London School of Hygiene and Tropical Medicine, London, UK.
AIDS. 2013 Feb 20;27(4):617-26. doi: 10.1097/QAD.0b013e32835b7048.
The routine offer of an HIV test during patient-provider encounters is gaining momentum within HIV treatment and prevention programmes. This review examined the operational implementation of provider-initiated testing and counselling (PITC) programmes in sub-Saharan Africa.
PUBMED, EMBASE, Global Health, COCHRANE Library and JSTOR databases were searched systematically for articles published in English between January 2000 and November 2010. Grey literature was explored through the websites of international and nongovernmental organizations. Eligibility of studies was based on predetermined criteria applied during independent screening by two researchers.
We retained 44 studies out of 5088 references screened. PITC polices have been effective at identifying large numbers of previously undiagnosed individuals. However, the translation of policy guidance into practice has had mixed results, and in several studies of routine programmes the proportion of patients offered an HIV test was disappointingly low. There were wide variations in the rates of acceptance of the test and poor linkage of those testing positive to follow-up assessments and antiretroviral treatment. The challenges encountered encompass a range of areas from logistics, to data systems, human resources and management, reflecting some of the weaknesses of health systems in the region.
The widespread adoption of PITC provides an unprecedented opportunity for identifying HIV-positive individuals who are already in contact with health services and should be accompanied by measures aimed at strengthening health systems and fostering the normalization of HIV at community level. The resources and effort needed to do this successfully should not be underestimated.
在艾滋病毒治疗和预防规划中，在医患接触时常规提供艾滋病毒检测正得到越来越多的重视。本研究审查了撒哈拉以南非洲地区开展的医护人员主动提供艾滋病毒检测和咨询（PITC）方案的实施情况。
系统地检索了 2000 年 1 月至 2010 年 11 月间以英文发表的 PUBMED、EMBASE、全球卫生、考科兰图书馆和 JSTOR 数据库中的文章，并通过国际和非政府组织的网站查阅灰色文献。根据两位研究人员独立筛选时应用的预定标准，确定研究的合格性。
我们从筛选出的 5088 篇参考文献中保留了 44 篇研究。医护人员主动提供艾滋病毒检测政策已被证明能够有效地发现大量以前未确诊的个体。然而，政策指导转化为实践的效果参差不齐，在一些常规方案的研究中，提供艾滋病毒检测的患者比例低得令人失望。接受检测的比例差异很大，而且阳性检测结果的患者与后续评估和抗逆转录病毒治疗的联系也很差。所遇到的挑战包括从后勤到数据系统、人力资源和管理等各个方面，反映出该区域卫生系统的一些弱点。
医护人员主动提供艾滋病毒检测的广泛采用为发现已经接触卫生服务的艾滋病毒阳性个体提供了前所未有的机会，同时应采取措施加强卫生系统，并促进社区一级艾滋病毒的正常化。成功开展这项工作所需的资源和努力不应被低估。
