Provider-initiated Testing and Counseling

Integrating HTC into Health Services

Provider-initiated testing and counseling (PITC) is when HTC is offered to patients accessing health services, regardless of the reason for their visit. PITC allows for more people to learn their HIV status and get linked to treatment and support services. Here, AIDSTAR-One provides PITC resources including a selection of literature, country PITC policies, assessment tools, and reports and guidelines.

About this resource

Introduction

HTC is a critical component of and gateway to HIV prevention, care, and treatment services, which reduce morbidity, mortality, and HIV transmission. As access to HIV services has grown, numerous approaches to HTC have emerged, including client-initiated HTC (or "voluntary counseling and testing"), and community-based HTC, as well as PITC. To facilitate PITC, clinical providers initiate or recommend HTC as a standard component of medical care in a range of medical settings, such as tuberculosis (TB) clinics, voluntary medical male circumcision (VMMC) sites, antenatal care (ANC) and labor/delivery sites, drug treatment programs, and general clinical care.

The 2007 World Health Organization/UNAIDS Guidance on PITC in Health Facilities defines PITC as "HIV testing and counseling which is recommended by health care providers to persons attending health care facilities as a standard component of medical care." This approach to HTC is increasingly used to facilitate diagnosis and access to HIV-related services by engaging clients at health facilities, a key setting for reaching individuals in need of HTC services. As of 2009, two-thirds of the countries in sub-Saharan Africa, Latin America, and the Caribbean have developed HIV testing and counseling policies or guidelines incorporating PITC. Since the release of the 2007 WHO guidelines, researchers and implementers have published several studies on PITC, some of which supplement related AIDSTAR-One PITC materials.

The PITC Literature Selection also contains resources on the feasibility, acceptability, and efficacy of PITC, and discusses opportunities and challenges. The Literature Selection provides an abbreviated database of PITC information for HIV policymakers, program planners, and implementers initiating PITC policies or programs.

PITC strengths identified from the literature include:

  • High feasibility and acceptability
  • Increased uptake of testing in ANC, TB, pediatric, and general health care settings
  • Ability to successfully link patients to HIV care and treatment
  • Ability to engage lay counselors and incorporate task-shifting approaches.

 

PITC challenges identified from the literature across a variety of settings include:

  • Poor linkages and referrals to high-quality HIV-related services
  • Limited availability of rapid HIV test kits, other commodities, and medications
  • Limited laboratory capacity
  • Ineffective or limited data collection tools
  • Limited human resource capacity, including the capacity to counsel and educate
  • Limited space for counseling
  • Problems with the quality and availability of HIV testing.

 

As approaches to implementing PITC evolve and HTC strategic scale-up efforts continue, the challenges with effective linkages and referral to care and treatment remain; there is limited literature on this issue. Please see the PEPFAR HTC Technical Considerations for specific guidance on approaches to PITC by epidemic type.