Challenges in the delivery of public HIV testing and counselling (HTC) in Douala, Cameroon: providers perspectives and implications on quality of HTC services

Abstract

BackgroundThe Cameroon government has made HIV testing and counselling (HTC) a priority in its HIV/AIDS strategic plan. However, there is a dearth of literature on the perspectives of providers on the quality of HTC services. The aim of this study was to explore challenges in the provision of HTC services and their implications on quality of HTC services in Douala’s district hospitals.MethodsTwo primary data collection methods supported by the Donabedian’s model of healthcare were used to explain the challenges in the provision of HTC services and their implications on quality of HTC services. This consisted of semi-structured individual interviews with 6 nurses and 16 lay counsellors and a non-participant observation of the physical environment for HTC by site. The study sites were the prevention and voluntary testing and counselling centre (PVTCC) of the six district hospitals of the city of Douala.ResultsThe study reveals concerns about confidentiality and privacy during the counselling sessions due to inadequate and limited space. An absence of consent, even verbal, was reported in one PVTCC. There is no specific accredited training curriculum that leads to a formal registration as a PVTCC staff, and some lay counsellors work without training. Lay counsellors carry the burden of HIV counselling, but the majority of them work for many years without remuneration and recognition. Another quality challenge is the high workload in the district hospitals’ lab, which leads to long waiting times for HIV test results, thus contributing to failure to return for results.ConclusionThe findings of this study highlighted some issues such as lack of adequate space and equipment for HIV testing and counselling that hinder the quality of HTC services and should challenge the health authorities of Cameroon on the need to reorganize HTC services and create a national HIV quality assurance program.Electronic supplementary materialThe online version of this article (doi:10.1186/s12914-017-0118-2) contains supplementary material, which is available to authorized users.

“I Don’t Want to go for an HIV Test Out of Fear that I Might be Positive”: Barriers and Facilitators to the Uptake of HIV testing Services Among Adolescents and Young Adults in Machinga District, Malawi.

“…20 At the health system level, lack of youth-friendly HIV testing services in particular, as well as youthfriendly health services in general, is the overarching barrier to HIV testing among young people. This barrier involves inadequate staff, lack of space and con dentiality -among others -and our ndings are consistent with those of researchers in other settings 21 . This barrier needs to be considered in the light of resource constraints facing the Malawian health care system.…”

Female sex workers perspectives and concerns regarding HIV self-testing: an exploratory study in Tanzania

“…A belief that HIVST will increase privacy and confidentiality were key factors that motivated FSWs towards HIVST. Studies on facility-based HTS conducted in SSA have associated low uptake with concerns about a breach of confidentiality [46] and fear of HIV stigma [47]. Participants in our study described their 'lived experience' of stigma and the societal perceptions portrayed towards FSWs as drivers of HIV transmissions.…”

Female sex workers perspectives and concerns regarding HIV self-testing: An exploratory study in Tanzania

“…A belief that HIVST will increase privacy and confidentiality were key factors that motivated FSWs towards HIVST. Studies on facility-based HTS conducted in SSA have associated low uptake with concerns about a breach of confidentiality [48] and fear of HIV stigma [49].…”