title: Lost opportunities to identify and treat HIV-positive patients: results from a baseline assessment of provider-initiated HIV testing and counselling (PITC) in Malawi.
abstract: OBJECTIVE
  To assess implementation of provider-initiated testing and counselling (PITC) for HIV in Malawi.
  
  
  METHODS
  A review of PITC practices within 118 departments in 12 Ministry of Health (MoH) facilities across Malawi was conducted. Information on PITC practices was collected via a health facility survey. Data describing patient visits and HIV tests were abstracted from routinely collected programme data.
  
  
  RESULTS
  Reported PITC practices were highly variable. Most providers practiced symptom-based PITC. Antenatal clinics and maternity wards reported widespread use of routine opt-out PITC. In 2014, there was approximately 1 HIV test for every 15 clinic visits. HIV status was ascertained in 94.3% (5293/5615) of patients at tuberculosis clinics, 92.6% (30,675/33,142) of patients at antenatal clinics and 49.4% (6871/13,914) of patients at sexually transmitted infection clinics. Reported challenges to delivering PITC included test kit shortages (71/71 providers), insufficient physical space (58/71) and inadequate number of HIV counsellors (32/71) while providers from inpatient units cited the inability to test on weekends.
  
  
  CONCLUSIONS
  Various models of PITC currently exist at MoH facilities in Malawi. Only antenatal and maternity clinics demonstrated high rates of routine opt-out PITC. The low ratio of facility visits to HIV tests suggests missed opportunities for HIV testing. However, the high proportion of patients at TB and antenatal clinics with known HIV status suggests that routine PITC is feasible. These results underscore the need to develop clear, standardised PITC policy and protocols, and to address obstacles of limited health commodities, infrastructure and human resources.
authors.affiliation: Baylor College of Medicine Children's Foundation Malawi, Lilongwe, Malawi.|Baylor International Pediatric AIDS Initiative at Texas Children's Hospital, Baylor College of Medicine, Houston, TX, USA.
authors.forename: Saeed
authors.initials: S
authors.lastname: Ahmed
authors.affiliation: University of Utah School of Medicine, Salt Lake City, UT, USA.
authors.forename: Monica
authors.initials: M
authors.lastname: Schwarz
authors.affiliation: Baylor College of Medicine Children's Foundation Malawi, Lilongwe, Malawi.|University of Colorado School of Medicine, Denver, CO, USA.|University of North Carolina Project-Malawi, Lilongwe, Malawi.
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Flick
authors.affiliation: Baylor College of Medicine Children's Foundation Malawi, Lilongwe, Malawi.
authors.forename: Chris A
authors.initials: CA
authors.lastname: Rees
authors.affiliation: Baylor College of Medicine Children's Foundation Malawi, Lilongwe, Malawi.
authors.forename: Mwelura
authors.initials: M
authors.lastname: Harawa
authors.affiliation: Baylor College of Medicine Children's Foundation Malawi, Lilongwe, Malawi.|Baylor International Pediatric AIDS Initiative at Texas Children's Hospital, Baylor College of Medicine, Houston, TX, USA.
authors.forename: Katie
authors.initials: K
authors.lastname: Simon
authors.affiliation: Department of Pediatrics, University of Utah, Salt Lake City, UT, USA.
authors.forename: Jeff A
authors.initials: JA
authors.lastname: Robison
authors.affiliation: Baylor College of Medicine Children's Foundation Malawi, Lilongwe, Malawi.
authors.forename: Peter N
authors.initials: PN
authors.lastname: Kazembe
authors.affiliation: Baylor College of Medicine Children's Foundation Malawi, Lilongwe, Malawi.|Baylor International Pediatric AIDS Initiative at Texas Children's Hospital, Baylor College of Medicine, Houston, TX, USA.
authors.forename: Maria H
authors.initials: MH
authors.lastname: Kim
mesh_terms: D015492:AIDS Serodiagnosis; D000554:Ambulatory Care Facilities; D019380:Anti-HIV Agents / Q000627:therapeutic use; D003376:Counseling; D015658:HIV Infections / Q000175:diagnosis* / Q000188:drug therapy; D006801:Humans; D008295:Malawi; D008403:Mass Screening; D011634:Public Health; D011787:Quality of Health Care
chemical_list: D019380:Anti-HIV Agents
keywords: HIV; HIV testing and counselling; Malawi; VIH; asesoramiento y prueba iniciado por el proveedor; conseil et dépistage du VIH; conseil et dépistage à l'initiative du soignant; consejería y prueba del VIH; provider-initiated testing and counselling; register, PITC; registre; registro