Factors associated with acceptance of HIV testing in African outpatient departments: Results from project status (Strengthening HIV Test Access and Treatment Uptake Study)

Background: Health facility-based provider-initiated HIV testing and counseling (HTC) has become a key testing approach in high prevalence settings. Little is known about what influences patients to accept HTC in these settings. Using data from Project STATUS, a randomized trial of HTC in outpatient departments (OPDs), we examined factors associated with HTC acceptance.

Methods: We randomly assigned thirty-six conveniently selected OPDs in South Africa, Tanzania and Uganda to implement one of three HTC models. Eligible patients (aged 18-49, not tested in past year, not known HIV positive) were: (A) referred to on-site voluntary counseling and testing (VCT) for HTC after clinical consultation; (B) offered and provided HTC during clinical consultation; (C) offered and provided HTC before clinical consultation. Data were collected October 2011 through September 2012. We used cluster-randomized survey analysis methods to assess bivariate associations between testing decision, patient, and HTC model, and multiple logistic regression to determine factors associated with HTC acceptance.

Results: Of 22,056 test-eligible patients, 19,964 (91%) were offered HTC and 16,153 (81%) accepted. Patients aged 18-29 (aOR=0.84, 95% CI=0.72-0.97) and 30-39 (aOR=0.83, 95% CI=0.71-0.97) compared with 40-49 were less likely to accept testing. Patients offered HTC in Models A and C were significantly more likely to accept testing (aOR=5.21, 95% CI=2.77-9.79; aOR=4.74, 95% CI=2.34-9.60) compared with Model B patients. Conclusions: HTC acceptance was very high overall, and highest when offered outside clinical consultation suggesting integrating HTC into clinical consultation may be less effective. Findings from STATUS can inform HTC policy and practice in OPD settings.