Start / Projects / The Multi-Country African Study on Testing and Counselling for HIV (MATCH)
HIV counseling and testing practices in Sub-Sahara Africa have changed dramatically in recent years due to the scaling up of anti-retroviral treatment (ART) programs. Provider-initiated HIV testing and counseling (PITC) is now becoming routine in a wide variety of African health facilities, and there are calls in some settings for mandatory testing. Until recently, African AIDS programs followed a voluntary counseling and testing (VCT) approach, in which clients would be given pre-test counseling in privacy, followed - if the client still wanted it - by the test itself. But VCT has only reached a limited proportion of the population: WHO reports that just 10% of people in most African countries know their HIV status (WHO 2007). By increasing uptake of HIV testing, the aim of PITC is explicitly to increase access to follow-up care and treatment for people living with HIV and AIDS.
This multi-site study has three objectives:
- to analyze the determinants of HIV test uptake in Malawi, Uganda, Kenya and Burkina Faso (the first three countries have high HIV prevalence rates, and are moving towards a PITC model, while Burkina Faso still predominantly implements VCT);
- to describe consent, confidentiality and counseling procedures from the perspective of health workers and their clients in a variety of health care settings (e.g. antenatal care, outpatient departments, TB clinics);
- to describe access (or lack of it) to follow-up care and social support as well as issues related to stigma and discrimination.
The study is conducted by multi-disciplinary teams in each participating country, including medical anthropologists and epidemiologists. Multi-level statistical methods are used to assess determinants of uptake and analyze differentials in access to follow-up care, while anthropological methods are used to validate these findings and to formulate hypotheses for subsequent testing.
This study contributes to our understanding of institutional change processes and allows us to develop advanced methodology to investigate differential uptake of and access to services. Preliminary qualitative findings suggest that both health care workers and clients are pleased with the routine provision of HIV tests in African health services. Uptake is increasing rapidly, creating pressures on understaffed health institutions to deal with ever-expanding follow-up care and social support needs.
Partners:
- Amsterdam School for Social Science Research (ASSR)
- World Health Organization (WHO)
- University of Aix-en-Provence
Funded by the U.S. National Institutes of Health (NIH)
Period: 1 September 2007 - 1 September 2012
Researchers: