Integration of HIV Testing and Counseling (HTC) into Voluntary Medical Male Circumcision: Factors influencing quality of HTC and links to client outcomes

Background:  While integration of HIV testing and counseling (HTC) into Voluntary Medical Male Circumcision (VMMC) presents an opportunity to test more men, there is concern that pressure to generate large numbers of circumcisions will result in diminishing quality of HTC.  In turn, low quality HTC may lead to client dissatisfaction and poor information retention.  This study aims to identify factors influencing quality of HTC offered within Tanzania’s VMMC program, and to determine the relationship between HTC quality and client outcomes, including satisfaction and information retention.

Methods: Structured provider-client counseling observations were conducted at clinics in Iringa, Tanzania (n=307).  In addition, surveys were administered to clients attending 48-hour follow-up appointments (n=320).  Observations and surveys were linked. A quality score was generated from observation data; client satisfaction and information retention measures were constructed from client survey data.  Bivariate relationships between facility-level predictors and quality of HTC, and between HTC quality and client outcomes were modeled using linear regression. 

Results: Temporary VMMC sites with low client load delivered the highest quality HTC, compared to temporary sites with high client load and permanent sites (p<0.01).  Clients who received high quality HTC reported higher satisfaction and demonstrated better HIV prevention information retention than clients who received medium or low quality HTC (p<0.05).

Conclusion: These results affirm the importance of quality in influencing client satisfaction and information retention and suggest that the high morale that accompanies establishment of temporary VMMC sites, coupled with a manageable client load, are key factors in enabling quality HTC service provision.