ensuring access to quality voluntary counseling and testing services. dr. gloria sangiwa. family...
TRANSCRIPT
Ensuring Access to Quality Ensuring Access to Quality Voluntary Counseling and Voluntary Counseling and
Testing servicesTesting services..
Dr. Gloria Sangiwa.Dr. Gloria Sangiwa.Family Health InternationalFamily Health International
OUTLINEOUTLINE
• VCT as entry point.• VCT guiding
principles.• Models of Service
delivery.• Key steps to
developing national VCT and testing guidelines.
• Lessons learned.
Voluntary Counseling
Testing
Acceptance of Serostatus and coping
Preventive therapy(TB and OI’s)
and contraceptive advice
Early management of OIs and STDs; Eligibility for ARV
Reduces mother-to-child transmission
Normalizes HIV/AIDS Facilitates
behavioral change
Planning for future orphan care; Will preparation
Referral to social and peer support
VCT Guiding PrinciplesVCT Guiding Principles
• Work with the community, including PLHAs, to develop culturally appropriate services.
• Advocate for sustainable and cost-efficient service
• Establish effective referral systems • Build-in quality assurance mechanisms• Promote equity and make services easily
accessible– Models : stand-alone, integrated,mobile, private, private/public.
Standalone Standalone vsvs Integrated Integrated VCTVCT sites
Standalone:
Pros:• High quality• Increased access –Flexible Hours,
• Focused Staff• Increased coverageCons:• Expensive• Poor linkages• Stigmatized• Limited geographical
accessibility
Integrated:
Pros:• VCT as part of other health or
care and support services.• Linked to other e.g TB and
MTCT• Potential for expansion• Less costlyCons:• Staff – low motivation and overload
• Difficulty to enforce quality• May not allow use of non HCW• Dilute quality of other services.
Key issues to address so as to offer high-Key issues to address so as to offer high-quality VCT servicesquality VCT services
• National policy issues and plans regarding VCT services e.g. Development of national VCT standards and guidelines.
• Training of appropriate staff
• Design and implementation of VCT services
• VCT communication strategies
• Quality assurance
• Monitoring and Evaluation of services
• Community Support and linkages with other services• Formation of post test clubs• Care for counselors
Key steps for establishing Key steps for establishing National VCT guidelinesNational VCT guidelines
• Political commitment and donor support• Stakeholders meeting to identify key elements.• Regular meetings to review the process.• Launching by Government official.• Distribution of the guidelines• Dissemination
• Develop user friendly version.• Train administrators and Service Providers.
HIV TESTING PROTOCOLSHIV TESTING PROTOCOLSDepend on:Depend on:
• Local HIV epidemiology e.g in ANE- adopt Strategy III.
• Existing laboratory infrastructure and capacity.
• The volume of HIV testing .
• The quality assurance capacity .
• Clients’ preference .
• Impact of the chosen protocol on the provision of the service
• Cost implication.
• Government regulatory bodies (MOH or NACP) are responsible to formulate the most feasible testing strategies for the country.
FHI/Kenya VCT activitiesFHI/Kenya VCT activities• Technical Consultative
meeting in Sept 2000.
– Plan for roll out of VCT services
• Feb 2001 VCT started in IMPACT project sites and in the first year:– 46 VCT sites mostly integrated
into health services– > 21,000 received VCT – National VCT Guidelines
developed and launched
FHI/Kenya VCT -ctdFHI/Kenya VCT -ctd• Other components of FHI efforts
with VCT Taskforce:– VCT task-force formed under
NASCOP with all partners– VCT communication strategy
and campaign launched– 184 counsellors trained. – Established Quality
assurance system for HIV testing and counselling.
– Logistics management – JSI deliver project
How unique are VCT activities in low How unique are VCT activities in low prevalence settings?prevalence settings?
• Integrating VCT into model STI clinics.• Modeling possibility of Behavioral and Biological
Surveillance coupled with VCT.• Linking VCT with Case management.• Primarily targeting Injecting drug users.• VCT in conjunction with 2002 DHS.• Voucher system is used to encourage clients to come for
tests and results.• Exploring on the private/public sector partnership model.
– E.g In Asia- Indonesia, and China and LAC-DR and Haiti
Lessons LearnedLessons Learned
• Partnering enhances rapid expansion of VCT services
• Integrated sites are attracting all types of clients.
• Integrating VCT in health care facilities does not guarantee access to care and support.
• In VCT linked with PMTCT, mothers find same day test results very stressful.
Lessons Learned Cont’dLessons Learned Cont’d
• There is an increasing demand for VCT.• Orientation of health care workers helps
- In general understanding of VCT
-Referral
- Reduction in stigma by HCW
CHALLENGESCHALLENGES
• « Flavor of the month » syndrome: VCT developed in the absence of care and support
• VCT sites are not evenly distributed causing under utilisation of some and overcrowding in others
• Competing priorities for service provision. • Limited support services for a comprehensive continuum of
care .• Translating lessons learned to government VCT roll up
plans.?• Combating stigma and discrimination.
Comprehensive Response Comprehensive Response HIV/AIDSHIV/AIDS
People seeking or needing care
in site of concentrated vulnerability
BCC
Legal support
VCT
peer support
Homecare
Clinical services incl. TB & STI care
Support to Families & children
Community Mobilization
PMTCTCommodities
Links to other services
SW empowerment
Youth empowerment
Male sexual health
OVC support
M&E
VCT is only an entry point and not the end
point!