title: The views and experiences of nurses and midwives in the provision and management of provider-initiated HIV testing and counseling: a systematic review of qualitative evidence.
abstract: BACKGROUND
  Global progress towards HIV prevention and care is contingent upon increasing the number of those aware of their status through HIV testing. Provider-initiated HIV testing and counseling is recommended globally as a strategy to enhance uptake of HIV testing and is primarily conducted by nurses and midwives. Research shows that provider-initiated HIV testing and counseling implementation is sub-optimal. The reasons for this are unclear.
  
  
  OBJECTIVE
  The review aimed to explore nurses' and midwives' views and experiences of the provision and management of provider-initiated HIV testing and counseling.
  
  
  METHODS
  
  
  
  METHODS
  All cadres of nurses and midwives were considered, including those who undertake routine HIV testing as part of a diverse role and those who are specifically trained as HIV counselors. Types of phenomenon of interest: The review sought to understand the views and experiences of the provision and management of provider-initiated HIV testing and counseling (including perceptions, opinions, beliefs, practices and strategies related to HIV testing and its implementation in practice).
  
  
  BACKGROUND
  The review included only provider-initiated HIV testing and counseling. It excluded all other models of HIV testing. The review included all countries and all healthcare settings. Types of studies: This review considered all forms of qualitative study design and methodology. Qualitative elements of a mixed method study were included if they were presented separately within the publication.
  
  
  METHODS
  A three-step search strategy was utilized. Eight databases were searched for papers published from 1996 to October 2014, followed by hand searching of reference lists. Only studies published in the English language were considered.
  
  
  METHODS
  Methodological quality was assessed using the Qualitative Assessment and Review Instrument developed by the Joanna Briggs Institute.
  
  
  METHODS
  Qualitative findings were extracted using the Joanna Briggs Institute Qualitative Assessment and Review Instrument.
  
  
  RESULTS
  Qualitative research findings were pooled using a pragmatic meta-aggregative approach and the Joanna Briggs Institute Qualitative Assessment and Review Instrument software.
  
  
  RESULTS
  This review included 21 publications from 18 research studies, representing a wide range of countries and healthcare settings. There were 245 findings which were aggregated into 12 categories and five synthesized findings. 1. Nurses/midwives are supportive of provider-initiated HIV testing and counseling if it is perceived to enhance patient care and to align with perceived professional roles. 2. Nurses'/midwives' ability to perform provider-initiated HIV testing and counseling well requires an appropriate infrastructure and adequate human and material resources. 3. At the organizational level, nurses'/midwives' engagement with provider-initiated HIV testing and counseling is facilitated by an inclusive management structure, alongside the provision of ongoing training and clinical supervision. Provider-initiated HIV testing and counseling is hindered by difficulties in fitting it into existing workloads and routines. 4. Nurses/midwives perceive that good quality care in provider-initiated HIV testing and counseling involves finding a balance between public health needs and individual patient needs. Good care requires time and the ability to apply a patient centred approach. 5. The emotional work involved in provider-initiated HIV testing and counseling can be stressful. Nurses/Midwives may require support to deal with complex moral and ethical issues.
  
  
  CONCLUSIONS
  This review shows that provider-initiated HIV testing and counseling is supported by nurses/midwives who strive to implement it according to principles of good care and a patient centered approach. Nurses/midwives face multiple operational, infra-structural, resource and ethical challenges in the implementation of provider-initiated HIV testing and counseling.
  
  
  CONCLUSIONS
  The implementation process for provider-initiated HIV testing and counseling would benefit from using a quality improvement framework. Nurses/midwives undertaking provider-initiated HIV testing and counseling require management support, ongoing training and adequate infrastructure/resources. Additional guidance is required on legal/ethical issues in testing of children and in third party disclosure.
  
  
  CONCLUSIONS
  Operational research is required to determine an optimal skill mix and optimal methods of integrating provider-initiated HIV testing and counseling into existing work routines.
authors.affiliation: University of Nottingham Center for Evidence Based Healthcare: a Collaborating Center of the Joanna Briggs Institute, United Kingdom.
authors.forename: Catrin
authors.initials: C
authors.lastname: Evans
authors.affiliation: University of Nottingham Center for Evidence Based Healthcare: a Collaborating Center of the Joanna Briggs Institute, United Kingdom.
authors.forename: Sylivia
authors.initials: S
authors.lastname: Nalubega
authors.affiliation: University of Nottingham Center for Evidence Based Healthcare: a Collaborating Center of the Joanna Briggs Institute, United Kingdom.
authors.forename: John
authors.initials: J
authors.lastname: McLuskey
authors.affiliation: University of Nottingham Center for Evidence Based Healthcare: a Collaborating Center of the Joanna Briggs Institute, United Kingdom.
authors.forename: Nicola
authors.initials: N
authors.lastname: Darlington
authors.affiliation: HIV Specialist Services, North Manchester Hospital.
authors.forename: Michelle
authors.initials: M
authors.lastname: Croston
authors.affiliation: University of Nottingham Center for Evidence Based Healthcare: a Collaborating Center of the Joanna Briggs Institute, United Kingdom.
authors.forename: Fiona
authors.initials: F
authors.lastname: Bath-Hextall
mesh_terms: D001291:Attitude of Health Personnel; D003376:Counseling; D003695:Delivery of Health Care / Q000458:organization & administration / Q000592:standards*; D019468:Disease Management; D005260:Female; D015658:HIV Infections / Q000175:diagnosis* / Q000517:prevention & control; D006801:Humans; D009721:Nurse Midwives / Q000523:psychology; D024802:Nurse's Role; D011247:Pregnancy; D024382:Professional Role; D036301:Qualitative Research
keywords: HIV; HIV testing; midwives; nurses; provider initiated