Enhancing HIV testing yield in southern Mozambique: the effect of a Ministry of Health training module in targeted provider-initiated testing and counselling

Background In Mozambique, targeted provider-initiated HIV testing and counselling (PITC) is recommended to increase HIV testing yield where universal PITC is not feasible. However, its effectiveness depends on healthcare providers’ training. We evaluated the effect of a Ministry of Health training module in targeted PITC on the HIV testing yield. Methods We conducted a single-group pre-post study between November 2018 and November 2019 in the triage and emergency departments of four healthcare facilities in Manhiça District. It consisted of two two-month phases split by a one-week targeted PITC training module (“observation phases”). During both phases, providers reported their recommendation to test or not for individuals ≥15 years, and study HIV counsellors performed universal testing. We calculated HIV testing yield of targeted PITC as the proportion of HIV-positive individuals among those provider-recommended and tested. We compared pre- and post-training yields using two-proportion z-test. Additionally, we extracted aggregated health information system data over the four months preceding and following the observation phases to compare yield in real-world conditions (“routine phases”). We used logistic regression to identify predictors of HIV test positivity. Results Among 7,102 participants in the pre- and post-training observation phases (58.5% and 41.5% respectively), 68% were women, and 96% were recruited at triage. While HIV testing yield between pre- and post-training observation phases was similar, we observed an increase in yield in the post-training routine phase for women in triage (Yield ratio=1.54; 95%CI: 1.11-2.14). Age (25-49 years) (OR=2.43; 95%CI: 1.37-4.33), working in industry/mining (OR=4.94; 95%CI: 2.17-11.23), unawareness of partner’s HIV status (OR=2.50; 95%CI: 1.91-3.27), and visiting a healer (OR=1.74; 95%CI: 1.03-2.93) were factors associated with HIV test positivity. Including these factors in the targeted PITC algorithm could increase new HIV diagnoses by 2.6%. Furthermore, testing individuals with ≥1 HIV risk factor/symptom and a negative HIV test within the past three months revealed an additional 3.5% of undiagnosed PLHIV. Conclusions We found over 50% increase in the HIV testing yield of targeted PITC among women in the four months following the training and observation phases. Including additional sociodemographic and risk factors in the targeted PITC algorithm could help identify undiagnosed PLHIV.