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No completing interests have been declared by the authors.
ELS participated in the design of the study, collection of data, conducted data analysis and helped draft the manuscript. KH participated in the design of the study, interpretation of findings and helped draft the manuscript. OM, GN BD, and LM conceived the study and facilitated its design and coordination, helped in the interpretation of findings and commented on the manuscript. PS participated in the design of the study, collection of data, qualitative data analysis and commented on the manuscript. AM participated in the design of the study, helped in the coordination of study activities and commented on the manuscript. GB participated in the design of the study and facilitated its coordination. FMC participated in the design of the study, supervised the research team, was involved in interpretation of study findings and helped draft the manuscript. All authors approved the final submitted version.
Provider-initiated HIV testing and counselling (PITC) is widely recommended to ensure timely treatment of HIV. The Zimbabwe Ministry of Health introduced PITC in 2007. We aimed to evaluate institutional capacity to implement PITC and investigate patient and health care worker (HCW) perceptions of the PITC programme.
Purposive selection of health care institutions was conducted among those providing PITC. Study procedures included 1) assessment of implementation procedures and institutional capacity using a semi-structured questionnaire; 2) in-depth interviews with patients who had been offered HIV testing to explore perceptions of PITC, 3) Focus group discussions with HCW to explore views on PITC. Qualitative data was analysed according to Framework Analysis.
Sixteen health care institutions were selected (two central, two provincial, six district hospitals; and six primary care clinics). All institutions at least offered PITC in part. The main challenges which prevented optimum implementation were shortages of staff trained in PITC, HIV rapid testing and counselling; shortages of appropriate counselling space, and, at the time of assessment, shortages of HIV test kits. Both health care workers and patients embraced PITC because they had noticed that it had saved lives through early detection and treatment of HIV. Although health care workers reported an increase in workload as a result of PITC, they felt this was offset by the reduced number of HIV-related admissions and satisfaction of working with healthier clients.
PITC has been embraced by patients and health care workers as a life-saving intervention. There is need to address shortages in material, human and structural resources to ensure optimum implementation.