The nursing implications of routine provider-initiated HIV testing and counselling in sub-Saharan Africa: A critical review of new policy guidance from WHO/UNAIDS

Evans, Catrin; Ndirangu, Eunice

doi:10.1016/j.ijnurstu.2008.11.003

Cited by 37 publications

(35 citation statements)

References 51 publications

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“…Proper communication channels between key players in various regions and their central administrations, unclear definition of roles and responsibilities, and ambiguous costing of PSM and distribution are all contributing factors to poor access to testing supplies as well as to antiretroviral therapy (ART). Nurses, as frontline care providers, assume a major role in provider-initiated HIV testing and counselling (PITC), but lack of time, staff, space, and resources, and work demands often operate to deter PITC (Evans & Ndirangu, 2009). In Sub-Saharan Africa, nurses have expressed the need for training and managerial support and health systems reform to promote PITC (Evans & Ndirangu, 2009).…”

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confidence: 99%

“…Nurses, as frontline care providers, assume a major role in provider-initiated HIV testing and counselling (PITC), but lack of time, staff, space, and resources, and work demands often operate to deter PITC (Evans & Ndirangu, 2009). In Sub-Saharan Africa, nurses have expressed the need for training and managerial support and health systems reform to promote PITC (Evans & Ndirangu, 2009). African health care leaders, therefore, require training to better understand the complexities of health care delivery, to strategically plan, implement, and test more efficient and sustainable PSM and distribution mechanisms, and to affect policy reforms to positively influence changes at the point of care (Evans & Ndirangu, 2009; Wheeler, Wolf, Kapesa, Surdo, & Dallabetta, 2015).…”

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confidence: 99%

“…In Sub-Saharan Africa, nurses have expressed the need for training and managerial support and health systems reform to promote PITC (Evans & Ndirangu, 2009). African health care leaders, therefore, require training to better understand the complexities of health care delivery, to strategically plan, implement, and test more efficient and sustainable PSM and distribution mechanisms, and to affect policy reforms to positively influence changes at the point of care (Evans & Ndirangu, 2009; Wheeler, Wolf, Kapesa, Surdo, & Dallabetta, 2015). WHO has emphasized that transforming and scaling up health professions education is dependent on relational activities; interactions between education, health, and other sectors; and embedding training for leaders in health care settings (WHO, 2013).…”

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confidence: 99%

See 2 more Smart Citations

Interprofessional Fellowship Training for Emerging Global Health Leaders in Africa to Improve HIV Prevention and Care: The Afya Bora Consortium

Ousman¹,

Polomano

Seloilwe

et al. 2016

Journal of the Association of Nurses in AIDS Care

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HIV continues to challenge health systems, especially in low- and middle-income countries in Sub-Saharan Africa. A qualified workforce of transformational leaders is required to strengthen health systems and introduce policy reforms to address the barriers to HIV testing, treatment, and other HIV services. The 1-year Afya Bora Consortium Fellowship in Global Health capitalizes on academic partnerships between African and U.S. universities to provide interprofessional leadership training through classroom, online, and service-oriented learning in 5 countries in Africa. This fellowship program prepares health professionals to design, implement, scale-up, evaluate, and lead health programs that are population-based and focused on prevention and control of HIV and other public health issues of greatest importance to African communities and health service settings. Afya Bora nurse fellows acquire leadership attributes and competencies that are continuously and systematically tested during the entire program. This multinational training platform promotes interprofessional networks and career opportunities for nurses.

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confidence: 99%

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confidence: 99%

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confidence: 99%

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Interprofessional Fellowship Training for Emerging Global Health Leaders in Africa to Improve HIV Prevention and Care: The Afya Bora Consortium

Ousman¹,

Polomano

Seloilwe

et al. 2016

Journal of the Association of Nurses in AIDS Care

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“…This hypothesis is supported by the finding that out-patients in this study who enrolled into pre-ART care had lower absolute CD4 counts than VCT patients both before and after the introduction of PITC. Several studies report that operational problems such as increased waiting times are common under PITC (Evans & Ndirangu, 2009;Roura et al, 2013;Topp et al, 2010). This could also have led to lower linkage-to-pre-ART-care after PITC in this study.…”

Section: Discussionmentioning

confidence: 71%

Linkage to HIV care before and after the introduction of provider-initiated testing and counselling in six Rwandan health facilities

Franse

Kayigamba²,

Bakker

et al. 2016

AIDS Care

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“…While this illustrates pragmatic agency in compensating for a lack of clear policy guidance, it also draws attention to the importance of ongoing training and managerial support in the implementation of PITC (Evans & Ndirangu, 2009), along with staff training in ethics. Transparent guidelines are urgently needed to set out viable procedures for HIV counselling and testing in critical care and to provide guidance on proxy consent and disclosure of results.…”

Section: Discussionmentioning

confidence: 96%

HIV testing in the critical care setting: views of patients, family members and health providers from urban South Africa

et al. 2014

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As antiretroviral treatment has led to decreased morbidity, HIV testing policy has increasingly shifted towards routine, provider-initiated approaches. Yet, few studies have examined the acceptability of provider-initiated HIV testing in the intensive, or critical care setting, where knowledge of HIV status is likely to impact on clinical management but explicit consent for testing is difficult to obtain. We conducted qualitative research in an urban hospital and clinic in Johannesburg. In-depth interviews were conducted among HIV testing clients (n = 20), recently discharged critical care patients (n = 13) and family members of critical care patients (n = 14). One focus group discussion was held with health care providers (n = 10). HIV testing in critical care was viewed as acceptable but challenging to implement. An overarching theme of ambivalence emerged from patients and families, who saw HIV testing as a pre-requisite to appropriate clinical care, but were concerned about the quality of its delivery. While providers were aware of the current "no testing without consent" policy, they expressed frustration in cases when testing was in the patient's best interest but consent could not be obtained. Furthermore, providers found it stressful to weigh up patient confidentiality against medical necessity when assessing patients' "best interests". Without specific guidelines, they often developed pragmatic, ad hoc ways to resolve dilemmas around testing in critical care. Our findings suggest that HIV testing guidelines specific to the critical care setting may help providers do their jobs more ethically and transparently. Provider-initiated approaches are likely to be acceptable to patients and may improve clinical outcomes, but training and support in policy implementation and ethical decision-making are essential.

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The nursing implications of routine provider-initiated HIV testing and counselling in sub-Saharan Africa: A critical review of new policy guidance from WHO/UNAIDS

Cited by 37 publications

References 51 publications

Interprofessional Fellowship Training for Emerging Global Health Leaders in Africa to Improve HIV Prevention and Care: The Afya Bora Consortium

Interprofessional Fellowship Training for Emerging Global Health Leaders in Africa to Improve HIV Prevention and Care: The Afya Bora Consortium

Linkage to HIV care before and after the introduction of provider-initiated testing and counselling in six Rwandan health facilities

HIV testing in the critical care setting: views of patients, family members and health providers from urban South Africa

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