Health System Barriers to Provider-Initiated HIV Testing and Counselling Services for Infants and Children: A Qualitative Study From 2 Districts in Njombe, Tanzania

BACKGROUND: There is low utilisation of provider-initiated HIV testing and counselling (PITC) services for infants and children under 5 years old in many low- and middle-income countries including Tanzania. Studies have shown that various factors contribute to low use of PITC, includes the unavailability of the polymerase chain reaction (PCR) test and other specialised techniques for testing children less than 18 months old as well as the reluctance of some parents and caregivers to undertake HIV testing for their children because of the fear of stigma associated with HIV/AIDS. This study explored health system barriers at the district and community levels affecting the provision of PITC for infants and children under 5 in Tanzania using a case study of 2 districts. METHODS: A qualitative study was conducted in 1 urban and 1 rural district in the southern part of Tanzania. In-depth interviews, focus group discussions, and a desk review of documents were used to obtain the information. Respondents were purposively enrolled in the study and thematic analysis was used to generate findings. RESULTS: Provision of PITC services faces a number of district-level health system barriers, including lack of adequate health staff in health facilities both in number and skills, lack of adequate infrastructure, and erratic shortage of supplies. At the community level, community members’ low understanding about the importance of PITC services as well as existing stigma associated with HIV/AIDS have constrained the provision of PITC services. CONCLUSION: This study concludes that for effective implementation of PITC, the health system should strengthen health facilities through training of service providers on PITC, deploying adequately skilled health workers, supplying sufficient medicines and other supplies, and promoting health campaigns focused on educating community members about the importance of early HIV testing for infants and children under 5.