Witzel T Charles, Lora Wezzie, Lees Shelley, Desmond Nicola
Sigma Research, Department of Public Health and Policy, London School of Hygiene and Tropical Medicine. London, United Kingdom.
Malawi-Liverpool Wellcome Trust Clinical Research Programme. Liverpool School of Tropical Medicine. Blantyre, Malawi.
PLoS One. 2017 Feb 16;12(2):e0170588. doi: 10.1371/journal.pone.0170588. eCollection 2017.
HIV testing and counselling (HTC) interventions are key to controlling the HIV epidemic in East and Southern Africa where HTC is primarily delivered through voluntary counselling and testing (VCT), provider initiated testing and counselling (PITC), and home-based counselling and testing (HBVCT). Decision making processes around uptake of HTC models must be taken into account when designing new interventions. Counselling in HTC aims to reduce post-test risk taking behaviour and to link individuals to care but its efficacy is unclear. This meta-ethnography aims to understand the contexts of HTC uptake in East and Southern Africa and to analyse the perceived impacts of counselling-based interventions in relation to sexual behaviour and linkage to care.
We conducted a systematic literature review of studies investigating HTC in East and Southern Africa from 2003 -April 2014. The search and additional snowballing identified 20 studies that fit our selection criteria. These studies were synthesised through a thematic framework analysis.
Twenty qualitative and mixed-methods studies examining impacts of HTC models in East and Southern Africa were meta-synthesised. VCT decisions were made individually while HBVCT decisions were located in family and community units. PITC was associated with coercion from healthcare providers. Low quality counselling components and multiple-intersecting barriers faced by individuals mean that counselling in HTC was not perceived to be effective in reducing post-test risk behaviour and had limited perceived effect in facilitating linkage to care.
HBVCT is associated with minimal stigma and should be considered as an area of priority. Counselling components in HTC interventions were effective in transmitting information about HIV and sexual risk, but were perceived as ineffective in addressing the broader personal circumstances preventing sexual behaviour change and modulating access to care.
艾滋病毒检测与咨询（HTC）干预措施是东非和南部非洲控制艾滋病毒流行的关键，在这些地区，HTC主要通过自愿咨询检测（VCT）、提供者发起的检测与咨询（PITC）以及上门咨询检测（HBVCT）来实施。在设计新的干预措施时，必须考虑围绕采用HTC模式的决策过程。HTC中的咨询旨在减少检测后冒险行为，并将个人与护理联系起来，但其效果尚不清楚。这项元民族志研究旨在了解东非和南部非洲采用HTC的背景，并分析基于咨询的干预措施在性行为和护理联系方面的感知影响。
我们对2003年至2014年4月期间调查东非和南部非洲HTC的研究进行了系统的文献综述。通过检索和额外的滚雪球式搜索，确定了20项符合我们选择标准的研究。这些研究通过主题框架分析进行了综合。
对20项定性和混合方法研究进行了元综合，这些研究考察了HTC模式在东非和南部非洲的影响。VCT决策是个人做出的，而HBVCT决策则基于家庭和社区单位。PITC与医疗服务提供者的强制行为有关。个人面临的低质量咨询内容和多重交叉障碍意味着，HTC中的咨询在减少检测后风险行为方面未被视为有效，在促进护理联系方面的感知效果也有限。
HBVCT的污名化程度最低，应被视为优先领域。HTC干预措施中的咨询内容在传播有关艾滋病毒和性风险的信息方面是有效的，但在解决阻止性行为改变和调节获得护理机会的更广泛个人情况方面被视为无效。
