Table 3 Similarities and differences between the VCT and the PITC interventions for STI patients in Cape town

Patient access

• Client-initiated: patients come on their own initiative or are medically referred for HIV testing.

• Provider-initiated: patients come to the clinic because they are seeking treatment for STI-related symptoms.

• Patients anticipate being tested for HIV at their clinic visit.

• The STI nurse offers all STI patients an HIV test, irrespective of their presenting complaint.

Providers

• Usually provided by trained lay counsellors.

• Professional healthcare providers (STI nurses) trained to provide PITC.

• Basic counselling training can be lengthy (10 to 20 days).

• Training is short (2 days) and is focused on how to offer the test and how to get informed consent from patients.

Primary purpose of the intervention

• The primary purpose is to promote uptake of HIV testing and to link people to HIV care and prevention services.

• The primary purpose is, similarly, to promote uptake of HIV testing and increase the number of people who know their HIV status.

• The emphasis is on assessing patient readiness to test, and the counsellor is supposed to remain neutral about the choice (and not to promote taking the HIV test as the preferred option).

• The intervention also aims to integrate HIV testing efficiently into a regular STI consultation, while still respecting the need for patient informed consent.

• The provider can promote HIV testing as the medically recommended option (rather than remaining neutral about the preferred choice).

Pre-test encounter

• Patient-centred counselling techniques focus on promoting an informed decision and include basic HIV information, risk assessment, test-readiness assessment, and risk reduction messages.

• Offer of HIV testing is introduced using regular clinical communication as part of the STI consultation.

• Written informed consent for testing is obtained.

• This involves a brief explanation of why an HIV test is recommended in the context of an STI consultation, a brief assessment of the patient’s readiness to test for HIV, offering the HIV test and opportunity for the patient to ask questions. Risk assessment and risk reduction are dealt with as part of the regular STI consultation.

• Can take up to 25 minutes.

• Written informed consent for testing is obtained.

• Intervention is meant to add maximum 5 to 10 minutes to the STI consultation when efficiently integrated.

The HIV test

• Due to limits to their scope of practice, lay counsellors cannot perform the rapid HIV test themselves.

• The nurse does the HIV rapid test along with other blood tests during the STI consultation, which reduces waiting time for patients.

• The rapid test is performed by a nurse, which may involve some waiting time.

Post-test and follow-up care

• The nurse communicates the result of the rapid HIV test to the lay counsellor.

• The nurse refers the patient to a lay counsellor in the facility, to receive the HIV test result and post-test counselling.

• The lay counsellor then informs the patient and provides post-test counselling.

• The patient may need to wait for a lay counsellor to be available.

• The primary focus is on providing emotional support for HIV-positive patients and linking them to care, as well as providing risk reduction messages for HIV-positive and HIV-negative patients.

• The primary focus is similarly on emotional support for HIV-positive patients, but with stronger linkage to HIV care (e.g., the nurse does the CD4 blood test on the same day, and the patient is encouraged to attend follow-up sessions with the lay counsellor).

• Lay counsellors are encouraged to provide up to three follow-up counselling sessions with HIV-positive patients.

• There is less focus on HIV-negative patients.