Original Research

Patient acceptance of HIV testing services in rural emergency departments in South Africa

Aditi Rao, Caitlin Kennedy, Pamela Mda, Thomas C. Quinn, David Stead, Bhakti Hansoti
Southern African Journal of HIV Medicine | Vol 21, No 1 | a1105 | DOI: https://doi.org/10.4102/sajhivmed.v21i1.1105 | © 2020 Aditi Rao, Caitlin Kennedy, Pamela Mda, Thomas C. Quinn, David Stead, Bhakti Hansoti | This work is licensed under CC Attribution 4.0
Submitted: 15 May 2020 | Published: 22 July 2020

About the author(s)

Aditi Rao, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, United States of America
Caitlin Kennedy, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, United States of America
Pamela Mda, Nelson Mandela Academic Clinical Research Unit, Mthatha, South Africa
Thomas C. Quinn, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, United States of America; and, Division of Intramural Research, National Institutes of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, United States of America
David Stead, Department of Medicine, Frere and Cecilia Makiwane Hospitals, East London, South Africa; and, Department of Medicine, Faculty of Health Sciences, Walter Sisulu University, East London, South Africa
Bhakti Hansoti, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, United States of America; and, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, United States of America


Share this article

Bookmark and Share

Abstract

Background: South Africa faces the highest burden of HIV infection globally. The National Strategic Plan on HIV recommends provider-initiated HIV counselling and testing (HCT) in all healthcare facilities. However, HIV continues to overwhelm the healthcare system. Emergency department (ED)-based HCT could address unmet testing needs.

Objectives: This study examines the reasons for accepting or declining HCT in South African EDs to inform the development of HCT implementation strategies.

Method: We conducted a prospective observational study in two rural EDs, from June to September 2017. Patients presenting to the ED were systematically approached and offered a point-of-care test in accordance with national guidelines. Patients demographics, presenting compaint, medical history and reasons for accepting/declining testing, were recorded. A pooled analysis is presented.

Results: Across sites, 2074 adult, non-critical patients in the ED were approached; 1880 were enrolled in the study. Of those enrolled, 19.7% had a previously known positive diagnosis, and 80.3% were unaware of their HIV status. Of those unaware, 90% patients accepted and 10% declined testing. The primary reasons for declining testing were ‘does not want to know status’ (37.6%), ‘in too much pain’ (34%) and ‘does not believe they are at risk’ (19.9%).

Conclusions: Despite national guidelines, a high proportion of individuals remain undiagnosed, of which a majority are young men. Our study demonstrated high patient acceptance of ED-based HCT. There is a need for investment and innovation regarding effective pain management and confidential service delivery to address patient barriers. Findings support a routine, non-targeted HCT strategy in EDs.


Keywords

HIV counselling and testing; South Africa; emergency department; patient acceptance; implementation research; linkage to care

Metrics

Total abstract views: 189
Total article views: 114


Crossref Citations

No related citations found.