Only small proportions of women are aware of their HIV status and can enter HIV treatment and care. The remainder cannot access essential HIV services, placing them at high-risk for early death and facilitating HIV transmission. To rectify this, many international organisations now recommend routine HIV testing in clinical settings. Provider-patient encounters in reproductive health services provide an ideal opportunity and conducive environment for testing. While rapid HIV tests, with results available the same day, have simplified testing, insufficient efforts have been made to modify pre- and post-test counselling. We argue for increased emphasis on group pre-test information given during health talks, especially in antenatal and child health clinics. Brief individual pre-test sessions would then only be for confirming information was comprehended. Little evidence supports effectiveness of behaviour change counselling for HIV-negatives. Consequently, more abbreviated and focused post-test information (or printed leaflets) could be given for those testing negative. Conversely, substantial evidence shows post-test counselling for HIV-positives is effective, and should be prioritised and meet pre-set standards of quality. Though attention is needed to ensure high-quality interventions before and after testing, simplifying pre-test information and post-test information for negatives could facilitate a rapid increase in testing coverage and frequency.
Keywords: HIV testing and counselling, prevention, health services, post-test counselling, women, provider-initiated testing