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Objective  To assess implementation of provider‐initiated testing and counselling ( PITC ) for  HIV  in Malawi.    Methods  A review of  PITC  practices within 118 departments in 12 Ministry of Health (MoH) facilities across Malawi was conducted. Information on  PITC  practices was collected via a health facility survey. Data describing patient visits and  HIV  tests were abstracted from routinely collected programme data.    Results  Reported  PITC  practices were highly variable. Most providers practiced symptom‐based  PITC . Antenatal clinics and maternity wards reported widespread use of routine opt‐out  PITC . In 2014, there was approximately 1  HIV  test for every 15 clinic visits.  HIV  status was ascertained in 94.3% (5293/5615) of patients at tuberculosis clinics, 92.6% (30 675/33 142) of patients at antenatal clinics and 49.4% (6871/13 914) of patients at sexually transmitted infection clinics. Reported challenges to delivering  PITC  included test kit shortages (71/71 providers), insufficient physical space (58/71) and inadequate number of  HIV  counsellors (32/71) while providers from inpatient units cited the inability to test on weekends.    Conclusions  Various models of  PITC  currently exist at MoH facilities in Malawi. Only antenatal and maternity clinics demonstrated high rates of routine opt‐out  PITC . The low ratio of facility visits to  HIV  tests suggests missed opportunities for  HIV  testing. However, the high proportion of patients at  TB  and antenatal clinics with known  HIV  status suggests that routine  PITC  is feasible. These results underscore the need to develop clear, standardised  PITC  policy and protocols, and to address obstacles of limited health commodities, infrastructure and human resources.

tropical medicine and international health

Lost opportunities to identify and treat  HIV ‐positive patients: results from a baseline assessment of provider‐initiated  HIV  testing and counselling (PITC) in  M alawi