Academic journal article Bulletin of the World Health Organization

Acceptability of Routine HIV Counselling and Testing, and HIV Seroprevalence in Ugandan hospitals/Acceptabilite Du Depistage Systematique et Des Conseils Concernant le VIH/sida et Determination De la Seroprevalence Du VIH Dans Des Hopitaux ougandais/Aceptabilidad del Asesoramiento Y Las Pruebas del VIH Sistematicas Y Seroprevalencia del VIH En Hospitales De Uganda

Academic journal article Bulletin of the World Health Organization

Acceptability of Routine HIV Counselling and Testing, and HIV Seroprevalence in Ugandan hospitals/Acceptabilite Du Depistage Systematique et Des Conseils Concernant le VIH/sida et Determination De la Seroprevalence Du VIH Dans Des Hopitaux ougandais/Aceptabilidad del Asesoramiento Y Las Pruebas del VIH Sistematicas Y Seroprevalencia del VIH En Hospitales De Uganda

Article excerpt

Introduction

Both counselling and testing are key components of HIV prevention and care programmes. (1) Through HIV counselling and testing (HCT), uninfected individuals can take steps to avoid becoming infected, while infected individuals can avoid transmission to sexual partners or children. (2-5) Moreover, HCT is the first step in referral to care and support services. (6,7) It has also become important for preventing mother-to-child transmission and increasing access to HIV/AIDS care, including antiretroviral therapy (ART). (8,9) Even with limited availability of ART, early diagnosis of HIV and access to basic preventive care, including co-trimoxazole, can slow progression to AIDS. (10,11) Providing HCT for family members of HIV-positive patients can identify other HIV-infected individuals in their households, facilitate partner disclosure and testing, identify HIV-discordant couples, and support care and medication adherence in HIV-infected individuals. (12) Worldwide, it is estimated that over 90% of HIV-infected individuals are still unaware of their status. (13-15) In Uganda, 15% of the general population has received HCT, while more than 70% would like to be tested. (16)

Hospitals in high-prevalence settings are crowded with HIV/AIDS patients, (17-19) though the majority only learn about their infection late in the disease course, if ever. (20-24) A survey at Mulago hospital in Uganda found that half of medical inpatients with HIV-related diagnoses left hospital without HCT. (25)

It has been proposed that offering HCT routinely in health-care settings will increase access to tare. (6,7,13,17) Routine HCT is initiated by healthcare providers and offers testing to all patients irrespective of their presenting illness. This approach differs from voluntary counselling and testing, which is client-initiated. The guidelines on provider-initiated HCT at health-care facilities, released by WHO in May 2007, recommend that testing should be part of standard medical care for all patients during widespread HIV epidemics. (26) The United States Centers for Disease Control and Prevention (CDC) also revised HCT guidelines to recommend routine screening for HIV infection in health-care settings for individuals aged 13-64 years. (27) When Botswana introduced routine opt-out HCT, HIV testing and interventions to prevent mother-to-child transmission both increased. (28) The revised Ugandan HCT policy recommends routine HCT in health-care facilities, including antenatal clinics. (29)

We implemented routine HCT at Mulago and Mbarara Hospitals in Uganda, assessed testing uptake, and estimated HIV seroprevalence among patients and their family members.

Methods

Setting

Mulago and Mbarara Hospitals are the largest, tertiary, public, university teaching hospitals in Uganda. Mulago hospital has more than 600 000 patient-visits per year while Mbarara hospital serves over 100 000 patients annually. Although outpatient HIV clinics have been operational since 1987 in Mulago and since 1998 in Mbarara, the services offered were limited. Until recently, HCT was provided for patients only on request and when they were able to pay the fee of 5000 Ugandan shillings (US$ 3). A survey in July 2003 revealed that 67% of medical inpatients at Mulago had never been tested for HIV and only 20% had been tested during hospitalization, although 64% wanted to be tested. (24)

HCT programme

The Mulago and Mbarara routine HCT programme was established in November 2004. Coverage had expanded from four to 25 wards or clinics (16 in Mulago and nine in Mbarara) by February 2006; this represents 31% of the wards and clinics in Mulago and 50% of those in Mbarara. Units that were thought to have patient populations in which there was a high HIV prevalence were prioritized. The units offering routine HCT included four medical wards, four obstetrics and gynaecology wards, two sexually transmitted disease (STD) outpatient clinics, two dermatology outpatient clinics, five paediatric inpatient wards, two cancer inpatient wards, one tuberculosis ward and two medical emergency outpatient units. …

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