HIV testing and care in Burkina Faso, Kenya, Malawi and Uganda: ethics on the ground

BMC International Health and Human Rights

Rachel Baggaley²  Alice Desclaux¹  Ron Bayer³  Sarah Bott⁵  Carla Makhlouf Obermeyer⁴ 

[1] Institut de Recherche pour le Développement, Dakar, Sénégal;HIV/AIDS Department, World Health Organization, Geneva, Switzerland;Center for the History and Ethics of Public Health, Mailman School of Public Health, Columbia University, New York, USA;Center for Research on Population and Health, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon;Independent consultant, Los Angeles, CA, USA

关键词: Mass screening;    Health policy;    Adult;    Health Services Accessibility;    HIV Seropositivity/diagnosis/transmission;    Counseling;    Confidentiality;    Informed consent;    control/transmission;    HIV Infections/diagnosis/drug therapy/prevention &;    Medical;    Ethics;   

Others  :  855328
DOI  :  10.1186/1472-698X-13-6

 received in 2012-05-25, accepted in 2012-12-20,  发布年份 2013

【 摘 要 】

Background

The ethical discourse about HIV testing has undergone a profound transformation in recent years. The greater availability of antiretroviral therapy (ART) has led to a global scaling up of HIV testing and counseling as a gateway to prevention, treatment and care. In response, critics raised important ethical questions, including: How do different testing policies and practices undermine or strengthen informed consent and medical confidentiality? How well do different modalities of testing provide benefits that outweigh risks of harm? To what degree do current testing policies and programs provide equitable access to HIV services? And finally, what lessons have been learned from the field about how to improve the delivery of HIV services to achieve public health objectives and protections for human rights? This article reviews the empirical evidence that has emerged to answer these questions, from four sub-Saharan African countries, namely: Burkina Faso, Kenya, Malawi and Uganda.

Discussion

Expanding access to treatment and prevention in these four countries has made the biomedical benefits of HIV testing increasingly clear. But serious challenges remain with regard to protecting human rights, informed consent and ensuring linkages to care. Policy makers and practitioners are grappling with difficult ethical issues, including how to protect confidentiality, how to strengthen linkages to care, and how to provide equitable access to services, especially for most at risk populations, including men who have sex with men.

Summary

The most salient policy questions about HIV testing in these countries no longer address whether to scale up routine PITC (and other strategies), but how. Instead, individuals, health care providers and policy makers are struggling with a host of difficult ethical questions about how to protect rights, maximize benefits, and mitigate risks in the face of resource scarcity.

【 授权许可】

   
2013 Obermeyer et al.; licensee BioMed Central Ltd.

【 图 表 】

【 参考文献 】

• [1]Bayer R, Fairchild AL: Changing the paradigm for HIV testing–the end of exceptionalism. N Engl J Med 2006, 355(7):647-649.
• [2]WHO, UNAIDS: Guidance on provider-initiated HIV testing and counseling in health facilities. Geneva: World Health Organization; 2007.
• [3]De Cock KM, Mbori-Ngacha D, Marum E: Shadow on the continent: public health and HIV/AIDS in Africa in the 21st century. Lancet 2002, 360(9326):67-72.
• [4]April MD: Rethinking HIV exceptionalism: the ethics of opt-out HIV testing in sub-Saharan Africa. Bull World Health Organ 2010, 88(9):703-708.
• [5]WHO, UNAIDS, UNICEF: Towards universal access: scaling up priority HIV/AIDS interventions in the health sector. Progress Report, 2010. Geneva: World Health Organization, Joint United Nations Programme on HIV/AIDS, UNICEF; 2010.
• [6]WHO: Global HIV/AIDS response: epidemic update and health sector progress towards universal access. Progress Report 2011. Geneva: World Health Organization, Joint United Nations Programme on HIV/AIDS, UNICEF; 2011.
• [7]Bayer R, Edington C: HIV testing, human rights, and global AIDS policy: exceptionalism and its discontents. J Health Polit Policy Law 2009, 34(3):301-323.
• [8]Rennie S, Behets F: Desperately seeking targets: the ethics of routine HIV testing in low-income countries. Bull World Health Organ 2006, 84(1):52-57.
• [9]Evans C, Ndirangu E: The nursing implications of routine provider-initiated HIV testing and counseling in sub-Saharan Africa: a critical review of new policy guidance from WHO/UNAIDS. Int J Nurs Stud 2009, 46(5):723-731.
• [10]Kippax S: A public health dilemma: a testing question. AIDS Care 2006, 18(3):230-235.
• [11]Yeatman SE: Ethical and public health considerations in HIV counseling and testing: policy implications. Stud Fam Plann 2007, 38(4):271-278.
• [12]Gruskin S, Ahmed S, Ferguson L: Provider-initiated HIV testing and counseling in health facilities–what does this mean for the health and human rights of pregnant women? Dev World Bioeth 2008, 8(1):23-32.
• [13]Monjok E, Smesny A, Mgbere O, Essien EJ: Routine HIV testing in health care settings: the deterrent factors to maximal implementation in Sub-Saharan Africa. J Int Assoc Physicians AIDS Care (Chic Ill) 2010, 9(1):23-29.
• [14]Wynia MK: Routine screening: informed consent, stigma and the waning of HIV exceptionalism. Am J Bioeth 2006, 6(4):5-8.
• [15]Smith CB, Battin MP, Francis LP, Jacobson JA: Should rapid tests for HIV infection now be mandatory during pregnancy? global differences in scarcity and a dilemma of technological advance. Dev World Bioeth 2007, 7(2):86-103.
• [16]Masiye F, Ssekubugu R: Routine third party disclosure of HIV results to identifiable sexual partners in Sub-Saharan Africa. Theor Med Bioeth 2008, 29(5):341-348.
• [17]Obermeyer CM, Baijal P, Pegurri E: Facilitating HIV disclosure across diverse settings: a review. Am J Public Health 2011, 101(6):1011-1023.
• [18]Mitchell S, Cockcroft A, Lamothe G, Andersson N: Equity in HIV testing: evidence from a cross-sectional study in ten southern African countries. BMC Int Health Hum Rights 2010, 10:23. BioMed Central Full Text
• [19]Makwiza I, Nyirenda L, Bongololo G, Banda T, Chimzizi R, Theobald S: Who has access to counseling and testing and anti-retroviral therapy in Malawi - an equity analysis. Int J Equity Health 2009, 8:13. BioMed Central Full Text
• [20]World Health Organization Global Health Observatory Data Repository. http://apps.who.int/gho/data/# webcite
• [21]Matovu JK, Makumbi FE: Expanding access to voluntary HIV counseling and testing in sub-Saharan Africa: alternative approaches for improving uptake, 2001-2007. Trop Med Int Health 2007, 12(11):1315-1322.
• [22]Angotti N, Bula A, Gaydosh L, Kimchi EZ, Thornton RL, Yeatman SE: Increasing the acceptability of HIV counseling and testing with three C′s: convenience, confidentiality and credibility. Soc Sci Med 2009, 68(12):2263-2270.
• [23]Bwambale FM, Ssali SN, Byaruhanga S, Kalyango JN, Karamagi CA: Voluntary HIV counseling and testing among men in rural western Uganda: implications for HIV prevention. BMC Publ Health 2008, 8:263. BioMed Central Full Text
• [24]Taegtmeyer M, Kilonzo N, Mung′ala L, Morgan G, Theobald S: Using gender analysis to build voluntary counseling and testing responses in Kenya. Trans R Soc Trop Med Hyg 2006, 100(4):305-311.
• [25]CNLS: Situation de la promotion du conseil dépistage volontaire au Burkina Faso: de 2004 à 2006. Rapport du Programme d′Appui au Monde Associatif et Communautaire à la 6e session du Secrétaire Permanent, Conseil National de Lutte Contre le Sida. Ouagadougou: Conseil National de Lutte Contre le Sida (CNLS), Burkina Faso; 2007.
• [26]PEPFAR: The U.S. President′s Emergency Plan for AIDS Relief: Country specific information. Washington, D.C: Office of U.S. Global AIDS Coordinator and the Bureau of Public Affairs, U.S. State Department; 2011.
• [27]Moses A, Zimba C, Kamanga E, Nkhoma J, Maida A, Martinson F, Mofolo I, Joaki G, Muita J, Spensley A, et al.: Prevention of mother-to-child transmission: program changes and the effect on uptake of the HIVNET 012 regimen in Malawi. AIDS 2008, 22(1):83-87.
• [28]Bemelmans M, van Den Akker T, Ford N, Philips M, Zachariah R, Harries A, Schouten E, Hermann K, Mwagomba B, Massaquoi M: Providing universal access to antiretroviral therapy in Thyolo, Malawi through task shifting and decentralization of HIV/AIDS care. Trop Med Int Health 2010, 15(12):1413-1420.
• [29]Some JF: Statistics on the activities of voluntary counseling and testing in Burkina Faso in 2002 [In French]. Ouagadougou, Burkina Faso: Programme d′Appui au Monde Associatif et Communautaire (PAMAC); 2003.
• [30]Obermeyer CM, Sankara A, Bastien V, Parsons M: Gender and HIV testing in Burkina Faso: an exploratory study. Soc Sci Med 2009, 69(6):877-884.
• [31]UNAIDS: Rapport d′activites sur la riposte au SIDA du Burkina Faso 2012 [Global AIDS response progress reporting, Burkina Faso (GARP 2012)]. Geneva: Joint United Nations Programme on HIV/AIDS (UNAIDS); 2012.
• [32]Alsop Z: Kenya′s HIV-testing drive runs into difficulties. Lancet 2010, 375(9722):1242.
• [33]Lugada E, Millar D, Haskew J, Grabowsky M, Garg N, Vestergaard M, Kahn J, Muraguri N, Mermin J: Rapid implementation of an integrated large-scale HIV counseling and testing, malaria, and diarrhea prevention campaign in rural Kenya. PLoS One 2010, 5(8):e12435.
• [34]Grabbe KL, Menzies N, Taegtmeyer M, Emukule G, Angala P, Mwega I, Musango G, Marum E: Increasing access to HIV counseling and testing through mobile services in Kenya: strategies, utilization, and cost-effectiveness. J Acquir Immune Defic Syndr 2010, 54(3):317-323.
• [35]Tumwesigye E, Wana G, Kasasa S, Muganzi E, Nuwaha F: High uptake of home-based, district-wide, HIV counseling and testing in Uganda. AIDS Patient Care STDS 2010, 24(11):735-741.
• [36]Menzies N, Abang B, Wanyenze R, Nuwaha F, Mugisha B, Coutinho A, Bunnell R, Mermin J, Blandford JM: The costs and effectiveness of four HIV counseling and testing strategies in Uganda. AIDS 2009, 23(3):395-401.
• [37]Odhiambo J, Kizito W, Njoroge A, Wambua N, Nganga L, Mburu M, Mansoer J, Marum L, Phillips E, Chakaya J, et al.: Provider-initiated HIV testing and counseling for TB patients and suspects in Nairobi, Kenya. Int J Tuberc Lung Dis 2008, 12(3 Suppl 1):63-68.
• [38]Zimba C, Kamanga E, Chilongozi D, Martinson F, Kayambo F, Meme J, Hoffman I, Van der Horst C: Impact of routine HIV counseling and testing with an opt-out strategy compared to voluntary counseling and testing in the implementation of PMTCT services, Lilongwe. Toronto: Malawi. In XVI International AIDS Conference; 2006.
• [39]Bassett IV, Walensky RP: Integrating HIV screening into routine health care in resource-limited settings. Clin Infect Dis 2010, 50(Suppl 3):S77-S84.
• [40]WHO: HIV in the WHO African Region: Progress towards achieving universal access to priority health sector interventions, 2011 update. Brazzaville, Republic of Congo: World Health Organization, Regional Office for Africa; 2011.
• [41]Kenya National AIDS Control Council: UNGASS 2010 Country Report – Kenya. Nairobi: Office of the President, National AIDS Control Council, Kenya; 2010.
• [42]Mishra V, Agrawal P, Alva S, Gu Y, Wang S: Changes in HIV-Related Knowledge and Behaviors in Sub-Saharan Africa. Calverton, Maryland, USA: ICF Macro; 2009.
• [43]INSD, ICF International: Enquête Démographique et de Santé et à Indicateurs Multiples du Burkina Faso 2010. Calverton, Maryland, USA: Institut National de la Statistique et de la Démographie (INSD) and ICF International; 2012.
• [44]KNBS, ICF Macro: Kenya Demographic and Health Survey 2008-09. Calverton, Maryland, USA: Kenya National Bureau of Statistics (KNBS) and ICF Macro; 2010.
• [45]CBS, ORC Macro: Kenya Demographic and Health Survey 2003. Calverton, Maryland, USA: Central Bureau of Statistics, Ministry of Health, Kenya and ORC Macro; 2004.
• [46]NSO, ICF Macro: Malawi Demographic and Health Survey 2010. Zomba, Malawi and Calverton, Maryland, USA: National Statistical Office (NSO) and ICF Macro; 2011.
• [47]NSO, ORC Macro: Malawi Demographic and Health Survey 2004. Calverton, Maryland, USA: National Statistical Office (NSO) Malawi, and ORC Macro; 2005.
• [48]MOH Uganda, ICF International: AIDS Indicator Survey (AIS), Uganda, 2011. Kampala, Uganda and Calverton, Maryland, USA: Ministry of Health (MOH), Uganda and ICF International; 2012.
• [49]Uganda Bureau of Statistics, Macro International Inc: Uganda Demographic and Health Survey 2006. Calverton, Maryland: Uganda Bureau of Statistics (UBOS) and Macro International Inc; 2007.
• [50]MOH Uganda, ORC Macro: Uganda HIV/AIDS Sero-behavioural Survey 2004-2005. Calverton Maryland, USA: Ministry of Health (MOH) and ORC Macro; 2006.
• [51]Government of Uganda: UNGASS country progress report, Uganda: January 2008-December 2009. Uganda: Uganda AID Commission, Government of Uganda; 2010.
• [52]Byamugisha R, Tylleskar T, Kagawa MN, Onyango S, Karamagi CA, Tumwine JK: Dramatic and sustained increase in HIV-testing rates among antenatal attendees in eastern Uganda after a policy change from voluntary counseling and testing to routine counseling and testing for HIV: a retrospective analysis of hospital records, 2002-2009. BMC Health Serv Res 2010, 10(1):290. BioMed Central Full Text
• [53]Ujiji OA, Rubenson B, Ilako F, Marrone G, Wamalwa D, Wangalwa G, Ekstrom AM: Is 'Opt-Out HIV testing' a real option among pregnant women in rural districts in Kenya? BMC Publ Health 2011, 11:151. BioMed Central Full Text
• [54]Kiene SM, Bateganya M, Wanyenze R, Lule H, Nantaba H, Stein MD: Initial outcomes of provider-initiated routine HIV testing and counseling during outpatient care at a rural Ugandan hospital: risky sexual behavior, partner HIV testing, disclosure, and HIV care seeking. AIDS Patient Care STDS 2010, 24(2):117-126.
• [55]Homsy J, Kalamya JN, Obonyo J, Ojwang J, Mugumya R, Opio C, Mermin J: Routine intrapartum HIV counseling and testing for prevention of mother-to-child transmission of HIV in a rural Ugandan hospital. J Acquir Immune Defic Syndr 2006, 42(2):149-154.
• [56]Cartoux M, Meda N, Van de Perre P, Newell ML, De Vincenzi I, Dabis F: Acceptability of voluntary HIV testing by pregnant women in developing countries: an international survey. Ghent international working group on mother-to-child transmission of HIV. AIDS 1998, 12(18):2489-2493.
• [57]Kiarie J, Nduati R, Koigi K, Musia J, John G: HIV-1 testing in pregnancy: acceptability and correlates of return for test results. AIDS 2000, 14(10):1468-1470.
• [58]Angotti N, Dionne KY, Gaydosh L: An offer you can′t refuse? provider-initiated HIV testing in antenatal clinics in rural Malawi. Health Policy Plan 2011, 26(4):307-315.
• [59]Larsson EC, Thorson A, Pariyo G, Conrad P, Arinaitwe M, Kemigisa M, Eriksen J, Tomson G, Ekstrom AM: Opt-out HIV testing during antenatal care: experiences of pregnant women in rural Uganda. Health Policy Plan 2012, 27(1):69-75.
• [60]Hardon A, Vernooij E, Bongololo-Mbera G, Cherutich P, Desclaux A, Kyaddondo D, Ky-Zerbo O, Neuman M, Wanyenze R, Obermeyer C: Women′s views on consent, counseling and confidentiality in PMTCT: a mixed-methods study in four African countries. BMC Publ Health 2012, 12:26. BioMed Central Full Text
• [61]Medley AM, Kennedy CE: Provider challenges in implementing antenatal provider-initiated HIV testing and counseling programs in Uganda. AIDS Educ Prev 2010, 22(2):87-99.
• [62]Sarker M, Papy J, Traore S, Neuhann F: Insights on hiv pre-test counseling following scaling-up of PMTCT program in rural health posts, Burkina Faso. East Afr J Public Health 2009, 6(3):280-286.
• [63]Njeru MK, Blystad A, Shayo EH, Nyamongo IK, Fylkesnes K: Practicing provider-initiated HIV testing in high prevalence settings: consent concerns and missed preventive opportunities. BMC Health Serv Res 2011, 11:87. BioMed Central Full Text
• [64]Obermeyer CM, Neuman M, Desclaux A, Wanyenze R, Ky-Zerbo O, Cherutich P, Namakhoma I, Hardon A: Associations between mode of HIV testing and consent, confidentiality, and referral: a comparative analysis in four African countries. PLoS Med 2012, 9(10):e1001329.
• [65]Homsy J, King R, Malamba SS, Opio C, Kalamya JN, Mermin J, Okallanyi A, Obonyo JH: The need for partner consent is a main reason for opting out of routine HIV testing for prevention of mother-to-child transmission in a rural Ugandan hospital. J Acquir Immune Defic Syndr 2007, 44(3):366-369.
• [66]Karamagi CA, Tumwine JK, Tylleskar T, Heggenhougen K: Antenatal HIV testing in rural eastern Uganda in 2003: incomplete rollout of the prevention of mother-to-child transmission of HIV programme? BMC Int Health Hum Rights 2006, 6:6. BioMed Central Full Text
• [67]Dahl V, Mellhammar L, Bajunirwe F, Bjorkman P: Acceptance of HIV testing among women attending antenatal care in south-western Uganda: risk factors and reasons for test refusal. AIDS Care 2008, 20(6):746-752.
• [68]Mbonye AK, Hansen KS, Wamono F, Magnussen P: Barriers to prevention of mother-to-child transmission of HIV services in Uganda. J Biosoc Sci 2010, 42(2):271-283.
• [69]Bajunirwe F, Muzoora M: Barriers to the implementation of programs for the prevention of mother-to-child transmission of HIV: a cross-sectional survey in rural and urban Uganda. AIDS Res Ther 2005, 2:10. BioMed Central Full Text
• [70]Aarnio P, Olsson P, Chimbiri A, Kulmala T: Male involvement in antenatal HIV counseling and testing: exploring men's perceptions in rural Malawi. AIDS Care 2009, 21(12):1537-1546.
• [71]Pignatelli S, Simpore J, Pietra V, Ouedraogo L, Conombo G, Saleri N, Pizzocolo C, De Iaco G, Tall F, Ouiminga A, et al.: Factors predicting uptake of voluntary counseling and testing in a real-life setting in a mother-and-child center in Ouagadougou, Burkina Faso. Trop Med Int Health 2006, 11(3):350-357.
• [72]Medley A: Antenatal HIV counseling and testing in Uganda: women's experiences, counselors' challenges, and men's attitudes. Baltimore, Maryland; Johns Hopkins University; 2009.
• [73]Maman S, King E: Changes in HIV testing policies and the implications for women. J Midwifery Womens Health 2008, 53(3):195-201.
• [74]The Voluntary HIV-1 Counseling and Testing Efficacy Study Group: Efficacy of voluntary HIV-1 counseling and testing in individuals and couples in Kenya, Tanzania, and Trinidad: a randomised trial. Lancet 2000, 356(9224):103-112.
• [75]National AIDS Commission of Malawi: Malawi HIV and AIDS monitoring and evaluation report, 2008-2009: UNGASS country progress report, January 2008-December 2009. Malawi: National AIDS Commission of Malawi; 2010.
• [76]Burkina Faso CNLS/IST: Rapport UNGASS 2010 du Burkina Faso: suivi de la declaration d'engagement sur le VIH/SIDA. Burkina Faso: Conseil National de Lutte Contre le Sida et les Infections Sexuellement Transmisibles (CNLS/IST); 2010.
• [77]Rosen S, Fox MP: Retention in HIV care between testing and treatment in Sub-Saharan Africa: a systematic review. PLoS Med 2011, 8(7):e1001056.
• [78]Bila B, Kouanda S: Desclaux A: [from economic difficulties to social suffering of people living with HIV in Burkina Faso]. Sante 2008, 18(4):187-191.
• [79]Kouanda S, Bocoum FY, Doulougou B, Bila B, Yameogo M, Sanou MJ, Sawadogo M, Sondo B, Msellati P, Desclaux A: User fees and access to ARV treatment for persons living with HIV/AIDS: implementation and challenges in Burkina Faso, a limited-resource country. AIDS Care 2010, 22(9):1146-1152.
• [80]Zachariah R, Tayler-Smith K, Manzi M, Massaquoi M, Mwagomba B, Van Griensven J, Van Engelgem I, Arnould L, Schouten EJ, Chimbwandira FM, et al.: Retention and attrition during the preparation phase and after start of antiretroviral treatment in thyolo, Malawi, and kibera, Kenya: implications for programmes? Trans R Soc Trop Med Hyg 2011, 105(8):421-430.
• [81]Nyandiko WM, Otieno-Nyunya B, Musick B, Bucher-Yiannoutsos S, Akhaabi P, Lane K, Yiannoutsos CT, Wools-Kaloustian K: Outcomes of HIV-exposed children in western Kenya: efficacy of prevention of mother to child transmission in a resource-constrained setting. J Acquir Immune Defic Syndr 2010, 54(1):42-50.
• [82]Otieno PA, Kohler PK, Bosire RK, Brown ER, Macharia SW, Stewart GCJ: Determinants of failure to access care in mothers referred to HIV treatment programs in Nairobi, Kenya. AIDS Care 2010, 22(6):729-736.
• [83]n.a.: HIV testing and treatment among tuberculosis patients --- Kenya, 2006-2009 MMWR Morb Mortal Wkly Rep 2010, 59(46):1514-1517.
• [84]Chinkonde JR, Sundby J, Martinson F: The prevention of mother-to-child HIV transmission programme in Lilongwe, Malawi: why do so many women drop out. Reprod Health Matters 2009, 17(33):143-151.
• [85]Bwirire LD, Fitzgerald M, Zachariah R, Chikafa V, Massaquoi M, Moens M, Kamoto K, Schouten EJ: Reasons for loss to follow-up among mothers registered in a prevention-of-mother-to-child transmission program in rural Malawi. Trans R Soc Trop Med Hyg 2008, 102(12):1195-1200.
• [86]Braun M, Kabue MM, Mc Collum ED, Ahmed S, Kim M, Aertker L, Chirwa M, Eliya M, Mofolo I, Hoffman I, et al.: Inadequate coordination of maternal and infant HIV services detrimentally affects early infant diagnosis outcomes in Lilongwe, Malawi. J Acquir Immune Defic Syndr 2011, 56(5):e122-128.
• [87]Lubega M, Nsabagasani X, Tumwesigye NM, Wabwire-Mangen F, Ekstrom AM, Pariyo G, Peterson S: Policy and practice, lost in transition: reasons for high drop-out from pre-antiretroviral care in a resource-poor setting of eastern Uganda. Health Policy 2010, 95(2–3):153-158.
• [88]Barigye H, Levin J, Maher D, Tindiwegi G, Atuhumuza E, Nakibinge S, Grosskurth H: Operational evaluation of a service for prevention of mother-to-child transmission of HIV in rural Uganda: barriers to uptake of single-dose nevirapine and the role of birth reporting. Trop Med Int Health 2010, 15(10):1163-1171.
• [89]Kunihira NR, Nuwaha F, Mayanja R, Peterson S: Barriers to use of antiretroviral drugs in rakai district of Uganda. Afr Health Sci 2010, 10(2):120-129.
• [90]Macpherson P, Lalloo DG, Choko AT, Mann GH, Squire SB, Mwale D, Manda E, Makombe SD, Desmond N, Heyderman R, et al.: Suboptimal patterns of provider initiated HIV testing and counseling, antiretroviral therapy eligibility assessment and referral in primary health clinic attendees in Blantyre, Malawi. Trop Med Int Health 2012, 17(4):507-517.
• [91]Lubega M, Nsabagasani X, Tumwesigye MN, Wabwire-Mangen F, Ekstrom AM, Peterson S, Pariyo G: Inadequate pre-antiretroviral care, stock-out of antiretroviral drugs and stigma: policy challenges/bottlenecks to the new WHO recommendations for earlier initiation of antiretroviral therapy (CD < 350 cells/microL) in eastern Uganda. Health Policy 2010, 97(2–3):187-194.
• [92]Ridde V, Some PA, Pirkle CM: NGO-provided free HIV treatment and services in Burkina Faso: scarcity, therapeutic rationality and unfair process. Int J Equity Health 2012, 11:11. BioMed Central Full Text
• [93]Amuron B, Namara G, Birungi J, Nabiryo C, Levin J, Grosskurth H, Coutinho A, Jaffar S: Mortality and loss-to-follow-up during the pre-treatment period in an antiretroviral therapy programme under normal health service conditions in Uganda. BMC Publ Health 2009, 9:290. BioMed Central Full Text
• [94]Geng EH, Bangsberg DR, Musinguzi N, Emenyonu N, Bwana MB, Yiannoutsos CT, Glidden DV, Deeks SG, Martin JN: Understanding reasons for and outcomes of patients lost to follow-up in antiretroviral therapy programs in Africa through a sampling-based approach. J Acquir Immune Defic Syndr 2010, 53(3):405-411.
• [95]Donahue MC, Dube Q, Dow A, Umar E, Van Rie A: ″They Have Already Thrown Away Their Chicken″: barriers affecting participation by HIV-infected women in care and treatment programs for their infants in Blantyre. AIDS Care: Malawi; 2012.
• [96]Parrott FR, Mwafulirwa C, Ngwira B, Nkhwazi S, Floyd S, Houben RM, Glynn JR, Crampin AC, French N: Combining qualitative and quantitative evidence to determine factors leading to late presentation for antiretroviral therapy in Malawi. PLoS One 2011, 6(11):e27917.
• [97]Braitstein P, Songok J, Vreeman RC, Wools-Kaloustian KK, Koskei P, Walusuna L, Ayaya S, Nyandiko W, Yiannoutsos C: ″Wamepotea″ (they have become lost): outcomes of HIV-positive and HIV-exposed children lost to follow-Up from a large HIV treatment program in western Kenya. J Acquir Immune Defic Syndr 2011, 57(3):e40-46.
• [98]Cames C, Saher A, Ayassou KA, Cournil A, Meda N, Simondon KB: Acceptability and feasibility of infant-feeding options: experiences of HIV-infected mothers in the World Health Organization kesho Bora mother-to-child transmission prevention (PMTCT) trial in Burkina Faso. Matern Child Nutr 2010, 6(3):253-265.
• [99]Ochieng-Ooko V, Ochieng D, Sidle JE, Holdsworth M, Wools-Kaloustian K, Siika AM, Yiannoutsos CT, Owiti M, Kimaiyo S, Braitstein P: Influence of gender on loss to follow-up in a large HIV treatment programme in western Kenya. Bull World Health Organ 2010, 88(9):681-688.
• [100]Maman S, King E, Amin A, Garcia-Moreno C, Higgins D, Okero A: Addressing violence against women in HIV testing and counseling: a meeting report. Geneva: Department of Gender, Women and Health, Department of HIV/AIDS, World Health Organization; 2006.
• [101]Hardon A, Kageha E, Kinsman J, Kyaddondo D, Wanyenze R, Obermeyer CM: Dynamics of care, situations of choice: HIV tests in times of ART. Med Anthropol 2011, 30(2):183-201.
• [102]Turan JM, Bukusi EA, Onono M, Holzemer WL, Miller S, Cohen CR: HIV/AIDS stigma and refusal of HIV testing among pregnant women in rural Kenya: results from the MAMAS study. AIDS Behav 2011, 15(6):1111-1120.
• [103]Medley A, Garcia-Moreno C, McGill S, Maman S: Rates, barriers and outcomes of HIV serostatus disclosure among women in developing countries: implications for prevention of mother-to-child transmission programmes. Bull World Health Organ 2004, 82(4):299-307.
• [104]Desgrées-du-Loû A, Orne-Gliemann J: Couple-centred testing and counseling for HIV serodiscordant heterosexual couples in sub-Saharan Africa. Reprod Health Matters 2008, 16(32):151-161.
• [105]Were E, Curran K, Delany-Moretlwe S, Nakku-Joloba E, Mugo NR, Kiarie J, Bukusi EA, Celum C, Baeten JM: A prospective study of frequency and correlates of intimate partner violence among African heterosexual HIV serodiscordant couples. AIDS 2011, 25(16):2009-2018.
• [106]Njunga J, Blystad A: 'The divorce program': gendered experiences of HIV positive mothers enrolled in PMTCT programs - the case of rural Malawi. Int Breastfeed J 2010, 5:14. BioMed Central Full Text
• [107]Maman S, Medley A: Gender dimensions of HIV status disclosure to sexual partners: rates, barriers and outcomes. A review paper. Geneva; World Health Organization; 2004.
• [108]Eyawo O, De Walque D, Ford N, Gakii G, Lester RT, Mills EJ: HIV status in discordant couples in sub-Saharan Africa: a systematic review and meta-analysis. Lancet Infect Dis 2010, 10(11):770-777.
• [109]Bunnell R, Opio A, Musinguzi J, Kirungi W, Ekwaru P, Mishra V, Hladik W, Kafuko J, Madraa E, Mermin J: HIV transmission risk behavior among HIV-infected adults in Uganda: results of a nationally representative survey. AIDS 2008, 22(5):617-624.
• [110]Turan JM, Bukusi EA, Cohen CR, Sande J, Miller S: Effects of HIV/AIDS on maternity care providers in Kenya. J Obstet Gynecol Neonatal Nurs 2008, 37(5):588-595.
• [111]Angotti N: Working outside of the box: how HIV counselors in Sub-Saharan Africa adapt western HIV testing norms. Soc Sci Med 2010, 71(5):986-993.
• [112]Angotti N: Testing differences: the implementation of western HIV testing norms in sub-Saharan Africa. Cult Health Sex 2012, 14(4):365-378.
• [113]Sanon P, Kabore S, Wilen J, Smith SJ, Galvao J: Advocating prevention over punishment: the risks of HIV criminalization in Burkina Faso. Reprod Health Matters 2009, 17(34):146-153.
• [114]UNAIDS, UNDP: International Consultation on the Criminalization of HIV Transmission, 31 October - 2 November 2007. Summary of main issues and conclusions. Geneva, Switzerland: Joint United Nations Programme on HIV/AIDS and United Nations Development Programme; 2008.
• [115]UNAIDS: Criminalization of HIV Transmission. Geneva: Joint United Nations Programme on HIV/AIDS; 2008.
• [116]UNAIDS Reference Group on HIV AIDS and Human Rights: Statement on criminalization of HIV transmission and exposure. Geneva: UNAID Reference Group on HIV AIDS and Human Rights; 2008.
• [117]Office of the UN High Commissioner for Human Rights, UNAIDS: International guidelines on HIV/AIDS and human rights, 2006 consolidated version. Geneva: Office of the United Nations, High Commissioner for Human Rights and the Joint United Nations Programme on HIV/AIDS; 2006.
• [118]National Council for Law Reporting: HIV and AIDS Prevention and Control Act (No. 14 of 2006). Nairobi: National Council for Law Reporting, with the Authority of the Attorney-General, Kenya; 2012.
• [119]WHO: Addressing violence against women and HIV/AIDS. What works? Report of a consultation. Geneva: World Health Organization and Joint United Nations Programme on HIV/AIDS (UNAIDS); 2010.
• [120]Brown LB, Miller WC, Kamanga G, Nyirenda N, Mmodzi P, Pettifor A, Dominik RC, Kaufman JS, Mapanje C, Martinson F, et al.: HIV partner notification is effective and feasible in sub-Saharan Africa: opportunities for HIV treatment and prevention. J Acquir Immune Defic Syndr 2011, 56(5):437-442.
• [121]Potterat JJ: Puzzling observations in a trial of HIV partner notification in sub-Saharan Africa. J Acquir Immune Defic Syndr 2011, 56(5):381-383.
• [122]Bila B, Egrot M: Gender asymmetry in healthcare-facility attendance of people living with HIV/AIDS in Burkina Faso. Soc Sci Med 2009, 69(6):854-861.
• [123]Kouanda S, Yameogo WM, Berthe A, Bila B, Bocoum Yaya FK, Somda A, Doulougou B, Sanou MJ, Sondo B, Msellati P: Partage de l'information sur le statut sérologique VIH positif: facteurs associés et conséquences pour les personnes vivant avec le VIH/sida au Burkina Faso[Self-disclosure of a HIV-positive serostatus: factors favoring disclosure and consequences for persons living with HIV/AIDS in Burkina Faso]. Rev Epidemiol Santé Publique 2012, 60(3):221-228.
• [124]Kigozi IM, Dobkin LM, Martin JN, Geng EH, Muyindike W, Emenyonu NI, Bangsberg DR, Hahn JA: Late-disease stage at presentation to an HIV clinic in the era of free antiretroviral therapy in sub-Saharan Africa. J Acquir Immune Defic Syndr 2009, 52(2):280-289.
• [125]Kululanga LI, Sundby J, Malata A, Chirwa E: Striving to promote male involvement in maternal health care in rural and urban settings in Malawi - a qualitative study. Reprod Health 2011, 8:36. BioMed Central Full Text
• [126]Allen S, Karita E, Chomba E, Roth DL, Telfair J, Zulu I, Clark L, Kancheya N, Conkling M, Stephenson R, et al.: Promotion of couples′ voluntary counseling and testing for HIV through influential networks in two African capital cities. BMC Publ Health 2007, 7:349. BioMed Central Full Text
• [127]Conkling M, Shutes EL, Karita E, Chomba E, Tichacek A, Sinkala M, Vwalika B, Iwanowski M, Allen SA: Couples′ voluntary counseling and testing and nevirapine use in antenatal clinics in two African capitals: a prospective cohort study. J Int AIDS Soc 2010, 13(1):10. BioMed Central Full Text
• [128]Kairania R, Gray RH, Kiwanuka N, Makumbi F, Sewankambo NK, Serwadda D, Nalugoda F, Kigozi G, Semanda J, Wawer MJ: Disclosure of HIV results among discordant couples in rakai, Uganda: a facilitated couple counseling approach. AIDS Care 2010, 22(9):1041-1051.
• [129]Auvinen J, Suominen T, Valimaki M: Male participation and prevention of human immunodeficiency virus (HIV) mother-to-child transmission in Africa. Psychol Health Med 2010, 15(3):288-313.
• [130]Katz DA, Kiarie JN, John-Stewart GC, Richardson BA, John FN, Farquhar C: Male perspectives on incorporating men into antenatal HIV counseling and testing. PLoS One 2009, 4(11):e7602.
• [131]Gaillard P, Melis R, Mwanyumba F, Claeys P, Muigai E, Mandaliya K, Bwayo J, Temmerman M: Vulnerability of women in an African setting: lessons for mother-to-child HIV transmission prevention programmes. AIDS 2002, 16(6):937-939.
• [132]Reece M, Hollub A, Nangami M, Lane K: Assessing male spousal engagement with prevention of mother-to-child transmission (pMTCT) programs in western Kenya. AIDS Care 2010, 22(6):743-750.
• [133]Kizito D, Woodburn PW, Kesande B, Ameke C, Nabulime J, Muwanga M, Grosskurth H, Elliott AM: Uptake of HIV and syphilis testing of pregnant women and their male partners in a programme for prevention of mother-to-child HIV transmission in Uganda. Trop Med Int Health 2008, 13(5):680-682.
• [134]Larsson EC, Thorson A, Nsabagasani X, Namusoko S, Popenoe R, Ekstrom AM: Mistrust in marriage–reasons why men do not accept couple HIV testing during antenatal care- a qualitative study in eastern Uganda. BMC Publ Health 2010, 10:769. BioMed Central Full Text
• [135]Smith AD, Tapsoba P, Peshu N, Sanders EJ, Jaffe HW: Men who have sex with men and HIV/AIDS in sub-Saharan Africa. Lancet 2009, 374(9687):416-422.
• [136]National AIDS Control Council of Kenya, Population Council: The overlooked epidemic: Addressing HIV prevention and treatment among men who have sex with men in sub-Saharan Africa. Report of a consultation, Nairobi, Kenya 14–15 May 2008. Nairobi: Population Council; 2009.
• [137]Geibel S, Tun W, Tapsoba P, Kellerman S: HIV vulnerability of men who have sex with men in developing countries: horizons studies, 2001-2008. Public Health Rep 2010, 125(2):316-324.
• [138]Geibel S, Tun W, Tapsoba P, Kellerman SE: Looking back, moving forward: Understanding the HIV risk and sexual health needs of men who have sex with men, Horizons studies 2001 to 2008. Horizons Synthesis Background Papers. Washington DC: Population Council, HIV and AIDS Program; 2008:2010.
• [139]Denis-Cooper L, Grosso A, Hanada Y, Knodell C, Lin E, Obas V, Shannon L, Tram KH: Achieving an AIDS-free generation for gay men and other MSM: Financing and implementation of HIV programs targeting MSM. New York and Baltimore: amfAR, The Foundation for AIDS Research and Johns Hopkins Bloomberg School of Public Health; 2012.
• [140]Bruce-Jones E, Itaborahy LP: State-sponsored homophobia: a world survey of laws criminalising same-sex sexual acts between consenting adults. Belgium: The International Lesbian, Gay, Bisexual, Trans and Intersex Association, Brussels; 2011.
• [141]WHO: Towards universal access: scaling up priority HIV/AIDS interventions in the health sector, 2009. Geneva: World Health Organization, Joint United Nations Programme on HIV/AIDS (UNAIDS) and UNICEF; 2009.
• [142]Tambashe BO, Speizer IS, Amouzou A, Djangone AM: Evaluation of the PSAMAO ″roulez protege″mass media campaign in Burkina Faso. AIDS Educ Prev 2003, 15(1):33-48.
• [143]De Ver Dye T, Apondi R, Lugada E: A qualitative assessment of participation in a rapid scale-up, diagonally-integrated MDG-related disease prevention campaign in rural Kenya. PLoS One 2011, 6(1):e14551.
• [144]Marum E, Morgan G, Hightower A, Ngare C, Taegtmeyer M: Using mass media campaigns to promote voluntary counseling and HIV-testing services in Kenya. AIDS 2008, 22(15):2019-2024.
• [145]Malawi Office of the President and Cabinet: Malawi HIV and AIDS Monitoring and Evaluation Report 2007. Lilongwe: Republic of Malawi; 2008.
• [146]Helleringer S, Kohler HP, Frimpong JA, Mkandawire J: Increasing uptake of HIV testing and counseling among the poorest in sub-Saharan countries through home-based service provision. J Acquir Immune Defic Syndr 2009, 51(2):185-193.
• [147]Bateganya M, Abdulwadud OA, Kiene SM: Home-based HIV voluntary counseling and testing (VCT) for improving uptake of HIV testing. Cochrane Database Syst Rev 2010, 7:CD006493.
• [148]Negin J, Wariero J, Mutuo P, Jan S, Pronyk P: Feasibility, acceptability and cost of home-based HIV testing in rural Kenya. Trop Med Int Health 2009, 14(8):849-855.
• [149]Yoder P, Katahoire A, Kyaddondo D, Akol Z, Bunnel R: Home-based testing and counseling in a survey context in Uganda. Calverton, Maryland: ORC Macro; 2006.
• [150]Sekandi JN, Sempeera H, List J, Mugerwa MA, Asiimwe S, Yin X, Whalen CC: High acceptance of home-based HIV counseling and testing in an urban community setting in Uganda. BMC Publ Health 2011, 11(1):730. BioMed Central Full Text
• [151]Wachira J, Kimaiyo S, Ndege S, Mamlin J, Braitstein P: What is the impact of home-based HIV counseling and testing on the clinical status of newly enrolled adults in a large HIV care program in western Kenya? Clin Infect Dis 2012, 54(2):275-281.
• [152]Corbett EL, Dauya E, Matambo R, Cheung YB, Makamure B, Bassett MT, Chandiwana S, Munyati S, Mason PR, Butterworth AE, et al.: Uptake of workplace HIV counseling and testing: a cluster-randomised trial in Zimbabwe. PLoS Med 2006, 3(7):e238.
• [153]Choko AT, Desmond N, Webb EL, Chavula K, Napierala-Mavedzenge S, Gaydos CA, Makombe SD, Chunda T, Squire SB, French N, et al.: The uptake and accuracy of oral kits for HIV self-testing in high HIV prevalence setting: a cross-sectional feasibility study in Blantyre. Malawi. PLoS Med 2011, 8(10):e1001102.
• [154]Cohen MS, Chen YQ, McCauley M, Gamble T, Hosseinipour MC, Kumarasamy N, Hakim JG, Kumwenda J, Grinsztejn B, Pilotto JH, et al.: Prevention of HIV-1 infection with early antiretroviral therapy. N Engl J Med 2011, 365(6):493-505.
• [155]Williams B, Wood R, Dukay V, Delva W, Ginsburg D, Hargrove J, Stander M, Sheneberger R, Montaner J, Welte A: Treatment as prevention: preparing the way. J Int AIDS Soc 2011, 14(Suppl 1):S6. BioMed Central Full Text