Ethical issues surrounding the provider initiated opt--Out prenatal HIV screening practice in Sub-Saharan Africa: a literature review.
BACKGROUND
Prevention of mother to child transmission of HIV remains a key public health priority in most developing countries. The provider Initiated Opt - Out Prenatal HIV Screening Approach, recommended by the World Health Organization (WHO) lately has been adopted and translated into policy in most Sub - Saharan African countries. To better ascertain the ethical reasons for or against the use of this approach, we carried out a literature review of the ethics literature.


METHODS
Papers published in English and French Languages between 1990 and 2015 from the following data bases were searched: Pubmed, Cochrane literature, Embase, Cinhal, Web of Science and Google Scholar. After screening from 302 identified relevant articles, 21 articles were retained for the critical review.


CONCLUSIONS
Most authors considered this approach ethically justifiable due to its potential benefits to the mother, foetus and society (Beneficence). The breaching of respect for autonomy was considered acceptable on the grounds of libertarian paternalism. Most authors considered the Opt - Out approach to be less stigmatizing than the Opt - In. The main arguments against the Opt - Out approach were: non respect of patient autonomy, informed consent becoming a meaningless concept and the HIV test becoming compulsory, risk of losing trust in health care providers, neglect of social and psychological implications of doing an HIV test, risk of aggravation of stigma if all tested patients are not properly cared for and neglect of sociocultural peculiarities.


CONCLUSIONS
The Opt - Out approach could be counterproductive in case gender sensitive issues within the various sociocultural representations are neglected, and actions to offer holistic care to all women who shall potentially test positive for HIV were not effectively ascertained. The Provider Initiated Opt - Out Prenatal HIV Screening option remains ethically acceptable, but deserves caution, active monitoring and evaluation within the translation of this approach into to practice.
Centre for Population Studies and Health Promotion, CPSHP, BP, 7535, Yaounde, Cameroon. lebaiins@gmail.com.|Department of Military Health, Ministry of Defense, Yaounde, Cameroon. lebaiins@gmail.com.
Luchuo Engelbert
LE
Bain
Interfaculty Centre for Biomedical Ethics and Law, KU, Leuven, Belgium. kris.dierickx@med.kuleuven.be.
Kris
K
Dierickx
Interfaculty Centre for Biomedical Ethics and Law, KU, Leuven, Belgium. Kristien.Hens@kuleuven.be.
Kristien
K
Hens
D015492:AIDS Serodiagnosis / Q000941:ethics* / Q000706:statistics & numerical data; D017954:Africa South of the Sahara; D037001:Directive Counseling; D005260:Female; D015658:HIV Infections / Q000517:prevention & control*; D006266:Health Education; D006282:Health Personnel; D006801:Humans; D018445:Infectious Disease Transmission, Vertical / Q000941:ethics / Q000517:prevention & control*; D008403:Mass Screening / Q000941:ethics* / Q000706:statistics & numerical data; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D010353:Patient Education as Topic