration*; D005260:Female; D017144:Focus Groups; D015658:HIV Infections / Q000175:diagnosis* / Q000628:therapy; D006297:Health Services Accessibility; D006801:Humans; D008403:Mass Screening / Q000706:statistics & numerical data*; D009276:Namibia; D009726:Nurses; D010342:Patient Acceptance of Health Care / Q000523:psychology / Q000706:statistics & numerical data; D036301:Qualitative Research
chemical_list: D019380:Anti-HIV Agents
keywords: HIV testing; Namibia; nursing; provider-initiated; sub-Saharan Africa; task shifting