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Facilitators and barriers to implementing provider-initiated HIV counselling and testing at the clinic-level in Ekurhuleni District, South Africa

BACKGROUND: HIV testing is the entry point into the HIV care continuum and critical for HIV epidemic control. Facility-based HIV testing services (HTS) reach individuals who are already seeking clinical care and engaging with the medical care system. For this reason, individuals diagnosed with HIV d...

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Autores principales: Mshweshwe-Pakela, Nolundi, Mabuto, Tonderai, Ntombela, Nasiphi, Hlongwane, Mpho, Kubeka, Griffiths, Kerrigan, Deanna L., Hoffmann, Christopher J.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8845300/
https://www.ncbi.nlm.nih.gov/pubmed/35168677
http://dx.doi.org/10.1186/s43058-022-00269-3
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author Mshweshwe-Pakela, Nolundi
Mabuto, Tonderai
Ntombela, Nasiphi
Hlongwane, Mpho
Kubeka, Griffiths
Kerrigan, Deanna L.
Hoffmann, Christopher J.
author_facet Mshweshwe-Pakela, Nolundi
Mabuto, Tonderai
Ntombela, Nasiphi
Hlongwane, Mpho
Kubeka, Griffiths
Kerrigan, Deanna L.
Hoffmann, Christopher J.
author_sort Mshweshwe-Pakela, Nolundi
collection PubMed
description BACKGROUND: HIV testing is the entry point into the HIV care continuum and critical for HIV epidemic control. Facility-based HIV testing services (HTS) reach individuals who are already seeking clinical care and engaging with the medical care system. For this reason, individuals diagnosed with HIV during facility-based HIV testing are more likely to continue into HIV care. To increase the number of PLHIV who are diagnosed and initiated on ART, in 2015, the South African Department of Health instituted Provider-Initiated Counselling and Testing (PICT) policy—encouraging healthcare providers to recommend HIV testing, but this strategy remains under-utilized. We aimed to identify key constraints to the normalization of PICT implementation in 10 Ekurhuleni District healthcare facilities in South Africa. METHODS: In-depth interviews were conducted with 40 healthcare workers (28 clinicians and 12 lay counsellors). Health care workers were purposefully selected to participate in the interviews, stratified by health facility and work category. Interviews were audio-recorded, transcribed, and translated for analysis. Thematic analysis was guided by the normalization process theory (NPT). NPT theory explains how practices are routinely embedded within organizational contexts. We used NVivo 10 software for qualitative data management. RESULTS: Both clinicians and lay counsellors exhibited a clear understanding of the PICT policy— acknowledging its purpose and value. The identified barrier to normalization of PICT among clinicians was offering HIV testing based on suspicion of HIV despite understanding that PICT involves offering testing to all clients. Additionally, clinicians perceived PICT as incongruent with their clinical roles and perceived it to be lay counsellors’ responsibility. The main facilitator was the participation of all healthcare workers, specifically the presence of lay counsellors, although they also faced barriers such as a lack of workspace and under-appreciation. CONCLUSIONS: Use of NPT helped identify barriers that prevent the normalization of PITC and its integration into routine patient care. These barriers can be modified by low-cost interventions that promote congruence of PICT to the roles of clinicians and integrate the role of lay counsellors within the patient flow in the facility. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s43058-022-00269-3.
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spelling pubmed-88453002022-02-16 Facilitators and barriers to implementing provider-initiated HIV counselling and testing at the clinic-level in Ekurhuleni District, South Africa Mshweshwe-Pakela, Nolundi Mabuto, Tonderai Ntombela, Nasiphi Hlongwane, Mpho Kubeka, Griffiths Kerrigan, Deanna L. Hoffmann, Christopher J. Implement Sci Commun Research BACKGROUND: HIV testing is the entry point into the HIV care continuum and critical for HIV epidemic control. Facility-based HIV testing services (HTS) reach individuals who are already seeking clinical care and engaging with the medical care system. For this reason, individuals diagnosed with HIV during facility-based HIV testing are more likely to continue into HIV care. To increase the number of PLHIV who are diagnosed and initiated on ART, in 2015, the South African Department of Health instituted Provider-Initiated Counselling and Testing (PICT) policy—encouraging healthcare providers to recommend HIV testing, but this strategy remains under-utilized. We aimed to identify key constraints to the normalization of PICT implementation in 10 Ekurhuleni District healthcare facilities in South Africa. METHODS: In-depth interviews were conducted with 40 healthcare workers (28 clinicians and 12 lay counsellors). Health care workers were purposefully selected to participate in the interviews, stratified by health facility and work category. Interviews were audio-recorded, transcribed, and translated for analysis. Thematic analysis was guided by the normalization process theory (NPT). NPT theory explains how practices are routinely embedded within organizational contexts. We used NVivo 10 software for qualitative data management. RESULTS: Both clinicians and lay counsellors exhibited a clear understanding of the PICT policy— acknowledging its purpose and value. The identified barrier to normalization of PICT among clinicians was offering HIV testing based on suspicion of HIV despite understanding that PICT involves offering testing to all clients. Additionally, clinicians perceived PICT as incongruent with their clinical roles and perceived it to be lay counsellors’ responsibility. The main facilitator was the participation of all healthcare workers, specifically the presence of lay counsellors, although they also faced barriers such as a lack of workspace and under-appreciation. CONCLUSIONS: Use of NPT helped identify barriers that prevent the normalization of PITC and its integration into routine patient care. These barriers can be modified by low-cost interventions that promote congruence of PICT to the roles of clinicians and integrate the role of lay counsellors within the patient flow in the facility. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s43058-022-00269-3. BioMed Central 2022-02-15 /pmc/articles/PMC8845300/ /pubmed/35168677 http://dx.doi.org/10.1186/s43058-022-00269-3 Text en © The Author(s) 2022 https://creativecommons.org/licenses/by/4.0/Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) . The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/ (https://creativecommons.org/publicdomain/zero/1.0/) ) applies to the data made available in this article, unless otherwise stated in a credit line to the data.
spellingShingle Research
Mshweshwe-Pakela, Nolundi
Mabuto, Tonderai
Ntombela, Nasiphi
Hlongwane, Mpho
Kubeka, Griffiths
Kerrigan, Deanna L.
Hoffmann, Christopher J.
Facilitators and barriers to implementing provider-initiated HIV counselling and testing at the clinic-level in Ekurhuleni District, South Africa
title Facilitators and barriers to implementing provider-initiated HIV counselling and testing at the clinic-level in Ekurhuleni District, South Africa
title_full Facilitators and barriers to implementing provider-initiated HIV counselling and testing at the clinic-level in Ekurhuleni District, South Africa
title_fullStr Facilitators and barriers to implementing provider-initiated HIV counselling and testing at the clinic-level in Ekurhuleni District, South Africa
title_full_unstemmed Facilitators and barriers to implementing provider-initiated HIV counselling and testing at the clinic-level in Ekurhuleni District, South Africa
title_short Facilitators and barriers to implementing provider-initiated HIV counselling and testing at the clinic-level in Ekurhuleni District, South Africa
title_sort facilitators and barriers to implementing provider-initiated hiv counselling and testing at the clinic-level in ekurhuleni district, south africa
topic Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8845300/
https://www.ncbi.nlm.nih.gov/pubmed/35168677
http://dx.doi.org/10.1186/s43058-022-00269-3
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