Provider-initiated testing and counselling for HIV - from debate to implementation

Recent statements by the new Minister of Health about ‘mass voluntary counselling and Testing (VCT) campaigns’, and references in the latest draft VCT policy to ‘provider-initiated VCT’, suggest that a policy space is opening up in South Africa for the expansion of HIV testing models beyond the current VCT approach. The existing VCT programme is showing some successes. For example, the Human Sciences Research Council (HSRC) has reported a dramatic increase in the number of 15 - 48-year-olds who report awareness of their HIV status, from 11.9 % in 2005 to 24.7% in 2008. Despite increased testing rates and willingness to test, most HIV-positive people do not know their status, do not consider themselves at risk and do not self-initiate testing, even with widespread awareness of and accessibility to VCT services. Barriers associated with VCT uptake include clients having to initiate testing themselves, lengthy pre- and post-test counselling, implementation barriers (organisational management, supervision, human resource and infrastructure limitations), and patient concerns about confidentiality. Possible strategies for expanding HIV testing include ‘provider-initiated HIV testing and counselling’ (PITC)6 – also referred to as ‘opt-out’ HIV testing or ‘routine offer of HIV testing’ – and broad-based testing approaches such as ‘mass VCT’ campaigns, mobile VCT services, community- and home-based HIV testing initiatives and self-testing.