Task-Shifting and Quality of HIV Testing Services: Experiences from a National Reference Hospital in Zambia

Abstract

BackgroundWith new testing technologies, task-shifting and rapid scale-up of HIV testing services in high HIV prevalence countries, assuring quality of HIV testing is paramount. This study aimed to explore various cadres of providers’ experiences in providing HIV testing services and their understanding of elements that impact on quality of service in Zambia.MethodsSixteen in-depth interviews and two focus group discussions were conducted with HIV testing service providers including lay counselors, nurses and laboratory personnel at purposively selected HIV testing sites at a national reference hospital in Lusaka. Qualitative content analysis was adopted for data analysis.ResultsLay counselors and nurses reported confidentiality and privacy to be greatly compromised due to limited space in both in- and out-patient settings. Difficulties in upholding consent were reported in provider-initiated testing in in-patient settings. The providers identified non-adherence to testing procedures, high workload and inadequate training and supervision as key elements impacting on quality of testing. Difficulties related to testing varied by sub-groups of providers: lay counselors, in finger pricking and obtaining adequate volumes of specimen; non-laboratory providers in general, in interpreting invalid, false-negative and false-positive results. The providers had been participating in a recently established national HIV quality assurance program, i.e. proficiency testing, but rarely received site supervisory visits.ConclusionTask-shifting coupled with policy shifts in service provision has seriously challenged HIV testing quality, protection of confidentiality and the process of informed consent. Ways to better protect confidentiality and informed consent need careful attention. Training, supervision and quality assurance need strengthening tailored to the needs of the different cadres of providers.

Challenges in the delivery of public HIV testing and counselling (HTC) in Douala, Cameroon: providers perspectives and implications on quality of HTC services

“…The WHO has identified five key elements to be respected and observed by all HTC services: consent, confidentiality, counselling, correct test results and connection (linkage to prevention, care and treatment) [7, 27]. For that purpose, a regular assessment of counselling and testing services is needed to ensure compliance with the standards recommended by the WHO [3, 7, 27].…”

“…For that purpose, a regular assessment of counselling and testing services is needed to ensure compliance with the standards recommended by the WHO [3, 7, 27]. This study aimed to identify factors that influence the quality of HIV counselling and testing services in district hospitals of the city of Douala in Cameroon using the Donabedian’s structure-process-outcome framework.…”

“…However, in the absence of a specific curriculum and national training standards, the counsellors’ training varied in duration and content, depending on the training organization and there is also a variation of training among lay counsellors in the same health facility. This situation calls into question the quality of the training and the counselling [7, 8]. …”

“…In the HIV testing and counselling services, the lay counsellors help to reduce the workload of health workers and allow them to focus on other aspects of clinical care [7–9, 49]. The contribution of this specialized staff has increased HIV testing and counselling rates in many sub-Saharan Africa’s countries [7–9, 49].…”

“…However, this expansion might affect quality of HTC services in different ways [6]. For example, in many studies conducted in sub-Saharan Africa, providers reported lack of confidentiality and privacy due to limited space, difficulties in upholding consent in provider-initiated testing, high workload, inadequate training and supervision as key elements impacting on quality of counselling and testing [7–10]. …”