Overview

In 2008, Ghana adopted WHO/UNAID's provider-initiated opt-out HIV testing policy and integrated it into all maternal services. The intervention's central principle was that women are free to choose whether or not to test for HIV (Consent), assured of Confidentiality, Correct test results, Connection to care, and Counselling services( referred to as 5Cs). However, the weak healthcare infrastructure, low hospital staffing levels, hierarchical and paternalistic nursing and midwifery culture in sub-Saharan Africa were considered potential threats to achieving rights-based testing. Despite these concerns, much mainstream HIV testing research had focused on outcome-related to report high HIV test uptake among women attending the antenatal clinic. However, the reported high testing uptake had not produced the desired impact, as many women testing positive for HIV did not enter care. To date, no process evaluation exists to explain these outcomes. The current study recognises the need for a careful examination of the delivery process. Therefore, it has aimed to evaluate the antenatal clinic-based opt-out HIV testing programme's implementation fidelity to explain the observed outcomes.

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