A review of research on the nature and quality of HIV testing services: a proposal for process-based studies

Considerable research has been conducted on various issues associated with HIV testing. However, rather than conceptualizing HIV testing as a dynamic process which consists of interrelated elements, this body of work has focused on discrete aspects of the HIV testing process. As an example of such research, studies which have examined HIV testing in terms of various behavioural and psychological outcomes are critically reviewed. Their limitations are attributed to their failure to account for all the elements involved in the HIV testing process that-singly and in dynamic combination-could have produced the measured outcomes. It is contended that if research on HIV testing is to be of use in the development and improvement of HIV testing services, it should be able to identify and describe in detail the factors that might lead to various outcomes of testing. This requires an in-depth examination of all aspects of the HIV testing process and their interrelationships from the perspectives of those undergoing testing and those providing testing services. The principal process elements in HIV testing are described; existing research on these topics is critically reviewed; and recommendations are made for future research. The process elements of HIV testing are identified as making a decision to be tested; accessing testing services; test counseling; and waiting for the test result. Of these, most consideration is accorded to the HIV test counselling process. It is contended that research is needed which examines both clients' and counsellors' expectations, experiences of and satisfaction with HIV test counselling. Specific issues that could usefully be addressed by future research include the process of obtaining clients' informed consent for testing; the ways in which test results are conveyed to clients; the strategies used in HIV counselling to help clients avoid or reduce behaviours in the future; partner notification; and which professional groups are best placed to conduct HIV test counselling. Finally, the question of which research methods might be suitable for process-based studies is considered. It is concluded that qualitative methods could be particularly appropriate as they are well-placed to chart in detail the varied aspects of the HIV testing process and their interrelationships.