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.
