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Henry Greely, a bioethicist at Stanford Law School in Palo Alto, California, worries that patients will not receive the same level of counseling as the study's participants did from a busy doctor or through a genetic-testing company's online report.
Such intense and repeated counseling is unlikely to be representative of the level of counseling other adult men being circumcised receive.
You may not be as likely to be tested anonymously in either of these settings as at a dedicated HIV testing site or receive the same level of counseling, but you may have more flexibility in making an appointment and not have to wait as long to be tested.
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MSC is an adaptive treatment strategy that uses principles of negative reinforcement and avoidance to motivate both attendance to varying levels of counseling services and brief periods of abstinence [Brooner, R.K., Kidorf, M., 2002. Using behavioral reinforcement to improve methadone treatment participation. Sci. Pract. Perspect.
The community recruitment strategy utilized in the Ndola and Kitwe, Zambia sites, based on a model developed in Rwanda [2] and previously implemented in Lusaka, Zambia[21], was associated with high rates of enrollment despite relatively lower national levels of counseling and testing in Zambia.
Various settings may have different levels of counseling, support, standardization of medical procedures and availability of medications.
While overall levels of counseling were reported to be quite high, findings varied with site and topic (Table 3).
One concern has been that lower levels of counseling in PITC programs would undermine this preventive potential.
Higher levels of perceived effectiveness of obesity management aspects were also significantly associated with higher levels of counseling obese patients (r=0.61; p < 0.001).
A higher percentage of U.S. professionals expressed a desire to increase levels of counseling "very much", but only significantly so for eating habits (42% versus 28%, p = .037).037
Many have voiced concern that PITC policies may be accompanied by reduced levels of counseling and high levels of loss to follow up, both of which weaken the rationale for scaled up testing [ 11, 12, 73].
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