Barriers to Provider-Initiated Testing and Counselling for Children in a High HIV Prevalence Setting: A Mixed Methods Study

Abstract

Rashida Ferrand and colleagues combine quantitative and qualitative methods to investigate HIV prevalence among older children receiving primary care in Harare, Zimbabwe, and reasons why providers did not pursue testing. Please see later in the article for the Editors' Summary

Seeking wider access to HIV testing for adolescents in sub-Saharan Africa

“…With respect to HTC and SRH research among adolescents, these concerns have been countered with reassuring evidence and testing/recruitment approaches and strategies (34-37), however, challenges still exist with enactment and implementation of laws supporting HTC for minors. Even where the law permits access to HTC by younger adolescents or where parental/guardian consent can be sought, the behavior of healthcare providers may act as barriers due to the influence of socio-cultural norms consistent with limiting dialogue about sex, restricting services for HTC, judgmental attitudes during service provision to adolescents and determining appropriateness of caregivers to give consent (16,33,(37)(38)(39)(40)(41). Furthermore, confusion about testing guidelines and regulations and concern for the ward's increased vulnerability if HIV-positive, may limit healthcare providers' offering of HTC as PITC (41).…”

“…Even where the law permits access to HTC by younger adolescents or where parental/guardian consent can be sought, the behavior of healthcare providers may act as barriers due to the influence of socio-cultural norms consistent with limiting dialogue about sex, restricting services for HTC, judgmental attitudes during service provision to adolescents and determining appropriateness of caregivers to give consent (16,33,(37)(38)(39)(40)(41). Furthermore, confusion about testing guidelines and regulations and concern for the ward's increased vulnerability if HIV-positive, may limit healthcare providers' offering of HTC as PITC (41). Nevertheless, the involvement of family in an ALHIV's decision to test and their ward's ability to cope after disclosure of a positive test has been shown to be critical (28).…”

An update on the HIV treatment cascade in children and adolescents

“…Many barriers to linkage to care have been identified in infant, children, and adolescent studies. These are summarized in Table 1 [7,[23][24][25]. These barriers were found at all levels, that is, service provider, caregiver as well as patients themselves.…”

Paediatric HIV testing beyond the context of prevention of mother-to-child transmission: a systematic review and meta-analysis

“…4 Reasons cited for the poor uptake of WHO-recommended PITC include misperceptions about the importance of HIV testing in children after infancy and insuffi cient resources and time, and legal frameworks that make testing children diffi cult without legal guardian consent. 5 To improve implementation of PITC outside the context of PMTCT, it will be necessary to direct programmes towards improving education and awareness of healthcare workers about the importance of paediatric HIV testing, increase resources in key contexts, and address legal barriers. National programmes and other implementers will need evidence on which facilities can provide the highest screening effi ciency or yield and which testing programme strategies result in the lowest number needed to test to identify an HIV-positive child.…”