| Threats to confidentiality and informed consent |
Confidentiality difficult to maintain due to limited space in both in-patient and out-patient settings |
Lay counselors; Nurses |
|
Difficulties in upholding consent in PITC: Patients not willing to be tested, application of persuasion to consent to testing; reduced pre-test counseling |
Lay counselors; Nurses |
| Non-adherence to testing procedures and implications for quality care |
Difficulties in finger pricking and obtaining adequate blood volumes for testing |
Lay counselors |
|
Using more than recommended volume of buffer to quicken test procedure |
Lay counselors |
|
Substituting buffer with normal saline or other test kits buffers due to non-availability of buffer |
All providers |
|
Giving positive result based only on the screening test due to non-availability of confirmatory tests |
Laboratory personnel (with limited HIV testing training) |
|
Rushing to report results before test set time and possibility of giving inaccurate results |
All providers |
|
Difficulties describing, interpreting and understanding causes of false-negative, false-positive and invalid results |
Lay counselors; Nurses |
| High workload and stress |
High workload leading to rushed testing and counseling |
Lay counselors (primarily) |
|
High emotional stress due to dealing continuously with difficult patient situations e.g. giving positive results, rape victims. |
Lay counselors |
| Inadequate training and quality assurance |
Training duration too short, more practical sessions needed especially in finger pricking. |
Lay counselors |
|
No refresher trainings. Refresher training perceived important as a ‘revision’ or ‘reminder’. |
All providers |
|
No supervisory visit by trainers after training. Supervisory visit perceived important for assessing competence and for moral support. |
All providers |
|
IQC not performed consistently. EQA conducted once yearly in form of PT, but SSV rare. |
All providers |
