Routine HIV testing in the context of syndromic management of sexually transmitted infections: Outcomes of the first phase of a training programme in Botswana

Department of Health Services, University of Washington, 901 Boren, Seattle, WA 98104, USA.
Sexually transmitted infections (Impact Factor: 3.4). 02/2008; 84(4):259-64. DOI: 10.1136/sti.2007.028217
Source: PubMed


In 2004, the Ministry of Health adopted revised protocols for the syndromic management of sexually transmitted infections (STI) that included routine HIV testing. A training programme for providers was developed on the revised protocols that featured interactive case studies and training videos. An objective of the first phase of the training programme was to test its effect on four measures of clinical practice: (1) routine HIV testing; (2) performance of physical examination; (3) risk-reduction counselling and (4) patient education.
Clinical practice in a district where providers were trained was compared with a district without training. The measures of clinical practice were reported by 185 patients of providers who had been trained and compared with reports by 124 patients at comparison clinics.
Relative to patients at comparison clinics, a higher percentage of patients of trainees reported that the provider: (1) offered an HIV test (87% versus 29%; p<0.001); (2) conducted a physical examination (98% versus 64%; p<0.001); (3) helped them to make a plan to avoid future STI acquisition (95% versus 76%; p<0.001) and (4) provided patient-specific information about HIV risk (65% versus 32%; p<0.001). Among patients offered HIV testing, the percentage who accepted did not differ between groups (38% of 161 patients of trainees versus 50% of 36 comparison patients; p = 0.260). Overall, 33% of patients of trainees and 14% of comparison patients were tested (p<0.001).
A multifaceted training programme was associated with higher rates of HIV testing, physical examination, risk-reduction counselling and better HIV risk education.

Download full-text


Available from: Marcia R Weaver,
  • Source
    • "Video is currently used as an education tool in the health field in numerous facets: in preventive health measures [2], [3], [4], [5]; to teach medical students and practitioners new procedures [6], [7], [8], [9]; to demonstrate interventions [10], [11]; to improve counseling skills [12], [13], [14]; and to deliver health information to the patient [15], [16]. A review of the literature identified one article that addressed the influence of demonstration videos on the students' perspective on the counseling profession [17]. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Interest in integrative health care is a growing area of health practice, combining conventional medical treatments with safe and effective complementary and alternative medicine. These modalities relate to both improving physical and psychological well-being, and enhancing conventional talk therapy. In an interdisciplinary collaboration, teaching and library faculty have created a series of sixteen on-line video interviews that introduce practitioner-relevant experiences to students as supplemental course material. These videos are available through the department web-pages to students in other related disciplines as well, including Social Work, Counselor Education, Psychology, and the Colleges of Public Health, Nursing, and Medicine. The video series was undertaken as part of the educational mission of the library, bringing to the classroom new material that is essential to the professional development of future counselors.
  • Source
    • "The evidence for PITC with STI patients is limited to a few quasi-experimental studies in the UK and the Netherlands [20,21,25,26], and one controlled trial in Sub-Saharan Africa [27]. The European trials report significant increases in HIV testing for STI patients, although a recent UK study with low-risk STI patients showed that there was a significant increase in the offer of testing, not in the proportion of patients who accepted testing [28]. "
    [Show abstract] [Hide abstract]
    ABSTRACT: The effectiveness of provider-initiated HIV testing and counseling (PITC) for patients with sexually transmitted infection (STI) in resource-constrained settings are of particular concern for high HIV prevalence countries like South Africa. This study evaluated whether the PITC approach increased HIV testing amongst patients with a new episode of sexually transmitted infection, as compared to standard voluntary counseling and testing (VCT) at the primary care level in South Africa, a high prevalence and low resource setting. The design was a pragmatic cluster-controlled trial with seven intervention and 14 control clinics in Cape Town. Nurses in intervention clinics integrated PITC into standard HIV care with few additional resources, whilst lay counselors continued with the VCT approach in control clinics. Routine data were collected for a six-month period following the intervention in 2007, on new STI patients who were offered and who accepted HIV testing. The main outcome measure was the proportion of new STI patients tested for HIV, with secondary outcomes being the proportions who were offered and who declined the HIV test. A significantly higher proportion of new STI patients in the intervention group tested for HIV as compared to the control group with (56.4% intervention versus 42.6% control, p = 0.037). This increase was achieved despite a significantly higher proportion intervention group declining testing when offered (26.7% intervention versus 13.5% control, p = 0.0086). Patients were more likely to be offered HIV testing in intervention clinics, where providers offered the HIV test to 76.8% of new STI patients versus 50.9% in the control group (p = 0.0029). There was significantly less variation in the main outcomes across the intervention clinics, suggesting that the intervention also facilitated more consistent performance. PITC was successful in three ways: it increased the proportion of new STI patients tested for HIV; it increased the proportion of new STI patients offered HIV testing; and it delivered more consistent performance across clinics. Recommendations are made for increasing the impact and feasibility of PITC in high HIV prevalence and resource-constrained settings. These include more flexible use of clinical and lay staff, and combining PITC with VCT and other community-based approaches to HIV testing. Controlled trial ISRCTN93692532.
    Implementation Science 01/2010; 5(1):8. DOI:10.1186/1748-5908-5-8 · 4.12 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Providers (PITC) are a routine offered to adult clients attending at facilities. Tanzania PITC started in 2007, with the aim of increasing early diagnosis timely access to treatment support services. The objective of this study was to assess the level providers on PITC. This cross sectional study was conducted in April-May 2010 among nurse's clinicians working the government facilities Tanzania. Self-administered questionnaire was used to obtain relevant information from the study participants. A total of 402 (95% response rate) providers were interviewed. Their mean (± SD) age was 41 ± 9.5 years. The majority 304 (76%) were nurses. Their duration ranged from 4 months to 39 years. All the providers reported to be aware of PITC services. However, 35% of them had inadequate PITC. 269 (67%) reported to have ever offered PITC services. Median number of clients attended per week was 3 (IQR, 1-6 clients). Participants who had attended special training on PITC were 6-fold more likely to offer PITC services [OR = 6.2, 95% CI = 3.7-10.2; P<0.001] than those who had not attended. In conclusion more than one-third o providers do not routinely offer PITC leading to missed opportunity for early diagnosis. On job-service training to improve PITC supportive supervision for those trained is required.
    Tanzania journal of health research 10/2011; 13(4-4). DOI:10.4314/thrb.v13i4.62990
Show more