Background
Methods
Selection of study sites
Data collection
Qualitative data collection and analysis
Ethical approval
Results
Assessment of implementation activities and institutional capacity to provide PITC
Domain | Number in Central Hosp (2) | Number in Provincial Hosp (2) | Number in District Hosp (6) | Number in Clinic (6) | Total (16) |
---|---|---|---|---|---|
Staff skills/responsibilities | |||||
Availability of job descriptions for staff delivering HTC services | |||||
Yes | 1 | 2 | 3 | 2 | 8 |
No | 1 | 0 | 2 | 4 | 7 |
Availability of standard operating procedures for upholding confidentiality and informed consent | |||||
Yes | 2 | 2 | 5 | 2 | 11 |
No | 0 | 0 | 1 | 4 | 5 |
Interviewer’s opinion on commitment and level of interest of leadership in HTC programme | |||||
Highly committed | 2 | 2 | 5 | 6 | 15 |
Moderately Committed | 0 | 0 | 1 | 0 | 1 |
Not committed | 0 | 0 | 0 | 0 | 0 |
Adequacy of facilities
| |||||
Adequate space for confidential counselling | |||||
Yes | 2 | 0 | 0 | 1 | 3 |
No | 0 | 2 | 6 | 4 | 12 |
Adequate of space for confidential HIV testing | |||||
Yes | 2 | 1 | 4 | 3 | 10 |
No | 0 | 1 | 2 | 2 | 5 |
Availability of secure storage facilities | |||||
Yes | 2 | 2 | 5 | 3 | 12 |
No | 0 | 0 | 1 | 3 | 4 |
Implementation activities
| |||||
Number of days per week HTC services available | |||||
5 days | 1 | 1 | 2 | 2 | 6 |
7 days | 1 | 1 | 4 | 3 | 9 |
Provision of outreach activities | |||||
Yes | 0 | 1 | 4 | 0 | 5 |
No | 2 | 1 | 1 | 6 | 10 |
Availability of male condoms | |||||
At time of visit | 2 | 2 | 6 | 5 | 15 |
Always available | 2 | 2 | 6 | 4 | 14 |
Not always available | 0 | 0 | 1 | 1 | |
Availability of female condoms | |||||
At time of visit | 2 | 2 | 6 | 4 | 14 |
Always available | 1 | 2 | 3 | 4 | 10 |
Not always available | 1 | 0 | 2 | 1 | 3 |
Provision of cotrimoxazole prophylaxis | |||||
Yes | 2 | 2 | 6 | 5 | 15 |
No | 0 | 0 | 0 | 0 | 0 |
Provision of fluconazole prophylaxis | |||||
Yes | 2 | 2 | 6 | 1 | 11 |
No | 0 | 0 | 0 | 4 | 4 |
Provision of ART | |||||
Yes | 2 | 2 | 6 | 5 | 15 |
No | 0 | 0 | 0 | 1 | 1 |
Provision of PITC for TB patients | |||||
Yes | 2 | 2 | 6 | 4 | 14 |
No | 0 | 0 | 0 | 1 | 1 |
TB screening for HIV positive patients | |||||
Yes | 2 | 1 | 4 | 3 | 10 |
No | 0 | 1 | 2 | 2 | 5 |
Provision of TB treatment | |||||
Yes | 2 | 2 | 6 | 4 | 14 |
No | 0 | 0 | 0 | 1 | 1 |
Availability of PEP guidelines | |||||
Yes | 2 | 2 | 6 | 4 | 14 |
No | 0 | 0 | 0 | 1 | 1 |
Primary Counsellor Evaluation
| |||||
Availability of Primary Counsellors | |||||
Yes | 2 | 2 | 6 | 5 | 15 |
No | 0 | 0 | 0 | 1 | 1 |
Who pays Primary Counsellor monthly allowances | |||||
Global Fund | 1 | 1 | 5 | 7 | |
Expanded Support Program (ESP) | 1 | 1 | 2 | ||
Government | 1 | 1 | 2 | ||
Local Authority | 2 | 2 | |||
Support and Supervision from higher level
| |||||
Did staff from the higher levels visit the site to supervise data collection and management during the past three months? | |||||
Yes | 0 | 2 | 6 | 2 | 10 |
No | 1 | 0 | 0 | 3 | 4 |
Staff Skills and responsibilities
Adequacy of facilities
Stock levels
Implementation activities
Patient views on PITC
Characteristic | N |
---|---|
Sex | |
Male | 5 |
Female | 31 |
Age (years) | |
20- | 4 |
21-25 | 10 |
26-30 | 8 |
31-35 | 6 |
36-40 | 1 |
41-45 | 3 |
46-50 | 0 |
>50 | 4 |
Reason for Clinic Visit | |
Primary Care | 12 |
Antenatal Care | 13 |
In-patient | 2 |
VCT | 4 |
Other | 5 |
Facility attended | |
Central Hospital | 4 |
Provincial Hospital | 4 |
District Hospital | 18 |
Clinic | 10 |
HIV status | |
Positive | 12 |
Negative | 20 |
Awareness of the existence of PITC
" “They said you should come (for HIV testing) on Mondays, Wednesdays and Fridays…” (42-year old woman whose purpose of visit was VCT)."
Patient/Client Perceptions of PITC
" “It (PITC) is good because if you have HIV you know that you will then take tablets and live a longer life. If you have a family then you will take care of them.” (27 year old woman whose purpose of visit was VCT)"
" “…One will never be able to volunteer unless someone tells them to get tested; they are scared that maybe they will be found to be infected.” (23 year old woman who had come for antenatal care)"
" “I am one of those who said we will see to it (HIV testing) when we fall sick…I actually told myself I wouldn’t be able to handle it…I would commit suicide.” (33-year old woman who had come for ANC)"
" “Since last year I have wanted to get tested but didn’t know where to go…” (56 year old woman who was seeking primary care)"
Quality of service provided
“…they properly teach us so that we understand. They don’t get cross with us, no, they talk to us nicely; we are free and they are also free.” (42 year old woman who had come for VCT)
" “I thought that (if I refused) they would say so how do you want us to treat you.” "
" “… we didn’t know where to go if you want to get tested. We kept asking (for directions) .” (27-year old woman who had come for VCT)"
" “They will go about saying that woman said this and that.” (34-year old woman who had come for ANC)"
Participant’s awareness of post-test support services
Feelings about testing decision
" “I am happy that although I was found to have the disease I know that I will get a lot of help.” (29-year old woman who was seeking primary care)"" Right now I feel happy because when you have been told you have it (HIV) you now have the knowledge that if I fall sick I will go to the hospital where I will get help. If I had been sitting at home and I got sick I might have wasted time visiting (traditional healers) a n’anga, or a prophet… (30 year old woman who had come for VCT)."
Health Care Worker (HCW) views on PITC
HCW views of what had worked in the PITC programme
i) Reduction in illness and death
" “I am happy because they (patients) are coming while they are still able to move unaided.” (Female registered nurse (midwife), primary care clinic)"" “Yes, HIV testing is also good because I’ve noticed that the number of people who are being admitted in the wards, it’s now different from long ago like 2005, 2006 where there was no ART and cotrimoxazole. Bed-ridden patients are very few now… .” (Female nurse, District Hospital)"" “When there are less deaths the job is more interesting.” (Female registered nurse, District Hospital)"
ii) Increased patient confidence in health care system
" “And the other benefit I realise with PITC is the patients have more confidence in the health system. Like the patient will come today with a cough, you treat them. Suppose there was no PITC? They’ll come today with a cough. You treat them. They go. They come the next time with an abscess…” (Female registered nurse, primary care clinic)"
iii) Reduced stigma
" “…They will come, even when there are 15 or so people around and ask you, “XX, I want to come and collect my cotrimoxazole. Is it now available?”” ( Male nurse, primary care clinic)"
iv) Reduction in mother-to-child transmission of HIV
" … “I’m finding that among those mothers who went on this programme and they were Code 1 (HIV positive), all their babies are negative!” (Female registered nurse, central hospital)."
Challenges in scaling up PITC
i) Inadequate space
ii) Shortages of trained staff
" “They say you have had some whatever, HIV/AIDS… what, what workshops and the like and we haven’t attended. So since you have attended, just go and do it yourself” (Female nurse, district hospital)"" “They also argue that you are paid during your training. You got the T&S (the travel and subsistence allowances) , you were paid for it so do it yourself.” (Male nurse, another district hospital)"
iii) Shortages of HIV test kits
iv) Availability of CD-4 count machines
" “…you also become frustrated as the nurse because you have encouraged this patient to test and this patient now wants a CD4 count…but they can’t access it…” (Male registered nurse, primary care clinic)"
Effect of PITC on workload
" “Surely the workload has increased, but on the other hand, it has dramatically been reduced. They take their drugs and they improve. Their health improves. So, the time they spend at the hospital, it’s now limited….” (Male nurse, District Hospital)"