Patient acceptance of HIV testing services in rural emergency departments in South Africa

Southern African Journal of HIV Medicine

Field Value
Title Patient acceptance of HIV testing services in rural emergency departments in South Africa
Creator Rao, Aditi Kennedy, Caitlin Mda, Pamela Quinn, Thomas C. Stead, David Hansoti, Bhakti
Subject — HIV counselling and testing; South Africa; emergency department; patient acceptance; implementation research; linkage to care
Description Background: South Africa faces the highest burden of HIV infection globally. The National Strategic Plan on HIV recommends provider-initiated HIV counselling and testing (HCT) in all healthcare facilities. However, HIV continues to overwhelm the healthcare system. Emergency department (ED)-based HCT could address unmet testing needs.Objectives: This study examines the reasons for accepting or declining HCT in South African EDs to inform the development of HCT implementation strategies.Method: We conducted a prospective observational study in two rural EDs, from June to September 2017. Patients presenting to the ED were systematically approached and offered a point-of-care test in accordance with national guidelines. Patients demographics, presenting compaint, medical history and reasons for accepting/declining testing, were recorded. A pooled analysis is presented.Results: Across sites, 2074 adult, non-critical patients in the ED were approached; 1880 were enrolled in the study. Of those enrolled, 19.7% had a previously known positive diagnosis, and 80.3% were unaware of their HIV status. Of those unaware, 90% patients accepted and 10% declined testing. The primary reasons for declining testing were ‘does not want to know status’ (37.6%), ‘in too much pain’ (34%) and ‘does not believe they are at risk’ (19.9%).Conclusions: Despite national guidelines, a high proportion of individuals remain undiagnosed, of which a majority are young men. Our study demonstrated high patient acceptance of ED-based HCT. There is a need for investment and innovation regarding effective pain management and confidential service delivery to address patient barriers. Findings support a routine, non-targeted HCT strategy in EDs.
Publisher AOSIS
Date 2020-07-22
Type info:eu-repo/semantics/article info:eu-repo/semantics/publishedVersion — —
Format text/html application/epub+zip text/xml application/pdf
Identifier 10.4102/sajhivmed.v21i1.1105
Source Southern African Journal of HIV Medicine; Vol 21, No 1 (2020); 9 pages 2078-6751 1608-9693
Language eng
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Rights Copyright (c) 2020 Aditi Rao, Caitlin Kennedy, Pamela Mda, Thomas C. Quinn, David Stead, Bhakti Hansoti