Accueil > Conférences / Présentations > “We need incentives !” Health care professionals’ reluctance to propose (...)

IAS 2017

“We need incentives !” Health care professionals’ reluctance to propose systematically HIV testing during general consultation in Cote d’Ivoire

lundi 24 juillet 2017
Mis à jour le mercredi 19 juillet 2017

Poster MOPED1144 presented the 24th of July 2017 at the 9th IAS Conference on HIV Science (IAS 2017).


S. Carillon, A. Bekelynck, N. Assoumou, A. Kouadio, H. Ouantchi, C. Danel, J. Larmarange, DOD-CI ANRS 12323 Group


Background : To increase access to HIV testing, WHO recommended in 2007 provider-initiated HIV testing using a simplified but still exceptional approach in terms of pre-test counseling and consent. Cote d’Ivoire implemented in 2009 systematic HIV testing proposal in all medical consultations, irrespective of reasons. What are health care professionals (HCPs) perceptions and experiences related to testing proposal ?

Methods : An ethnographic multi-site study was conducted in 3 general medical services (urban, semi-urban, rural) in 2 Ivorian health districts : 37 in-depth interviews with HCPs and 200 observed medical consultations (general medicine). A thematic analysis was performed on HCPs’ practices and discourses.

Results : The proportion of patients offered an HIV test was low (around 20%), due to HCPs’ reluctance to propose an HIV test in the absence of clinical suspicion. When offered, HIV test was more often prescribed than proposed. The analysis revealed 4 types of explanations in HCPs discourses. (1) Due to stigma associated to HIV, HCPs feared a negative reaction from their patients : refusal, offence, distrust, loss of patients. (2) Time-consuming specificity of HIV testing in terms of counseling, consent and administrative procedure (separate record and dedicated prescription) is perceived by HCPs as not useful and inducing a work overload that should be financially compensated or realized by dedicated providers, as it was before 2009. (3) In the absence of clinical suspicion, they considered that proposing an HIV test during a general consultation is not medically justified and not their priority. (4) Finally, HCPs felt that they are not sufficiently trained.

Conclusion : HCPs experiences and perceptions are negatively affected by the legacy of the successive HIV policies implemented since the beginning of the epidemy. Some complex procedures, historically implemented due to confidentiality and stigma issues, could maybe be simplified today. Integrating HIV testing in routine is a challenge considering that these activities were previously implemented with dedicated incentives, training and human resources. In a context of limited resources and mixed epidemic, how to prioritize and reorganize HIV testing in general consultations while motivating HCPs and being efficient in terms of public health ?


Carillon Séverine, Bekelynck Anne, Assoumou Nelly, Kouadio Alexis, Ouantchi Honoré, Danel Christine, Larmarange Joseph et ANRS 12323 DOD-CI Group (2017) « “We need incentives!” Health care professionals' reluctance to propose systematically HIV testing during general consultation in Cote d'Ivoire » (poster MOPED1144), présenté à 9th IAS Conference on HIV Science (IAS 2017), Paris.

Voir en ligne : online abstract

Répondre à cet article

modération a priori

Attention, votre message n’apparaîtra qu’après avoir été relu et approuvé.

Qui êtes-vous ?

Pour afficher votre trombine avec votre message, enregistrez-la d’abord sur (gratuit et indolore) et n’oubliez pas d’indiquer votre adresse e-mail ici.

Ajoutez votre commentaire ici <{sinon{ul}} class="editer-groupe"> <{sinon{li}} class='editer saisie_texte obligatoire'>

Ce champ accepte les raccourcis SPIP {{gras}} {italique} -*liste [texte->url] <quote> <code> et le code HTML <q> <del> <ins>. Pour créer des paragraphes, laissez simplement des lignes vides.

<{sinon{li}} class="editer pleine_largeur editer_notification">
Ajouter un document <{sinon{ul}} class="editer-groupe"> <{sinon{li}} class='editer saisie_document_forum'>

Dans la même rubrique

1 / 9 »

Retour haut de page
Site réalisé avec SPIP | Plan du site | Contact | Crédits | Mentions Légales | Suivre la vie du site RSS 2.0
Habillage visuel © Larma par Joseph Larmarange sous Licence Creative Commons Attribution 2.5 License