AUB ScholarWorks

Associations between Mode of HIV Testing and Consent, Confidentiality, and Referral: A Comparative Analysis in Four African Countries

Show simple item record Obermeyer C.M. Neuman M. Desclaux A. Wanyenze R. Ky-Zerbo O. Cherutich P. Namakhoma I. Hardon A.
dc.contributor.editor 2012 2017-10-18T13:30:54Z 2017-10-18T13:30:54Z 2012
dc.identifier 10.1371/journal.pmed.1001329
dc.identifier.issn 15491277
dc.description.abstract Background: Recommendations about scaling up HIV testing and counseling highlight the need to provide key services and to protect clients' rights, but it is unclear to what extent different modes of testing differ in this respect. This paper examines whether practices regarding consent, confidentiality, and referral vary depending on whether testing is provided through voluntary counseling and testing (VCT) or provider-initiated testing. Methods and Findings: The MATCH (Multi-Country African Testing and Counseling for HIV) study was carried out in Burkina Faso, Kenya, Malawi, and Uganda. Surveys were conducted at selected facilities. We defined eight outcome measures related to pre- and post-test counseling, consent, confidentiality, satisfactory interactions with providers, and (for HIV-positive respondents) referral for care. These were compared across three types of facilities: integrated facilities, where testing is provided along with medical care; stand-alone VCT facilities; and prevention of mother-to-child transmission (PMTCT) facilities, where testing is part of PMTCT services. Tests of bivariate associations and modified Poisson regression were used to assess significance and estimate the unadjusted and adjusted associations between modes of testing and outcome measures. In total, 2,116 respondents tested in 2007 or later reported on their testing experience. High percentages of clients across countries and modes of testing reported receiving recommended services and being satisfied. In the unadjusted analyses, integrated testers were less likely to meet with a counselor before testing (83percent compared with 95percent of VCT testers; p0.001), but those who had a pre-test meeting were more likely to have completed consent procedures (89percent compared with 83percent among VCT testers; p0.001) and pre-test counseling (78percent compared with 73percent among VCT testers; p = 0.015). Both integrated and PMTCT testers were more likely to receive complete post-test counseling than were VCT testers (59percent among both PMTCT and integrated testers compared with 36percent among VCT testers; p0.001). Adjusted analyses by country show few significant differences by mode of testing: only lower satisfaction among integrated testers in Burkina Faso and Uganda, and lower frequency of referral among PMTCT testers in Malawi. Adjusted analyses of pooled data across countries show a higher likelihood of pre-test meeting for those testing at VCT facilities (adjusted prevalence ratio: 1.22, 95percent CI: 1.07-1.38) and higher satisfaction for stand-alone VCT facilities (adjusted prevalence ratio: 1.15; 95percent CI: 1.06-1.25), compared to integrated testing, but no other associations were statistically significant. Conclusions: Overall, in this study most respondents reported favorable outcomes for consent, confidentiality, and referral. Provider-initiated ways of delivering testing and counseling do not appear to be associated with less favorable outcomes for clients than traditional, client-initiated VCT, suggesting that testing can be scaled up through multiple modes without detriment to clients' rights. Please see later in the article for the Editors' Summary. Obermeyer et al.
dc.language English
dc.publisher SAN FRANCISCO
dc.relation.ispartof Publication Name: PLoS Medicine; Publication Year: 2012; Volume: 9; no. 10;
dc.source Scopus
dc.title Associations between Mode of HIV Testing and Consent, Confidentiality, and Referral: A Comparative Analysis in Four African Countries
dc.type Article
dc.contributor.affiliation Obermeyer, C.M., Center for Research on Population and Health, American University of Beirut, Beirut, Lebanon
dc.contributor.affiliation Neuman, M., Harvard School of Public Health, Boston, MA, United States
dc.contributor.affiliation Desclaux, A., Institut de Recherche pour le Développement, Dakar, Senegal
dc.contributor.affiliation Wanyenze, R., Makerere University School of Public Health, Kampala, Uganda
dc.contributor.affiliation Ky-Zerbo, O., Programme d'Appui au Monde Associatif et Communautaire, Ouagadougou, Burkina Faso
dc.contributor.affiliation Cherutich, P., National AIDS-STD Control Program, Ministry of Health, Nairobi, Kenya
dc.contributor.affiliation Namakhoma, I., REACH Trust, Lilongwe, Malawi
dc.contributor.affiliation Hardon, A., Anthropology of Care and Health, University of Amsterdam, Amsterdam, Netherlands
dc.contributor.authorAddress Obermeyer, C. M.; Center for Research on Population and Health, American University of Beirut, Beirut, Lebanon; email:
dc.contributor.authorCorporate University: American University of Beirut; Faculty: Faculty of Health Sciences; Department: Center for Research on Population and Health;
dc.contributor.authorDepartment Center for Research on Population and Health
dc.contributor.faculty Faculty of Health Sciences
dc.contributor.authorInitials Obermeyer, CM
dc.contributor.authorInitials Neuman, M
dc.contributor.authorInitials Desclaux, A
dc.contributor.authorInitials Wanyenze, R
dc.contributor.authorInitials Ky-Zerbo, O
dc.contributor.authorInitials Cherutich, P
dc.contributor.authorInitials Namakhoma, I
dc.contributor.authorInitials Hardon, A
dc.contributor.authorReprintAddress Obermeyer, CM (reprint author), Amer Univ Beirut, Ctr Res Populat and Hlth, Beirut, Lebanon.
dc.contributor.authorUniversity American University of Beirut
dc.description.cited Angotti N., 2010, HLTH POLICY PLAN, V26, P307; Bayer R, 2006, NEW ENGL J MED, V355, P647, DOI 10.1056-NEJMp068153; Bayer R, 2009, J HEALTH POLIT POLIC, V34, P301, DOI 10.1215-03616878-2009-002; Becker Joseph, 2009, Pan Afr Med J, V3, P4; Benjamini Y, 2006, BIOMETRIKA, V93, P491, DOI 10.1093-biomet-93.3.491; Centers for Disease Control and Prevention (U. S.), 2006, MMWR-MORBID MORTAL W, V55, P1; Cockcroft A, 2007, BMC INT HEALTH HUM R, V87, P5; Cohan D, 2009, PLOS ONE, V4, DOI 10.1371-journal.pone.0005166; Corneli A, 2008, Int J Tuberc Lung Dis, V12, P79; Csete J., 2006, HIV AIDS POLICY LAW, V11, P5; Csete Joanne, 2006, HIV AIDS Policy Law Rev, V11, P5; De Cock KM, 2006, NEW ENGL J MED, V354, P440, DOI 10.1056-NEJMp058327; Filmer D, 2001, DEMOGRAPHY, V38, P115, DOI 10.2307-3088292; Groves AK, 2010, AIDS CARE, V22, P538, DOI 10.1080-09540120903311508; Gruskin S, 2008, DEV WORLD BIOETH, V8, P23, DOI 10.1111-j.1471-8847.2007.00222.x; Institut National de la Statistique et de la Demographie, 2003, ENQ DEM SANT BURK FA; Joint United Nations Programme on HIV-AIDS World Health Organization, 2004, UNAIDS WHO POL STAT; Jurgens R, 2007, INCREASING ACCESS HI; Kabbash I. A., 2010, Eastern Mediterranean Health Journal, V16, P481; Kenya Central Bureau of Statistics Kenya Ministry of Health Kenya Medical Research Institute Kenya National Council for Population and Development ORC Macro Kenya Centers for Disease Control and Prevention, 2004, KEN DEM HLTH SURV 20; Leon N, 2010, IMPLEMENT SCI, V5, DOI 10.1186-1748-5908-5-8; Malawi National Statistical Office and ORC Macro, 2005, MAL DEM HLTH SURV 20; McQuoid-Mason D, 2007, SAMJ S AFR MED J, V97, P416; Newson R., 2003, STATA J, V3, P109; Bahati P. N., 2010, AIDS Care, V22, P119; Nieburg P, 2005, EXPANDED HIV TESTING; Njeru MK, 2011, BMC HEALTH SERV RES, V11, DOI 10.1186-1472-6963-11-87; Paxton S, 2005, AIDS CARE, V17, P413, DOI 10.1080-09540120412331299807; Perez F, 2006, JAIDS-J ACQ IMM DEF, V41, P514, DOI 10.1097-01.qai.0000191285.70331.a0; Podhurst LS, 2009, AIDS PATIENT CARE ST, V23, P331, DOI 10.1089-apc.2008.0186; Poljak M, 2009, INT J STD AIDS, V20, P77, DOI 10.1258-ijsa.2008.008438; Rahangdale L, 2008, J WOMENS HEALTH, V17, P465, DOI 10.1089-jwh.2007.0545; Rennie S, 2006, B WORLD HEALTH ORGAN, V84, P52; StataCorp, 2009, STAT STAT SOFTW REL; Turan JM, 2008, AIDS CARE, V20, P938, DOI 10.1080-09540120701767224; Uganda Bureau of Statistics Macro International, 2007, UG DEM HLTH SURV 200; Weigel R, 2009, BMC PEDIATR, V9, DOI 10.1186-1471-2431-9-80; Weiser SD, 2006, PLOS MED, V3, P1013, DOI 10.1371-journal.pmed.0030261; World Health Organisation, 2007, GUID PROV IN HIV TES; World Health Organization, 2010, HDB IMPR HIV TEST CO; World Health Organization Joint United Nations Programme on HIV-AIDS, 2005, SCAL UP HIV TEST COU; Zou GY, 2004, AM J EPIDEMIOL, V159, P702, DOI 10.1093-aje-kwh090
dc.description.citedCount 9
dc.description.citedTotWOSCount 11
dc.description.citedWOSCount 11
dc.format.extentCount 1
dc.identifier.articleNo e1001329
dc.identifier.pubmedID 23109914
dc.identifier.scopusID 84868156090
dc.publisher.address 1160 BATTERY STREET, STE 100, SAN FRANCISCO, CA 94111 USA
dc.relation.ispartOfISOAbbr PLos Med.
dc.relation.ispartOfIssue 10
dc.relation.ispartofPubTitle PLoS Medicine
dc.relation.ispartofPubTitleAbbr PLoS Med.
dc.relation.ispartOfVolume 9
dc.source.ID WOS:000310579000011
dc.type.publication Journal
dc.subject.otherIndex antiretrovirus agent
dc.subject.otherIndex adult
dc.subject.otherIndex article
dc.subject.otherIndex Burkina Faso
dc.subject.otherIndex comparative study
dc.subject.otherIndex confidentiality
dc.subject.otherIndex counseling
dc.subject.otherIndex health care facility
dc.subject.otherIndex health survey
dc.subject.otherIndex HIV test
dc.subject.otherIndex human
dc.subject.otherIndex Human immunodeficiency virus infection
dc.subject.otherIndex informed consent
dc.subject.otherIndex interview
dc.subject.otherIndex Kenya
dc.subject.otherIndex Malawi
dc.subject.otherIndex medical care
dc.subject.otherIndex outcome assessment
dc.subject.otherIndex patient referral
dc.subject.otherIndex prevalence
dc.subject.otherIndex satisfaction
dc.subject.otherIndex Uganda
dc.subject.otherIndex virus transmission
dc.subject.otherIndex Burkina Faso
dc.subject.otherIndex Confidentiality
dc.subject.otherIndex HIV Infections
dc.subject.otherIndex Humans
dc.subject.otherIndex Kenya
dc.subject.otherIndex Malawi
dc.subject.otherIndex Patient Acceptance of Health Care
dc.subject.otherIndex Referral and Consultation
dc.subject.otherIndex Uganda
dc.subject.otherKeywordPlus HUMAN-RIGHTS
dc.subject.otherKeywordPlus OPT-OUT
dc.subject.otherKeywordPlus SOUTH-AFRICA
dc.subject.otherKeywordPlus SERVICES
dc.subject.otherKeywordPlus DISCRIMINATION
dc.subject.otherKeywordPlus EXCEPTIONALISM
dc.subject.otherKeywordPlus SATISFACTION
dc.subject.otherKeywordPlus LABOR
dc.subject.otherKeywordPlus TRIAL
dc.subject.otherWOS Medicine, General and Internal

Files in this item

Files Size Format View

There are no files associated with this item.

This item appears in the following Collection(s)

Show simple item record

Search AUB ScholarWorks


My Account