Practices and Barriers to Provider-initiated HIV Testing and Counseling (PITC) among Midwives, Nurses and Physicians in Côte d'Ivoire
Background: Despite the implantation of Provider Initiated Testing and Counselling (PITC) in 2009, testing proposal remains lows in Cote d'Ivoire, even in recommended situations. The purpose of this study is to identify the practices and obstacles to PITC among midwives, nurses and physicians in Côte d´Ivoire. Methods: A nationally representative cross-sectional survey was conducted in 2018 by telephone among three separate samples of midwives, nurses and physicians practicing in Côte d´Ivoire. The number of HIV tests proposed during consultation in the month preceding the survey was collected for each professional. Factors associated with the number of proposed tests were identified through ordinal logistic regression models. These factors were classified in three dimensions according to the conceptual framework of work performance (Motivation-Capability-Opportunity). Results: A total of 298 midwives, 308 nurses and 289 physicians were interviewed. Midwives proposed the test more frequently, followed by nurses and physicians. Among midwives, a higher number of proposed test was associated with the perceptions (motivation dimension) that HIV testing do not require a specific consent compared to other diseases (aOR 4,00 [95% CI 1.37-14.29]). Among nurses, having received a HIV training (i.e. capability) and the presence of community HIV counselors (i.e. opportunity) was associated with a higher number of proposed tests (aOR 2.03 [1.33-3.12] and aOR 1.86 [1.21-2.87] respectively). For physicians, the presence of a voluntary testing center (i.e. opportunity) was associated with a higher number of proposed tests (aOR 1.69 [1.01-2.86]). Conclusion: PITC practices and barriers were different across professions. Beyond improving environmental opportunities such as dedicated staff or services, strengthening the motivations and capabilities of healthcare professionals to propose testing could improve PITC coverage.