Availability and acceptability of HIV counselling and testing services. A qualitative study comparing clients’ experiences of accessing HIV testing at public sector primary health care facilities or non-governmental mobile services in Cape Town, South Africa

Abstract

BackgroundThe South African government is striving for universal access to HIV counselling and testing (HCT), a fundamental component of HIV care and prevention. In the Cape Town district, Western Cape Province of South Africa, HCT is provided free of charge at publically funded primary health care (PHC) facilities and through non-governmental organizations (NGOs). This study investigated the availability and accessibility of HCT services; comparing health seeking behaviour and client experiences of HCT across public PHC facilities (fixed sites) and NGO mobile services.MethodsThis qualitative study used semi-structured interviews. Systematic sampling was used to select 16 participants who accessed HCT in either a PHC facility (8) or a NGO mobile service (8). Interviews, conducted between March and June 2011, were digitally recorded, transcribed and where required, translated into English. Constant comparative and thematic analysis was used to identify common and divergent responses and themes in relation to the key questions (reasons for testing, choice of service provider and experience of HCT).ResultsThe sample consisted of 12 females and 4 males with an age range of 19–60 years (median age 28 years). Motivations for accessing health facilities and NGO services were similar; opportunity to test, being affected by HIV and a perceived personal risk for contracting HIV. Participants chose a particular service provider based on accessibility, familiarity with and acceptability of that service. Experiences of both services were largely positive, though instances of poor staff attitude and long waiting times were reported at PHC facilities. Those attending NGO services reported shorter waiting times and overall positive testing experiences. Concerns about lack of adequate privacy and associated stigma were expressed about both services.ConclusionsRealised access to HCT is dependent on availability and acceptability of HCT services. Those who utilised either a NGO mobile service or a public PHC facility perceived both service types as available and acceptable. Mobile NGO services provided an accessible opportunity for those who would otherwise not have tested at that time. Policy makers should consider the perceptions and experiences of those accessing HCT services when increasing access to HCT.

Access to human immunodeficiency virus testing services in Cape Town, South Africa: a user perspective

“…This highlights the close proximity of the HTS to the user. This finding is in agreement with previous studies showing that mobile services are conveniently situated in communities, 14 providing users with the immediate opportunity to test, 13 and that physical proximity of health care is no longer a problem for reaching public facilities. 19 Findings may be different in rural settings, where the service may be further from the user.…”

“…Our findings nevertheless replicate findings in previous studies: high levels of patient acceptability were reported for mobile HTS, 14 and mobile HTS were found more acceptable than HTS at public facilities in terms of waiting times, cleanliness and perceived friendliness of staff. 13 Our study showed that although user satisfaction at the public facility was high, satisfaction levels were more widely distributed than at mobile and stand-alone modalities.…”

“…8 Access to HTS is broader than mere utilisation of the service; 9 it is dependent on three conceptually different dimensions: 10 availability (the extent to which HTS are geographically accessible), affordability (the cost of the HTS in relation to the user's ability to pay) and acceptability (self-perceived quality of the HTS). 11 Some studies have linked utilisation to the availability of services 12 and determined the availability and acceptability of HTS at public health care facilities 13 and mobile services. 14,15 An improved understanding of access, including availability, affordability and acceptability, to public and private (NGO) HTS modalities from the user's perspective can inform policy and potentially lead to increased numbers of people becoming aware of their HIV-positive status.…”

Knowledge, perception, access and utilisation of HIV counselling and testing among pregnant women in rural communities of Osogbo town, Nigeria

“…Fotso et al . and Meehan et al . submitted that it is not only enough to increase the availability of health services, but also make such services available to poor at affordable cost.…”

An ecological study of socioeconomic predictors in detection of COVID-19 cases across neighborhoods in New York City

“…Queens, and Staten Island); Fig 1B displays these cases on a map as a percentage of 49 total ZCTA population. 50…”