Rethinking HIV exceptionalism: the ethics of opt-out HIV testing in sub-Saharan Africa

April, Michael D.

doi:10.2471/blt.09.073049

Cited by 39 publications

(52 citation statements)

References 29 publications

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“…“Informed consent” is defined as an individual’s right to make an informed, voluntary decision authorizing or refusing a medical intervention [34]. Informed consent has always been considered as the cornerstone that guarantees autonomy during the HIV testing process [35–37]. Despite the benefits of knowing one’s HIV status and the desire to make routine HIV testing for people visiting the health facilities of countries with a high HIV prevalence, as recommended by the WHO, the problem of informed consent for these people remains an ethical issue with various and varied positions [38–40].…”

Section: Discussionmentioning

confidence: 99%

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

Ngangue

Gagnon

Bédard

2017

BMC Int Health Hum Rights

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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.

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Section: Discussionmentioning

confidence: 99%

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

Ngangue

Gagnon

Bédard

2017

BMC Int Health Hum Rights

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“…10,47 Moreover, although PITC can contribute to increased testing in clinical settings, 41 the adoption of PITC alone will not achieve universal access to HTC. Other approaches that enable people not attending health-care services to access HIV testing should be developed in parallel to ensure that access to testing is equitable and that individuals with HIV infections are diagnosed before they become symptomatic.…”

Section: Discussionmentioning

confidence: 99%

From caution to urgency: the evolution of HIV testing and counselling in Africa

Baggaley¹,

Hensen²,

Ajose³

et al. 2012

Bull World Health Org

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“…This may account for HCPs' concerns and render opt-out testing less feasible and possibly unethical (April, 2010;Csete et al, 2004;Rennie & Behets, 2006). If HIV treatment is not available, opt-out HIV testing may do more harm than good (April, 2010).…”

Section: Discussionmentioning

confidence: 92%

Health-care providers’ experiences with opt-out HIV testing: a systematic review

et al. 2015

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HIV is now a manageable chronic disease with a good prognosis, but early detection and referral for treatment are vital. In opt-out HIV testing, patients are informed that they will be tested unless they decline. This qualitative systematic review explored the experiences, attitudes, barriers, and facilitators of opt-out HIV testing from a health-care provider (HCP) perspective. Four articles were included in the synthesis and reported on findings from approximately 70 participants, representing diverse geographical regions and a range of human development status and HIV prevalence. Two synthesized findings emerged: HCP attitudes and systems. The first synthesized finding encompassed HCP decision-making attitudes about who and when to test for HIV. It also included the assumptions the HCPs made about patient consequences. The second synthesized finding related to systems. System-related barriers to opt-out HIV testing included lack of time, resources, and adequate training. System-related facilitators included integration into standard practice, support of the medical setting, and electronic reminders. A common attitude among HCPs was the outdated notion that HIV is a terrible disease that equates to certain death. Some HCPs stated that offering the HIV test implied that the patient had engaged in immoral behaviour, which could lead to stigma or disengagement with health services. This paternalism diminished patient autonomy, because patients who were excluded from opt-out HIV testing could have benefited from it. One study highlighted the positive aspects of opt-out HIV testing, in which participants underscored the professional satisfaction that arose from making an HIV diagnosis, particularly when marginalized patients could be connected to treatment and social services. Recommendations for opt-out HIV testing should be disseminated to HCPs in a broad range of settings. Implementation of system-related factors such as electronic reminders and care coordination procedures should be considered, and a social-justice commitment among HCPs should be encouraged.

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Rethinking HIV exceptionalism: the ethics of opt-out HIV testing in sub-Saharan Africa

Cited by 39 publications

References 29 publications

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

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

From caution to urgency: the evolution of HIV testing and counselling in Africa

Health-care providers’ experiences with opt-out HIV testing: a systematic review

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