Optimizing documentation of HIV testing and counseling practices in the emergency department and inpatient wards of the Muhimbili National Hospital in Dar es Salaam, Tanzania: A program and evaluation plan

While the impact of the HIV epidemic is felt worldwide, Africa is disproportionately affected, accounting for 70% of people living with the disease. Early diagnosis and viral suppression are critical to controlling the disease. According to UNAIDS, children with HIV are less likely to receive treatment than are infected adults (24% vs 38%). This is true in Tanzania, a sub-Saharan country where less than 30% of those 14 years old and under living with HIV are receiving treatment, compared with 30-50% of infected adults. The first step towards receiving treatment is HIV testing, counseling, and referral. Prior analysis of the physician documentation patterns specific to HIV testing, counseling, and referral patients for children < 18 years old presenting to the Muhimbili National Hospital Emergency Department in Dar es Salaam, Tanzania revealed several opportunities for improvement. Of 1632 children testing during the one-year study period, the test result was documented for only 74%, counseling was documented for 17%, and referral for follow-up care was documented for 38% of those testing positive and surviving to discharge. The goal of this hospital-based program and evaluation plan is to increase documentation of HIV test results, counseling of patients and/or their parent(s) or guardian(s), and referral of those testing positive to follow-up care. This will be accomplished by engaging key stakeholders to inform the development, implementation, and refinement of the program and encourage participation. The program will be built around the WHO consolidated guidelines on HIV testing services and their "5Cs: Consent, Confidentiality, Counseling, Correct Results, and Connection." The evaluation plan will measure the program inputs, outputs, and outcomes and be used to optimize the program. If proven successful, the program will be disseminated to other hospitals and recommended for inclusion in undergraduate and graduate physician training programs.Master of Public Healt