February 2002 Insights
Health Issue #2
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Quantity with quality
Scaling-up VCT in rural Kenya
The Kenyan government
is committed to the large-scale introduction of voluntary counselling
and testing for HIV (VCT) in its primary healthcare centres. At least
250 sites are expected to open during 2002. VCT can stimulate behaviour
change and provide an entry point to care and support services, but
it must be client-centred, rapid, reliable and fully confidential. Will
the proposed scale-up of VCT compromise the quality of the service?
Operational research
by the Kenya Medical Research Institute and the UK's Liverpool School
of Tropical Medicine is developing and testing affordable ways to integrate
VCT into existing health service provision whilst maintaining quality.
Since January 2001, they have helped to establish 23 integrated sites
throughout Kenya. They found that:
- Service users
want a confidential and private client-orientated service.
- Same-day testing
means that most clients receive their results - fewer than five percent
choose not to. With training, counsellors can perform these tests
in the counselling room.
- VCT sites are
well accepted by their communities and attract equal numbers of women
and men.
- Community mobilisation
strategies are effective when they are sensitive and appropriate to
the situation and avoid negative messages.
Quality assurance
at the sites involves:
- using two rapid
tests for each client
- sending five
to ten percent of samples for external validation
- certifying VCT
counsellors using a standardised training manual
- defining minimum
standards for site registration, including trained counsellors, private
rooms, and appropriate test kits
- inspecting sites
on request and linking approved centres to a well-publicised logo
- conducting client
exit interviews every six months and sharing the results with other
healthcare workers in the facility.
Early signs indicate
that establishing VCT at health centre level is both feasible and appropriate.
However maintaining a service requires a commitment to quality assurance
and control systems, and support for counsellors, including:
- training that
reflects the requirements of the job and includes considerable practice
and supervision
- guidance sessions
with an experienced counsellor/trainer every two weeks to prevent
burn-out and develop new skills.
Miriam
Taegtmeyer
Liverpool VCT Project
PO Box 43640
Nairobi
Kenya
T: +254 2 714590
F: +254 2 711673
Mtaegtmeyer@wtnairobi.mimcom.net
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