Opportunities and barriers for providing HIV testing through community health centers in mainland China: a nationwide cross-sectional survey

Abstract

BackgroundPrimary care may be an avenue to increase coverage of HIV testing but it is unclear what challenges primary healthcare professionals in low- and middle-income countries face. We describe the HIV testing practices in community health centres (CHCs) and explore the staff’s attitude towards further development of HIV testing services at the primary care level in China.MethodsWe conducted a national, cross-sectional survey using a stratified random sample of CHCs in 20 cities in 2015. Questionnaires were completed by primary care doctors and nurses in CHCs, and included questions regarding their demographics, clinical experience and their views on the facilitators and barriers to offering HIV testing in their CHC. Multivariate logistic regression was conducted to examine the association between staff who would offer HIV testing and their sociodemographic characteristics.ResultsA total of 3580 staff from 158 CHCs participated. Despite the majority (81%) agreeing that HIV testing was an important part of healthcare, only 25% would provide HIV testing when requested by a patient. The majority (71%) were concerned about reimbursement, and half (47%) cited lack of training as a major barrier. Almost half (44%) believed that treating people belonging to high-risk populations would scare other patients away, and 6% openly expressed their dislike of people belonging to high-risk populations. Staff who would offer HIV testing were younger (adjusted odds ratio (aOR) 0.97 per year increase in age, 95% confidence interval (CI):0.97–0.98); trained as a doctor compared to a nurse (aOR 1.79, 95%CI:1.46–2.15); held a bachelor degree or above (aOR 1.34, 95%CI:1.11–1.62); and had previous HIV training (aOR 1.55, 95%CI:1.27–1.89).ConclusionsImproving HIV training of CHC staff, including addressing stigmatizing attitudes, and improving financial reimbursement may help increase HIV testing coverage in China.

A systematic review and meta-analysis of the evidence for community-based HIV testing on men’s engagement in the HIV care cascade

“…[21][22][23][24][25] Social and structural factors (such as laws criminalizing same-sex relations) may restrict HIV testing accessibility for key populations, 26 while also impacting the knowledge, attitudes, and practices of healthcare providers responsible for assessing HIV risk, offering testing, communicating results, and initiating treatment. 21,27,28 Consequently, members of key populations may have heightened concerns regarding the confidentiality of their test results and sexual identity, 29,30 particularly in settings with punitive laws related to HIV test results and/or sexual identity. 31 The World Health Organization has recommended community-based HIV testing (CB-HTS) models to address such barriers and facilitate early HIV detection.…”

The Effectiveness Of Video-Online Education On Cadres’ Knowledge And Attitude About The Importance Of Human Immunodeficiency Virus (HIV) Testing In Public Health Center

“…Good knowledge about HIV can also change HIV stigma and discrimination that have a significant impact on individual wellbeing and increase HIV prevention campaigns, programs and policies [7], [26]. Improving HIV training for public health staff, including addressing stigmatization, can help to increase the coverage of HIV testing in China [27]. Training can be an intervention choice to increase knowledge and with training it can increase the confidence of officers to provide advice to people at risk of HIV.…”

Diagnostic aspects and in-service training in the decentralization of care to people living with HIV

“…A study conducted in a community health center in China, which aimed at describing practices related to the HIV test and the development of activities in primary level services, has emphasized that only one third of the nurses participating in the study were trained for HIV diagnosis. Therefore, training deficit was observed to have consequences for the execution and coverage of RT, in addition to perpetuating stigmatizing attitudes (25) .…”