KAMPALA, 11 June 2008 (PlusNews) - Routinely counselling and
testing patients for HIV during regular clinic visits is proving
effective in increasing testing numbers in several Ugandan
The Research Triangle Institute (RTI), an independent research
organisation with headquarters in North Carolina, has been
routinely offering HIV counselling and testing to patients and
their family members at 10 health centres in eight districts of
Uganda since 2004. About 99 percent of people have agreed to be
"We provide a health talk to all patients that includes the basic
facts about HV; then an HIV test is offered, with the patient
being given the choice to opt out," RTI's Jennifer Namusobya
explained to delegates at the recent HIV Implementers' Meeting in
Kampala, Uganda's capital. "There is no coercion and they are
informed of the confidential nature of the test."
People who test positive for the virus are offered further
counselling and referred to the centre's HIV clinic. Those who
test HIV-negative are counselled on risk reduction, given condoms
and advised to test again in three months if they have recently
engaged in behaviour that may have exposed them to the virus.
By March 2008, the 10 health centres had tested more than 124,000
people for HIV, 30 percent of them non-patients. An estimated 13
percent tested positive, of which 8,525 have been enrolled on
antiretroviral (ARV) treatment.
Figures estimating that only about 12 percent of men and 10
percent of women in sub-Saharan Africa know their HIV status, led
the World Health Organisation to revise its testing guidelines in
2007. HIV testing in the region has mainly been done on a
client-initiated voluntary counselling and testing (VCT) basis,
but fear of stigma and discrimination, the perception by many
people that they are not at risk as well as a lack of VCT
services in many areas has resulted in low uptake. The WHO urged
a move towards provider-initiated testing whereby health care
providers begin routinely recommending an HIV test to patients
attending their facilities.
According to Uganda's Ministry of Health, about 85 percent of the
population has never tested for HIV, although 70 percent report
they would like to know their status. In 2004, the ministry
revised its HIV policy to include provider-initiated counselling
and testing, but only in settings where comprehensive HIV care
and treatment was available.
Namusobya noted, however, that most Ugandan health facilities
were still ill-equipped to start provider-initiated counselling
and testing, and that much more investment in the public health
sector would be necessary before it could be introduced
In addition to upgrading hospitals without fully-fledged HIV
services, she said an intensive training programme would be
"We have trained more than 1,000 health workers in routine
counselling and testing, as well as volunteers," she pointed out.
Health centres would also need to set up several routine testing
points around their various wards and departments instead of
relying on one central point as with VCT, she added.
Moses Isabirye, an HIV counselling and testing coordinator with
the Makerere University Walter Reed Project (MUWRP), which has
been piloting provider-initiated HIV testing at four government
health centres in the central Ugandan district of Kayunga,
described to delegates at the Kampala meeting how health workers
had approached patients, family members accompanying them and
other visitors with information about HIV and the offer of a free
"We were able to identify HIV-positive friends and family, as
well as target couples on the male ward when wives came to visit
their husbands," he said.
Isabirye noted that routine counselling and testing had the
additional benefit of freeing up staff usually dedicated to
carrying out VCT. These staff members could then assist in
dealing with the increased number of patients identified as in
need of ARV medication.
"It also reduced costs for patients and their families, who
struggle to meet transport costs to come to the clinic; now they
are able to make one visit and kill two birds with one stone," he