A clinical audit of provider-initiated HIV counselling and testing in a gynaecological ward of a district hospital in KwaZulu-Natal, South Africa

Abstract

Background. Early initiation of antiretroviral therapy reduces transmission of HIV and prolongs life. Expansion of HIV testing is therefore pivotal in overcoming the HIV pandemic. Provider-initiated counselling and testing (PICT) at first clinical contact is one way of increasing the number of individuals tested. Our impression is that not all patients admitted to a general gynaecological ward are offered PICT.
Objective. To assess whether patients admitted to a gynaecological ward in a district-level hospital in KwaZulu-Natal, South Africa, are being offered PICT.
Methods. We conducted a retrospective chart review over an 8-month period. Patients who had a hospital stay of 3 days were enrolled. The case records were reviewed and relevant data, including demographic  information and whether the patients were offered HIV testing, were recorded.
Results. Of 1 014 patients, 451 reported that they had been tested  previously; 98 (21.7%) of these were HIV-infected. There were therefore 916 patients (563 not tested previously and 353 who reported that they had tested negatively previously) who should have been offered PICT. Of these, 157 (17.1%) were offered it; 116 (73.9%) accepted and 41  declined. Forty-five (38.8%) tested positive.
Conclusion. A large number of patients who stayed for 3 days in a  gynaecology ward of a district-level hospital were not offered PICT.  However, the high rate of HIV infection in those who accepted the offer of testing strengthens the case for PICT.