Enablers and barriers to implementation of provider initiated HIV testing and counselling for hospitalized patients in Kasese District, Uganda

Abstract

The World Health Organization (WHO) recommends Provider-Initiated Testing and Counselling (PITC) in order to increase early diagnosis and intervention. Studies indicate that in low resource-settings like Uganda, HIV positive severely ill hospitalised patients are three times more likely to die during hospitalization. However, implementation of PITC remains under-utilized. This study sought to explore the enablers and barriers of PITC implementation for severely ill hospitalised patients in three hospitals in Western Uganda. The study adopted qualitative approaches. Purposive sampling was used to select a sample of 20 participants. Fifteen semi-structured in-depth interviews were conducted on nurses, lay counsellors, clinicians and lab personnel. Five key informants’ interviews were conducted on hospital managers, exploring the resources, provider knowledge, skills and attitudes towards PITC as well as patient factors. Interviews were audio recorded and transcribed in English and then analysed using atlas-ti. Findings show concerns over inadequate human resources to offer PITC, heavy workload, limited space for counselling and intermittent supply of HIV testing kits and other supplies. Providers expressed concerns over inadequate knowledge and skills about PITC and HIV Counselling. Concerns were also expressed over challenges in maintaining confidentiality. Low understanding of PITC benefits by patients and caretakers results in refusal to undertake HIV testing. Training and re-training of healthcare providers PITC guidelines, increasing infrastructural and logistical resources and improving online stock requisitioning were identified some of the important enablers to implementation of PITC. Despite WHO recommendations of HIV testing for hospitalised patients and Ministry of Health legislation to offer PITC for all patients, full implementation of this policy remains a challenge. Concerns over availability of resources, capacity and stigma still persist. This study recommends that structural and human resource gaps need to be addressed. HCT should be adopted and a seventh vital sign to reduce missed opportunities for testing.