Secrets of HIV Testing Success

25 June 2010

A HCT counseling session at a farm

TB/HIV Care’s Western Cape HIV testing and counseling teams have outstripped expectations. During the first quarter of 2010 the teams managed to increase the number of people they tested for HIV and screened for TB in the previous quarter by 62%.

Testing for HIV is a critical part of both HIV prevention and treatment. Because HIV testing includes counseling on how to avoid spreading this disease, both for those who are negative as well as positive, the HIV test itself is an important tool in HIV prevention. Similarly, if patients don’t know their HIV status, they cannot be treated for HIV, so testing is the first step in accessing appropriate health care.
To address the importance of testing, TB/HIV Care has 5 teams of people in the Western Cape devoted solely to counseling and testing people for HIV and screening them for STIs and TB. Each team consists of one registered professional nurse counselor, and three lay counselors who also act as community mobilisers. These teams are mobile units meaning they can conduct their testing campaigns in diverse places; from farms and factories to correctional facilities and institutions of higher learning.

Although the HCT units often work in the harsh outdoor conditions, sheltered only by their customized testing caravans and gazebos, they have succeeded in boosting their efficiency remarkably. Over sequential quarters, the same number of TB/HIV Care teams and staff have managed to massively increase the number of people they counsel, test and screen from 4462 people in the last quarter of 2009 to 7153 people during the first quarter of 2010. Perhaps just as impressive is the fact that these 7153 people were part of a total of 12000 people tested through the public sector in the health districts that TB/HIV Care supports in the Western Cape.
This means that TB/HIV Care has provided 68% of the public testing services offered in these districts during this quarter.

TB/HIV Care’s HCT manager, Phebe Gribble, attributes the success of the teams to ‘working smarter’. Part of this strategy has entailed adopting the new ‘ACTS’ model of testing. The model’s name is an acronym of the order of activities it proposes – HCT teams should ‘advise, get consent from, test and support’ the clients they test and screen. Because the ‘ACTS’ model focuses on post-test rather than pre-test counseling, the HCT clients receive counseling tailor-made to their status rather than general advice and support that may not be relevant to them.

Another radical shift in the HCT strategy was making all the HCT teams mobile. Previously some teams were based in clinics or other fixed sites, but these teams soon realised that they quickly met the need for testing in those areas, and were then not optimally utilized. By taking their services on the road, the HCT teams are now able to travel to new sites all the time and so reach a greater number of people. It also means that they can reach people who may have very limited access to health services, such as people working on outlying farms. This strategy has paid off in another unexpected way, as nearly 60% of those who are testing with the mobile teams are male. Because males seem to test far less frequently in most clinical settings than women, this percentage suggests that the mobile teams are an effective method of reaching men.

The teams have also learnt valuable lessons about what works best during a testing campaign. For example, workplace HCT campaigns attract far more workers when the managers and supervisors decide to be tested by the teams first. They have also adopted a specialized model of testing when large numbers of people are expected to test, which optimizes the time spent with each individual while maintaining the high quality of service.

The need for leadership in the HIV counseling and testing arena has recently been taken up at the highest level with the National Minister of Health, Dr Aaron Motsoaledi’s, radical call for a national HIV testing and counseling (HCT) campaign in which 15 million South Africans will be tested for HIV and screened for TB in one year.

With their new HCT strategies in place, and an impressive track record behind them, TB/HIV Care Association’s HCT Teams are well-placed to take up the Minister of Health’s challenge. The testing and screening is a quick and simple process, but its importance as the first step in accessing health care should not be overlooked. HCT can be a life-saving intervention.

Sources:
TB/HIV Care Association, tel: 021 425 0050, email: alison@tbhivcare.org