Effectiveness of provider-initiated testing and counseling in increasing HIV testing and counselling utilization and HIV detection rates in Ebonyi State, South-Eastern Nigeria.

HIV testing and counselling is crucial in identifying new HIV cases and linking them to treatment. Provider-initiated testing and counselling can help to increase uptake of HIV testing and counselling and HIV case detection. We implemented provider-initiated testing and counselling in 32 health facilities in Ebonyi State, South-East Nigeria in order to achieve both objectives. Provider-initiated testing and counselling was implemented across the 32 facilities from January to June 2016. Provider-initiated testing and counselling data were compared with the preceding six months (July–December 2015) when only voluntary counselling and testing was done. A total of 11,787 out of 22,153 who visited the outpatient clinics within the intervention period (53%) were tested. In the preceding six months, only 3172 clients were tested via voluntary counselling and testing out of 50,898 clients who visited the outpatient clinics (6.2%). This was a 3.72-fold increase over the numbers tested via voluntary counselling and testing, within a similar time frame. Also, 158 new cases were diagnosed during the period from provider-initiated testing and counselling compared to 24 from voluntary counselling and testing in the preceding six months – an increase of 4.65-fold in case detection. Apart from the 11,787 tested through provider-initiated testing and counselling, another 6999 clients were tested through community-based outreaches during the intervention period. Comparison of case detection between both strategies shows that provider-initiated testing and counselling accounted for 158 cases (97%) while outreaches accounted for only five cases (3%). Provider-initiated testing and counselling led to an increase in uptake of HIV testing and counselling services as well as in HIV case detection across the 32 facilities where our programme was implemented.