AIDS and Behavior

, Volume 17, Issue 5, pp 1571–1590 | Cite as

Provider-Initiated HIV Testing and Counseling in Low- and Middle-Income Countries: A Systematic Review

  • Caitlin E. KennedyEmail author
  • Virginia A. Fonner
  • Michael D. Sweat
  • F. Amolo Okero
  • Rachel Baggaley
  • Kevin R. O’Reilly
Original Paper


Provider-initiated HIV testing and counseling (PITC) has expanded since 2007 WHO guidelines were established. We conducted a systematic review of PITC in low- and middle-income countries. Peer-reviewed studies were included if they measured pre-post or multi-arm outcomes. Two coders abstracted data using standardized forms. Nineteen studies were included, all from sub-Saharan Africa (N = 15) or Asia (N = 4). Studies were conducted in clinics for antenatal/family planning/child health (N = 12), tuberculosis (N = 4), outpatient (N = 1), sexually transmitted diseases (N = 1), and methadone maintenance (N = 1). HIV testing uptake increased after PITC. Condom use also increased following PITC in most studies; nevirapine uptake and other outcomes were mixed. Few negative outcomes were identified. Findings support PITC as an important intervention to increase HIV testing. PITC’s impact on other outcomes is mixed, but does not appear to be worse than voluntary counseling and testing. PITC should continue to be expanded and rigorously evaluated across settings and outcomes.


Provider-initiated testing and counseling HIV testing Systematic review 


Los servicios de pruebas de VIH y asesoramiento (PITC por sus siglas en inglés) se ha ampliado desde que las directrices del 2007 de la OMS fueron establecidas. Llevamos a cabo una revisión sistemática del PITC en países de bajos y medianos ingresos. Estudios revisados se incluyeron si medían resultados antes-despues o múltiple brazo. Dos codificadores obtuvieron los datos mediante formularios estandarizados. Se incluyen diecinueve estudios, todos ellos de África subsahariana (N = 15) o de Asia (N = 4). Los estudios se llevaron a cabo en las clínicas de atención prenatal / planificación familiar / salud infantil (N = 12), tuberculosis (N = 4), para pacientes ambulatorios (N = 1), enfermedades de transmisión sexual (N = 1), y de mantenimiento con metadona (N = 1). La captación de las pruebas del VIH aumentó después de PITC. El uso de condones también aumentó después de PITC en la mayoría de los estudios, la utilización de nevirapina y otros resultados fueron variados. Se identificaron pocos resultados negativos. Los resultados apoyan la premisa de que el PITC es una intervención importante para aumentar las pruebas de VIH. El impacto del PITC en otros resultados es variado, pero no demuestra menor eficiencia que el asesoramiento y pruebas voluntarias. El PITC debe seguir ampliándose y evaluándose rigurosamente en todos los entornos y los resultados.



This research was supported by the US National Institute of Mental Health, grant number 1R01MH090173. We wish to thank Samantha Dovey, Jewel Gausman, Alexandria Smith, Eugenia Pyntikova, Hieu Pham, Tina Dickenson, Erica Layer, Jeremy Lapedis, Aisha Yansaneh, and Lindsay Litwin for their screening and coding work on this review.


  1. 1.
    WHO. Guidance on provider-initiated HIV testing and counselling in health facilities 2007.Google Scholar
  2. 2.
    Bayer R, Edington C. HIV testing, human rights, and global AIDS policy: exceptionalism and its discontents. J Health Polit Policy Law. 2009;34(3):301–23.PubMedCrossRefGoogle Scholar
  3. 3.
    Denison JA, O’Reilly KR, Schmid GP, Kennedy CE, Sweat MD. HIV voluntary counseling and testing and behavioral risk reduction in developing countries: a meta-analysis, 1990–2005. AIDS Behav. 2008;12(3):363–73.PubMedCrossRefGoogle Scholar
  4. 4.
    Hensen B, Baggaley R, Wong VJ, Grabbe KL, Shaffer N, Lo YR, et al. Universal voluntary HIV testing in antenatal care settings: a review of the contribution of provider-initiated testing & counselling. Trop Med Int Health. 2012;17(1):59–70.Google Scholar
  5. 5.
    Bertrand JT, O’Reilly K, Denison J, Anhang R, Sweat M. Systematic review of the effectiveness of mass communication programs to change HIV/AIDS-related behaviors in developing countries. Health Educ Res. 2006;21(4):567–97.PubMedCrossRefGoogle Scholar
  6. 6.
    Sweat M, O’Reilly K, Kennedy C, Medley A. Psychosocial support for HIV-infected populations in developing countries: a key yet understudied component of positive prevention. AIDS. 2007;21(8):1070–1.PubMedCrossRefGoogle Scholar
  7. 7.
    Kennedy C, O’Reilly K, Medley A, Sweat M. The impact of HIV treatment on risk behaviour in developing countries: a systematic review. AIDS Care. 2007;19(6):707–20.PubMedCrossRefGoogle Scholar
  8. 8.
    Medley A, Kennedy C, O’Reilly K, Sweat M. Effectiveness of peer education interventions for HIV prevention in developing countries: a systematic review and meta-analysis. AIDS Educ Prev. 2009;21(3):181–206.PubMedCrossRefGoogle Scholar
  9. 9.
    Kennedy CE, Medley AM, Sweat MD, O’Reilly KR. Behavioural interventions for HIV positive prevention in developing countries: a systematic review and meta-analysis. Bull World Health Organ. 2010;88(8):615–23.PubMedCrossRefGoogle Scholar
  10. 10.
    Sweat MD, Denison J, Kennedy CE, Tedrow V, O’Reilly KR. Effects of condom social marketing on condom use in developing countries: a systematic review and meta-analysis: 1990–2010. Bull World Health Organ. 2012 (in press).Google Scholar
  11. 11.
    Moher D, Liberati A, Tetzlaff J, Altman DG. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Ann Intern Med. 2009;151(4):264–9, W64.Google Scholar
  12. 12.
  13. 13.
    Allen S, Serufilira A, Bogaerts J, Van de Perre P, Nsengumuremyi F, Lindan C, et al. Confidential HIV testing and condom promotion in Africa: impact on HIV and gonorrhea rates. J Am Med Assoc. 1992;268(23):3338–43.CrossRefGoogle Scholar
  14. 14.
    Allen S, Serufilira A, Gruber V, Kegeles S, Van de Perre P, Carael M, et al. Pregnancy and contraception use among urban Rwandan women after HIV testing and counseling. Am J Public Health. 1993;83(5):705–10.PubMedCrossRefGoogle Scholar
  15. 15.
    Allen S, Tice J, Van de Perre P, Serufilira A, Hudes E, Nsengumuremyi F, et al. Effect of serotesting with counselling on condom use and seroconversion among HIV discordant couples in Africa. BMJ. 1992;304(6842):1605–9.PubMedCrossRefGoogle Scholar
  16. 16.
    Bentley ME, Spratt K, Shepherd ME, Gangakhedkar RR, Thilikavathi S, Bollinger RC, et al. HIV testing and counseling among men attending sexually transmitted disease clinics in Pune, India: changes in condom use and sexual behavior over time. AIDS. 1998;12(14):1869–77.PubMedCrossRefGoogle Scholar
  17. 17.
    Brou H, Viho I, Djohan G, Ekouevi DK, Zanou B, Leroy V, et al. Contraceptive use and incidence of pregnancy among women after HIV testing in Abidjan, Ivory Coast. Rev Epidemiol Sante Publique. 2009;57(2):77–86.PubMedCrossRefGoogle Scholar
  18. 18.
    Chandisarewa W, Stranix-Chibanda L, Chirapa E, Miller A, Simoyi M, Mahomva A, et al. Routine offer of antenatal HIV testing (“opt-out” approach) to prevent mother-to-child transmission of HIV in urban Zimbabwe. Bull World Health Organ. 2007;85(11):843–50.PubMedGoogle Scholar
  19. 19.
    Creek TL, Ntumy R, Seipone K, Smith M, Mogodi M, Smit M, et al. Successful introduction of routine opt-out HIV testing in antenatal care in Botswana. J Acquir Immune Defic Syndr. 2007;45(1):102–7.PubMedCrossRefGoogle Scholar
  20. 20.
    Desgrées-Du-Loû A, Brou H, Djohan G, Becquet R, Ekouevi D, Zanou B, et al. Beneficial effects of offering prenatal HIV counselling and testing on developing a HIV preventive attitude among couples. Abidjan, 2002–2005. AIDS Behav. 2009;13(2):348–55.PubMedCrossRefGoogle Scholar
  21. 21.
    Harris JB, Hatwiinda SM, Randels KM, Chi BH, Kancheya NG, Jham MA, et al. Early lessons from the integration of tuberculosis and HIV services in primary care centers in Lusaka, Zambia. Int J Tuberc Lung Dis. 2008;12(7):773–9.PubMedGoogle Scholar
  22. 22.
    Huerga H, Spillane H, Guerrero W, Odongo A, Varaine F. Impact of introducing human immunodeficiency virus testing, treatment and care in a tuberculosis clinic in rural Kenya. Int J Tuberc Lung Dis. 2010;14(5):611–5.PubMedGoogle Scholar
  23. 23.
    Khoshnood K, Wilson KS, Filardo G, Liu Z, Keung NH, Wu Z. Assessing the efficacy of a voluntary HIV counseling and testing intervention for pregnant women and male partners in Urumqi City, China. AIDS Behav. 2006;10(6):671–81.PubMedCrossRefGoogle Scholar
  24. 24.
    Kiene SM, Bateganya M, Wanyenze R, Lule H, Nantaba H, Stein MD. Initial outcomes of provider-initiated routine HIV testing and counseling during outpatient care at a rural Ugandan hospital: risky sexual behavior, partner HIV testing, disclosure, and HIV care seeking. AIDS Patient Care STDS. 2010;24(2):117–26.PubMedCrossRefGoogle Scholar
  25. 25.
    Moses A, Zimba C, Kamanga E, Nkhoma J, Maida A, Martinson F, et al. Prevention of mother-to-child transmission: program changes and the effect on uptake of the HIVNET 012 regimen in Malawi. AIDS. 2008;22(1):83–7.PubMedCrossRefGoogle Scholar
  26. 26.
    Pang L, Hao Y, Mi G, Wang C, Luo W, Rou K, et al. Effectiveness of first eight methadone maintenance treatment clinics in China. AIDS. 2007;21(Suppl 8):S103–7.PubMedCrossRefGoogle Scholar
  27. 27.
    Stringer JSA, Sinkala M, Stout JP, Goldenberg RL, Acosta EP, Chapman V, et al. Comparison of two strategies for administering nevirapine to prevent perinatal HIV transmission in high-prevalence, resource-poor settings. J Acquir Immune Defic Syndr. 2003;32(5):506–13.PubMedCrossRefGoogle Scholar
  28. 28.
    Van Rie A, Sabue M, Jarrett N, Westreich D, Behets F, Kokolomani J, et al. Counseling and testing TB patients for HIV: evaluation of three implementation models in Kinshasa, Congo. Int J Tuberc Lung Dis. 2008;12(3 Suppl 1):73–8.PubMedGoogle Scholar
  29. 29.
    van’t Hoog AH, Mbori-Ngacha DA, Marum LH, Otieno JA, Misore AO, Nganga LW, et al. Preventing mother-to-child transmission of HIV in Western Kenya: operational issues. J Acquir Immune Defic Syndr. 2005;40(3):344–9.CrossRefGoogle Scholar
  30. 30.
    Wiktor SZ, Abouya L, Angoran H, McFarland J, Sassan-Morokro M, Tossou O, et al. Effect of an HIV counseling and testing program on AIDS-related knowledge and practices in tuberculosis clinics in Abidjan, Cote d’Ivoire. Int J Tuberc Lung Dis. 2004;8(4):445–50.PubMedGoogle Scholar
  31. 31.
    Xu F, Kilmarx PH, Supawitkul S, Manopaiboon C, Yanpaisarn S, Limpakarnjanarat K, et al. Incidence of HIV-1 infection and effects of clinic-based counseling on HIV preventive behaviors among married women in northern Thailand. J Acquir Immune Defic Syndr. 2002;29(3):284–8.PubMedGoogle Scholar
  32. 32.
    World Health Organization. Towards universal access: scaling up priority HIV/AIDS interventions in the health sector: progress report. Geneva: World Health Organization; 2008.Google Scholar
  33. 33.
    Sabin M, Lo YR. Progress in providing HIV testing and counseling in health facilities: WHO/UNAIDS guidance. JAMA. 2010;304(3):342–3.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2012

Authors and Affiliations

  • Caitlin E. Kennedy
    • 1
    Email author
  • Virginia A. Fonner
    • 1
  • Michael D. Sweat
    • 2
  • F. Amolo Okero
    • 3
  • Rachel Baggaley
    • 3
  • Kevin R. O’Reilly
    • 3
  1. 1.Social and Behavioral Interventions Program, Department of International Health, Room E5033Johns Hopkins Bloomberg School of Public HealthBaltimoreUSA
  2. 2.The Medical University of South CarolinaCharlestonUSA
  3. 3.World Health OrganizationGenevaSwitzerland

Personalised recommendations