Changing from anonymous to confidential HIV voluntary counseling and testing in Uganda.

Two thirds of all individuals with HIV worldwide live in Africa where increasingly diagnostic and routine HIV testing is used to refer HIV-infected individuals to care and prevention programmes. This challenges healthcare systems throughout Africa that are interested in integrating care and antiretroviral treatment into prevention programmes because anonymous HIV testing limits the success of referrals to health services and adds costs as a result of repeat testing. The cost of a single HIV counseling and testing session is relatively high and in Uganda is similar (US$13) to the national per capita expenditure on healthcare (US$14). HIV-positive clients benefit from many services including psychosocial support CD4 cell count testing and disease staging cotrimoxazole and isoniazid prophylaxis tuberculosis screening and treatment and provision of antiretroviral treatment if indicated. They also benefit from HIV prevention services such as the prevention of mother-to-child transmission safer sex counseling and condom provision. Many of these interventions require long-term follow-up for maintaining effectiveness and assessing adherence. The provision of these services is impeded within the context of anonymous HIV testing. For example in Uganda national policy states that name-based registration for voluntary counseling and testing (VCT) may occur; however it has been extremely uncommon in practice. (excerpt)