Understanding Health worker Perspectives on Risk Screening for HIV Testing - A Qualitative Study from Zimbabwe

Abstract Background The use of screening tools during targeted human immunodeficiency virus (HIV) testing services improves efficiency by identifying individuals who are likely to test positive. Effective utilization of screening tools requires an understanding of health care worker perception and willingness to use the tools. We determined health workers’ perspectives on screening tools to enhance their effective and consistent utilisation. Methods We conducted a qualitative study among healthcare workers at 8 selected primary healthcare facilities in Zimbabwe. Interviewer guided, in-depth interviews were conducted with healthcare workers and their immediate supervisors. Inductive and deductive coding (hybrid) was applied to develop and analyze themes following a framework built around the grounded theory model to describe perspectives that influence the effective and consistent utilization of HIV screening tools and suggestions for improved eligibility screening. Results Behavioural factors facilitating the utilisation of the screening tool included motivation to adhere to standard practice, awareness of screening role in targeting testing, and its ability to manage workload through screening out ineligible clients. This was evident across service delivery levels. Barriers included limited healthcare capacity, confidentiality space, multiple screening tools and opaque screening in/out criteria and the potential of clients not responding to screening questions truthfully. Conclusions Across geographical and service delivery levels, correct placing of the screening tool at HIV testing entry point, healthcare worker knowledge on screening in/out criteria emerged as enablers for correct and consistent use of the screening tools. Further, standardizing the tools used would improve the utilisation of the correct tool.