Ethical considerations of providers and clients on HIV testing campaigns in Burkina Faso

[Outreach strategies of HIV testing in Côte d’Ivoire: community providers under pressure]

BACKGROUND

Outreach HIV testing strategies have significantly contributed to the increase in the number of people knowing their HIV status in sub-Saharan Africa. This article analyzes the articulation of donor and field constraints on the implementation of outreach HIV testing strategies in Côte d’Ivoire.

METHODS

Qualitative research was conducted in three health districts (Man, Cocody-Bingerville and Aboisso) in Côte d’Ivoire in 2015-2016, through in-depth interviews with community providers, local leaders and people tested and through observation of outreach HIV testing activities.

RESULTS

Implementing organizations feel “under pressure” to meet donors’ objectives that are deemed unattainable, as well as the lack of training and funding. As a result, providers do not observe systematically the rules of the “three Cs” (counselling, informed consent, confidentiality), and propose testing to individuals who are “off-target” (in terms of locations and populations).

DISCUSSION

Implementing NGOs experience two types of constraints those resulting from the functioning of international aid (inadequate funding compared to actual costs, objectives too high, the important chain of intermediaries) and those related to the local context (spaces not adapted to guarantee confidentiality and the professional activity of target populations).

CONCLUSION

The pressure that is exerted at different levels on implementing NGOs is detrimental to the quality of HIV testing. It is now essential to develop a more qualitative approach in defining strategies and evaluation criteria.

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

Background

The 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.

Methods

Two 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.

Results

The 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.

Conclusion

The 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 material

The online version of this article (doi:10.1186/s12914-017-0118-2) contains supplementary material, which is available to authorized users.

Aconselhamento em doenças sexualmente transmissíveis na atenção primária: percepção e prática profissional

Resumo Objetivo Compreender percepção dos profissionais sobre a prática do aconselhamento em doenças sexualmente transmissíveis/HIV na atenção primária. Métodos Estudo qualitativo realizado com enfermeiros e médicos que atuam na atenção primária de saúde. A coleta de dados ocorreu mediante a técnica grupo focal, ancorada no Reporting Pesquisa Qualitativa - COREQ. A análise dos dados foi submetida aos passos da Fenomenologia Social, Alfred Schütz, evidenciando-se as categorias do estudo. Resultados Os profissionais realizam o aconselhamento de forma reduzida baseada na orientação para prevenção de doenças. Essa prática está inserida no planejamento familiar e atividades escolares. O acesso do usuário com doença sexualmente transmissível é marcado por procura mínima. No acolhimento, apontou-se a priorização do atendimento dos casos. Constataram-se sensação de despreparo e insegurança na comunicação do resultado de exames, dificuldades para o aconselhamento na visita domiciliar, manutenção do sigilo e da privacidade de informações dos usuários. Conclusão Os profissionais percebem o aconselhamento como uma prática relevante, porém acompanhada de limitações e barreiras na realização.