Abstract
Objectives
The study aimed to assess the fidelity to the intended content of the WHO/UNAID's provider-initiated opt-out HIV testing policy in 12 antenatal clinics across three regions in Ghana. Specifically, the focus was on understanding the implementation of key components, including informed consent, confidentiality, counselling, and connection to care.
Methods
Carroll's conceptual framework of implementation fidelity guided the quantitative data collection in the 12 antenatal clinics across three regions in Ghana. We measured adherence through brief facility surveys, healthcare providers, pregnant women's self-reports and structured observation of counselling sessions. Descriptive statistical analysis was used to describe the sample and antenatal clinic characteristics. The percentage means and standard deviation (SD) of components delivered were used to calculate fidelity scores.
Results
Routine provider-initiated HIV testing was widely available in the 12 antenatal clinics. Although adherence to test coverage was high (98.1%), just under half (41.7%) of the clinics surveyed obtained informed consent through the recommended opt-out approach. Adherence to the content of consent, confidentiality, counselling, and connection to care was low (38%) for direct observation, moderate (54%) for pregnant woman self-reports and moderately high (78.9%) for healthcare provider self-reports.
Conclusions
There is evidence of low to moderate fidelity to the intended content of the provider-initiated HIV testing in the 12 antenatal clinics. Gaps in the content delivery could limit the achievement of rights-based testing and may explain the lack of impact in the HIV testing efforts.