Study design, setting and participants
This retrospective cross-sectional survey was conducted at the HIV-day care unit of the Yaoundé Central Hospital, Cameroon, from January to December 2009. This is a specialised clinic, located inside the Yaoundé Central Hospital, and dedicated to the prevention and management of HIV infection. The large majority of HIV-infected patients residing in or around Yaoundé are followed-up in this clinic, around 40,000 people to date. Data were recorded from standardized data collection forms of patients who visited the clinic in order to be screened for HIV infection during the study period, but who never came back to collect their result.
A standardized data collection form is available at the study site for any patient coming to be screened for HIV infection. This form records socio-demographic data (age, sex, occupation, marital status, residence), reasons for screening (voluntary, travelling, confirmation of a positive test, prenuptial assessment, or any associated disease [i.e. justifying the screening like tuberculosis or zona] among others), and information on pre- and post-test counselling. Prior to HIV-testing, each patient must undergo a pre-test counselling, first collective and then individual, the aim of which is to evaluate the patient’s knowledge on HIV infection. Additionally, the patient is questioned on the possible different strategies that could be put in place to cope with the newly discovered status, and the possibility to receive a close medical and psycho-social follow-up if the patient is tested positive.
At the end of the pre-test counselling, a clear approval is obtained from each patient before performing any blood sampling to screen for HIV-1 and HIV-2 antibodies. Only rapid diagnostic tests are used, the first of which has a sensitivity of almost 100%. When this first test is positive, a second one, which has a specificity approaching 100% and uses a different principle, is performed. It is only when these two tests are positive to HIV antibodies that the patient is declared HIV infected. After blood collection, an appointment is given to the patient within 3 days, for him/her to come back and get his/her result, something which cannot be done without undergoing a post-test counselling. The pre- and post-test counsellings are undertaken by trained psycho-social counsellors. The 3-day delay in giving back the patient’s result was explained by two main reasons: (1) the heavy workload: the clinic is highly solicited and the personnel has to receive patients coming to be tested and those already known infected who come for their regular follow-up visits; (2) the insufficient number of (trained) personnel working at the clinic: psycho-social counsellors (who had to conduct the pre-test and more importantly the post-test counselling); laboratory technicians (who had to sample the patients and perform the test), biologists (who confirmed, validated and signed patients’ results), and medical secretaries (who had to computerize patients’ records including their result).
We obtained approvals from the Ethical Review Board of the Yaoundé Central Hospital and the Institutional Ethical Review Board of the Faculty of Medicine and Biomedical Sciences of the University of Yaoundé I, Cameroon. As the study was retrospective; we could not obtain any participant’s consent. Nonetheless, the need for patients’ consent was waived by both ethical review boards. The present manuscript was written in accordance with the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines . Confidentiality of patients’ results was preserved.
Data analyses used Epi Info version 3.5.3 (CDC, Atlanta, USA). Quantitative variables are expressed as means and standard deviation (SD) whereas qualitative ones, as counts and percentages. Variables comparison used the Student’s t test or non-parametric equivalents for quantitative variables, and the Chi square test and equivalents for qualitative variables where appropriate. Odds ratios (OR) with 95% confidence intervals (CI) were used to investigate the impact of various factors on the refusal to withdraw HIV test results. A p < 0.05 served to characterize statistically significant results.