Patient and provider attitudes to emergency department-based HIV counselling and testing in South Africa

Abstract

BackgroundThe national South African HIV Counselling and Testing (HCT) guidelines mandate that voluntary counselling and testing (VCT) should be offered in all healthcare facilities. Emergency departments (EDs) are at the forefront of many healthcare facilities, yet VCT is not routinely implemented in this setting.MethodsWe conducted a cross-sectional study that surveyed patients and healthcare providers at a tertiary care ED in the spring and summer of 2016 to ascertain their attitudes to VCT in the ED. We also used two previously validated survey instruments to gather data on patients’ HIV knowledge and providers’ stigma against patients living with HIV, as we anticipated that these may have an impact on providers’ and patients’ attitudes to the provision of HIV testing within the ED, and may offer insights for future intervention development.ResultsA total of 104 patients and 26 providers were enrolled in the study. Overall, patients responded more favourably to ED-based HIV testing (92.3%) compared to providers (only 40% responded favourably). When asked about potential barriers to receiving or providing HIV testing, 16.4% of patients and 24% of providers felt that the subject of HIV was too sensitive and 58.7% of patients and 80% of providers indicated that privacy and confidentiality issues would pose major barriers to implementing ED-based HIV testing.ConclusionThis study shows that while ED-based HIV testing is overall highly acceptable to patients, providers seem less willing to provide this service. The survey data also suggest that future development of ED-based testing strategies should take into consideration privacy and confidentiality concerns that may arise within a busy emergency care setting. Furthermore, every effort should be made to tackle HIV stigma among providers to improve overall attitudes towards HIV-positive individuals that present for care in the ED.

The Impact of HIV Knowledge and Attitudes on HIV Testing Acceptance among Patients in an Emergency Department in the Eastern Cape, South Africa

“…Beliefs around confidentiality in our study are the single most significant modifiable attitude to improve HIV testing uptake. Our study findings are in line with other studies in sub-Saharan Africa and Europe, where the fear of a breach in confidentiality was found to be a major barrier to HIV testing, especially among the youth (7,(30)(31)(32).…”

“…To our knowledge, this is the first study to use a validated instrument to examine the effects of demographics, the LO curriculum, knowledge, and attitudes on HIV testing acceptance in an emergency department setting in South Africa. Studies in South Africa have shown favorable patient responses to ED-based HIV testing (7) and the PICT process has been successful in normalizing the HIV testing process and increasing uptake (11,12). Figure 1…”

“…10.21203/rs.2.12584/v2 South Africa, where stigma and low rates of risk perception were noted as significant barriers to HIV testing (7)(8)(9)(10)(11)(12). Likewise, individuals with more negative attitudes towards HIV were less likely to seek testing (10).…”

“…The questions and answer options were dictated to the patient by HCT staff in English, Afrikaans, or Xhosa, and responses were recorded on electronic tablets. (7). A breakdown of the survey used in this study can be found in Figure 1.…”

HIV testing in a South African Emergency Department: A missed opportunity

“…Documenting an HIV diagnosis in this setting is not thought of as a priority. [ 31 , 40 , 41 ] Our study revealed a high rate of POC test acceptance across the SATS severity grades, indicating that critical illness was not a significant obstacle in practice to patients. Interestingly we also found that patients who reported a known diagnosis of HIV infection requested repeat testing in the ED.…”