Witzel, T.C., Lora, W., Lees, S., and Desmond, N. PLOS ONE (February 2017), 12(2): e0170588, eCollection 2017, doi:10.1371/journal.pone.0170588.
This meta-ethnography examined the context and efficacy of HIV testing and counseling (HTC) uptake in East and Southern Africa and analyzed the perceived impacts of counseling on sexual behavior and linkage to care. HTC is usually delivered through voluntary counseling and testing (VCT), provider-initiated counseling and testing (PITC), and home-based voluntary counseling and testing (HBVCT). Following a systematic literature review, the authors identified 20 qualitative and mixed-method studies conducted from 2003 through April 2014. They found that decisions on VCT were made individually, usually related to prolonged illness or perceived risk, and also in the context of mutual encouragement by peers. Decisions on HBVCT were made in families and communities, often through the influence of partners, village chiefs, and counselors. PITC was associated with coercion from providers, especially in antenatal care settings where women did not feel able to refuse testing. Numerous factors, especially stigma, the quality of health services, fear of test outcomes, and gender norms, facilitated or impeded uptake of the different testing models. The authors concluded that HBVCT, which minimizes stigma, should be prioritized. They added that although good counseling can effectively convey information on HIV and sexual risk, it was seen as ineffective in addressing broader personal circumstances that affect sexual risk behavior and access to care.