Provider perspectives on client and provider-initiated HIV testing service models at the Kenyatta National Hospital

Abstract

Objective: To compare provider perspectives on processes, staff, and physical infrastructure between client (CITC) and provider-initiated testing counselling (PITC) models.

Design: Cross-sectional study.

Setting: Kenyatta National Hospital (KNH).

Participants: HIV testing service (HTS) providers at the voluntary counselling and testing center (VCT), out-patient departments, and in-patient wards.

Main outcome measures: Provider perspectives rated using a 5-point Likert scale. Multivariate analysis was used to compare perspectives on processes, staff, and physical infrastructure between the two models.

Results: Providers were predominantly female (67%), median age 35 years, and with university education (63%). Providers rated the CITC processes higher (4.51) than those at PITC (3.98), mainly due to challenges with PITC booking processes. Waiting time before booking for HTS (PITC: 3.08, CITC: 4.33, χ 2 =20.44, p-value: 0.01), the booking process for HTS (PITC: 3.08, CITC: 4.67, χ 2 =20.88, p-value: 0.01) and waiting time after booking prior to HIV testing (PITC: 3.17, CITC: 4.42, χ 2 =17.78, p-value: 0.01) were significantly longer at PITC. On staff performance, providers felt that the booking staff supporting PITC were not as readily available (PITC: 3.75, CITC: 4.17, χ 2 =5.88, p-value: 0.027) or as friendly (PITC: 3.83, CITC: 4.17, χ 2 = 6.96, p-value= 0.037) as those at CITC, which was statistically significantly. Physical infrastructure was rated lowest overall, with PITC infrastructure (3.62) rated a lot lower than that at CITC (4.33).

Conclusion: Improvements in booking processes and physical infrastructure, especially at the PITC, will likely improve overall HTS provision at KNH VCT.