Role of Targeted Testing using Provider Initiated Testing and Counseling (PITC) as a Model to Identify more HIV Positive Clients in Nigeria

Background: Jhpiego is implementing a CDC-funded HIV prevention project focusing on HTC/PMTCT in 15 Nigerian hospitals. All identified HIV+ clients are referred from the point of testing to the closest comprehensive site for further management. The number of HIV+ clients identified and linked to care is one of the tracked indicators. At the onset of the project, generalized counseling and testing and outreach approach was used

With this approach, very few HIV+ clients were identified and linked to care. The project then adopted a PITC model (provider initiated testing and counseling) with targeted testing and improved its two way referral systems using patient escort service. With this model, bulk of HIV testing was carried out in the: Admission wards, STI clinics, TB and other specialized clinics. Outreach was also targeted to Most at Risk Populations.

Methods: The study team then reviewed targeted indicators from the 15-facilities two-years before the introduction of PITC/Escort-model and two-years afterward. Results from the two separate periods were then compared. Results: Results over a period of two-years before PITC implementation shows that 0.8% of the total clients tested were found to be HIV+ compared to 2.8% two-years after its implementation. Furthermore, 93% of HIV+ clients were successfully linked to care with PITC/Escort-model compared to 42% before, These differences were found to be statistically significant (p<0.01)

Conclusion: Implementation of PITC/Escort-model with targeted testing is a valuable strategy to increase case detection,useful in low HIV prevalence settings where programs can not afford to test every available client