HIV testing services in healthcare facilities in South Africa: a missed opportunity

Abstract

IntroductionSouth Africa (SA) has the world's highest burden of HIV infection (approximately 7.2 million), yet it is estimated that 23.5% women and 31.5% of men are unaware that they are living with HIV. The 2015 national South African HIV testing guidelines mandate the universal offer of HIV testing services (HTS) in all healthcare facilities.MethodsA multi‐prong approach was used from January 2017 to June 2017 to evaluate the current implementation of HTS in ten facilities in the Ekurhuleni District of SA. First, we conducted patient exit interviews to quantify engagement in HTS services. Second, we systematically mapped the flow of individual patients through the clinic.ResultsWe conducted a total of 2989 exit interviews and followed 568 patients for value stream mapping. Overall self‐reported testing acceptance was high at 84.7% (244), but <10% of the patients (288) were offered testing. Female patients were more likely to be offered testing (233/2046, 11.4% vs. 55/943, 5.8% in males; chi‐square p < 0.005), and also more likely to accept testing (203/233, 87.1% vs. 41/55, 74.6% in males; chi‐square p = 0.02). Value stream mapping revealed that patients offered HIV testing had a total visit time of 51 minutes more (95% CI: 30‐72) compared to those not offered testing.ConclusionsThe poor delivery of HTS appears to be due to a failure to recommend HTS and the added time burden placed on those accepting testing. There were significant differences in both the offer and acceptance of testing by gender. Health system issues need to be addressed to improve HTS delivery.

Findings from a novel and scalable community-based HIV testing approach to reduce the time required to complete point-of-care HIV testing in South Africa

“…The full process is time consuming with much of the time spent waiting for test results. This constrains the volume of HTS because a single counsellor is limited to testing 2-3 clients per hour and the lack of private spaces in a mobile setup limits the number of counsellors that can provide HTS at any given time [12].…”

The Role of Value Stream Mapping in Healthcare Services: A Scoping Review

“…Finally, the reported VSM implementations in several countries leave no doubt about the transferability of VSM in different contexts. However, many of the studies reviewed in which VSM is implemented have a lot of similarities, being single-case applications where the outcome to be improved is, mainly, time reduction [95,101,111]. The quality of these studies is diverse, and more quality research continues to be needed, not only in the design, but also in the reporting of it.…”

“…We grouped these indicators in the areas shown in Figure 9. Most articles are related to lead time: length of stay [78,80,81,143], in-the-door to out-the-door time [89], flow time [102,127,146], time of stay [90], stream time [114] and visiting time [111]. These indicators cannot be directly compared to one another as they deal with different actions or sections in healthcare.…”

Facilitators &amp; Barriers to Implementing Provider-Initiated HIV Counselling and Testing at the Clinic-Level in Ekurhuleni District, South Africa

“…Health care providers should recommend HCT to all patients in a health facility, regardless of whether they show signs or symptoms of HIV infection"(6). Despite the policy, HIV testing continues to be offered to a small proportion of eligible patients (1,7,8).…”