High Rate of HIV- Positives in a Surgery Focused Medical Outreach in Jos Nigeria: Lessons from a Provider Initiated HIV Counseling and Testing

Abstract

Background: Despite the multisectoral response to HIV epidemic and the promotion of combination prevention with HIV Counseling and Testing (HCT) as an entry into Treatment, Care and Support, coverage has remained low and certain HIV positive persons continue to witness stigmatization and discrimination.Though strategies to scale up HCT services have largely promoted provider initiated mobile HCT including home testing, we investigated the outcome of a provider initiated faith based organization, Faith Alive Foundation and Hospital located in Jos and its facility based HCT among pre-surgical patients in Jos Plateau state, North Central Nigeria.Methods: We conducted a cross sectional survey among pre-surgical patients at Faith Alive Foundation and Hospital in Jos Plateau state from 16-20th December 2013. Participants were selected by simple random as they presented at the hospital after vital signs and clinical diagnosis. HIV Counseling and Testing was provided according to the National guidelines and standards with the “opt out” algorithm.Data were captured and analyzed on Epi Info 6.04. Cross tabulations were used to generate descriptive statistics including frequency distribution, percentages and Fisher’s exact odds ratios at 95% confidence limits with 5% probability level of significance. Results:More than half (56%) of participants were males, 44% were females with a median age of 39 years. HIV seropositive rate was at least two fold higher in females than in male participants and overall HIV positive estimate was 12.2% ( 95%CI , 9.6 – 16.3). In addition, majority (84%) of surgical presentations identified during the outreach were hernia cases (33%), and the rest lipoma (25%), appendicitis (12%) and other forms of lumps (12%). Response rate during the provider initiated pre-surgical HCT “opt-out” design was 100%.Conclusion: Though strategies to scale up HCT services have largely promoted provider initiated mobile HCT, we found high rate of HIV in a provider initiated facility based HCT among pre-surgical patients in Jos, Plateau state of North Central Nigeria with 100% response rate in an “opt-out” design.Therefore, pre-surgical Patient Initiated HIV Testing and Counseling (PITC) is a viable strategy that may significantly contribute towards Universal Access to HIV/AIDS prevention service