Strengthening provider-initiated testing and counselling in Zimbabwe by deploying supplemental providers: a time series analysis

• Main Authors: Aaron F. Bochner, Beth A. Tippett Barr, Batsirai Makunike, Gloria Gonese, Blessing Wazara, Richard Mashapa, Elizabeth Meacham, Ponesai Nyika, Gertrude Ncube, Shirish Balachandra, Ruth Levine, Frances Petracca, Tsitsi Apollo, Ann Downer, Stefan Z. Wiktor
• Format: Article
• Language: English
• Published: BMC 2019-06-01
• Series: BMC Health Services Research
• Subjects: HIV testing services; Provider initiated testing and counselling; Human resources; Zimbabwe; Implementation science
• Online Access: http://link.springer.com/article/10.1186/s12913-019-4169-z

Abstract Background Expansion of provider-initiated testing and counselling (PITC) is one strategy to increase accessibility of HIV testing services. Insufficient human resources was identified as a primary barrier to increasing PITC coverage in Zimbabwe. We evaluated if deployment of supplemental PITC providers at public facilities in Zimbabwe was associated with increased numbers of individuals tested and diagnosed with HIV. Methods From July 2016 to May 2017, International Training and Education Center for Health (I-TECH) deployed 138 PITC providers to supplement existing ministry healthcare workers offering PITC at 249 facilities. These supplemental providers were assigned to facilities on a weekly basis. Each week, I-TECH providers reported the number of HIV tests and positive diagnoses they performed. Using routine reporting systems, we obtained from each facility the number of clients tested and diagnosed with HIV per month. Including data both before and during the intervention period, and utilizing the weekly variability in placement locations of the supplemental PITC providers, we employed generalized estimating equations to assess if the placement of supplemental PITC providers at a facility was associated with a change in facility outputs. Results Supplemental PITC providers performed an average of 62 (SD = 52) HIV tests per week and diagnosed 4.4 (SD = 4.9) individuals with HIV per week. However, using facility reports from the same period, we found that each person-week of PITC provider deployment at a facility was associated with an additional 16.7 (95% CI, 12.2–21.1) individuals tested and an additional 0.9 (95% CI, 0.5–1.2) individuals diagnosed with HIV. We also found that staff placement at clinics was associated with a larger increase in HIV testing than staff placement at polyclinics or hospitals (24.0 vs. 9.8; p < 0.001). Conclusions This program resulted in increased numbers of individuals tested and diagnosed with HIV. The discrepancy between the average weekly HIV tests conducted by supplemental PITC providers (62) and the increase in facility-level HIV tests associated with one week of PITC provider deployment (16.7) suggests that supplemental PITC providers displaced existing staff who may have been reassigned to fulfil other duties at the facility.