Insights on hiv pre-test counseling following scaling-up of PMTCT program in rural health posts, Burkina Faso.

BACKGROUND: Quality of pre-test counseling in empowering women to make informed decisions related to HIV/AIDS is regarded as a key element to ensure effectiveness of PMTCT interventions. This cross-sectional study examined how well HIV testing services with 'Opt in' strategy are being delivered following scaling-up of PMTCT programs in rural peripheral health centers in Burkina Faso. METHODS: We observed the process of HIV testing service delivery and evaluate 19 pre- test counseling sessions linked with 16 in-depth interviews with the pregnant women. We also conducted interviews with 6 counselors, district health officer and the PMTCT coordinator. Secondary data on acceptance of HIV testing were collected from each study site. RESULTS: The district authority decentralized the implementation of PMTCT service to the peripheral health facility. No health center has on spot HIV testing facility. The proportion of pregnant women agreed to join pre test counseling was very low (7%-29%). Acceptance of HIV testing after PTC was as high as 100%. There is a substantial gap between the standards set by the National Guidelines and the actual practice of conducting the counseling sessions. Major barriers for health workers were lack of training, disruption of service, work load, difficulties to discuss risk behavior with women and lack of partner involvement. Interviewed women were satisfied with the services and majority wanted to disclose their HIV status. CONCLUSION: Our findings warrant regular supervision with refresher training and a focus on quality counseling would help health workers to enhance their performance and support them to comply with the program. Encouraging women to engage in a discussion about testing with their partners with male involvement activity in the community could improve couple testing. Strengthening group counseling and reorganizing the strategy including introduction of on site rapid HIV testing could effectively improve coverage.