ReviewThe nursing implications of routine provider-initiated HIV testing and counselling in sub-Saharan Africa: A critical review of new policy guidance from WHO/UNAIDS
Introduction
After much controversy and a lengthy process of global consultation, in 2007, WHO/UNAIDS released guidelines urging countries to adopt provider-initiated HIV testing and counselling (PITC) in health facilities (WHO/UNAIDS, 2007). This paper presents an overview of this new policy guidance and critically considers its implementation in the sub-Saharan African context, focusing specifically on its implications for the nursing profession.
Section snippets
The HIV epidemic in sub-Saharan Africa
Sub-Saharan Africa is the world's most severely affected region by HIV/AIDS, making up 67% of all people living with HIV/AIDS, and 72% of AIDS-related deaths in 2007 (UNAIDS, 2008). National HIV prevalence rates vary widely from 2 to 39% in this vast and diverse region comprising 47 different countries (UNAIDS, 2008). In some Western and Central African countries, average HIV prevalence is just under 2% compared with over 15% in many southern African countries and 5% in other countries in
Review of the PITC policy guidance: aims and methods
As the key personnel who will be in charge of PITC related service development and implementation, it is important that nurses are fully aware of the ethical debates surrounding PITC and the existing evidence on its implementation. In particular, nurses need to consider: (i) how to protect patients’ human rights, and, (ii) how best to support each other to provide optimal care in difficult working conditions. This paper aims to discuss both these issues through a comprehensive analysis of
Experiences with PITC implementation
The section below considers the challenges involved in implementing an ‘enabling environment’ by reviewing PITC's acceptability and the extent to which ethical principles are being adhered to.
HIV counselling and care: a nursing perspective
The limited available evidence indicates that there are two key issues determining the quality of nursing practice in HIV testing and counselling: structural/health system factors and organisational/professional culture.
PITC in sub-Saharan Africa: recommendations and conclusion
This policy review demonstrates that PITC has a strong public health rationale and, if implemented carefully, should contribute to a much needed increase in HIV testing and access to care in the sub-Saharan African region. This review has also reiterated the importance of protecting human rights during PITC and has revealed a number of areas where challenges may exist to the development of good practice. In particular it has highlighted how health system factors (for example lack of staff, lack
Conflict of interest
We (both authors) declare that there is no conflict of interest within the following paper: The nursing implications of routine provider-initiated HIV testing and counselling in sub-Saharan Africa: A critical review of new policy guidance from WHO/UNAIDS.
Acknowledgement
We are very grateful to the U.K. National HIV Nurses’ Association (NHIVNA) for providing a research grant to support our work on the PITC policy.
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