Overview of Voluntary Counseling and Testing (VCT) Patrick Osewe, MD, MPH.

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Presentation transcript:

Overview of Voluntary Counseling and Testing (VCT) Patrick Osewe, MD, MPH

Presentation Outline Introduction Rationale for VCT VCT Experience in Sub Saharan Africa Challenges to scaling up VCT services Operations research questions Closing remarks

Introduction HIV is spreading rapidly across Africa and Caribbean region Urgent measures are need to control the epidemic Requirement for epidemic control –Identification of a causative agent –Identification of the mode of spread –Case detection –Case management to prevent further transmission

Rationale for VCT Prevention –HIV-infected –PMTCT –HIV negative Care and Support Societal Benefits

Rationale for VCT (1) Prevention –HIV-infected Behavior change Partner notification Discussion of family size Care of children –PMTCT

Rationale for VCT (2) Prevention –HIV negative Re-enforcing negative status Delayed sexual onset amongst youth Everybody is positive except you! Safer sex negotiation – important for youth Promote use of female condoms

Rationale for VCT (3) Care and Support –Prevention and management of HIV related infections –Discussion on ART – when to initiate, benefits, dangers –Access to ongoing emotional and psychosocial support –Access to post test services (nutritional, material, spiritual, legal services)

Rationale for VCT (4) Societal benefits –Normalization of HIV –Challenges stigma – break cycle of fear –Making VCT as an entry point – but not a final destination to prevention, care and support

Impact of Knowing HIV Status

VCT Experience in Zimbabwe Initiated in 1999 with funding from USAID Branded New Start based on research Limited experience with in the region except Uganda Designed different VCT for different settings: –Public Sector –NGO Sector –Private companies –Free Standing –Outreach (mobile) service

Women Ever Tested for HIV and Learned Test Results, Zimbabwe YAS 2001 n=534

Men Ever Tested for HIV and Learned Test Results, Zimbabwe YAS 2001

Accurate Information Apply info to own situation Assess own risk Overcome barrier to change Availability of services & a supportive environment Reinforcement Activities: Objectives

Community Mobilization VCT Uptake Youth Teachers Pastors Health workers Community leaders PLWHA

Challenges for VCT Largely “latent” disease Highly stigmatized Frightening revelations if infected Benefits of testing not tangible or clear No treatment for majority

Challenges to Scaling Up Attitude of health care workers towards HIV testing – Training and sensitization Shortage of staff (nurses, social workers) Alternative counseling staff Regulation e.g HIV testing done by lab tech – Trained nurses to perform HIV test Fear of HIV testing – Get real campaign

Operations Research Questions What are the long term prevention benefits of VCT? Does support groups/post test services membership promote disclosure? Does VCT reduce stigma in a community? Does ART increase uptake for VCT services? What are the staffing requirements for an effective delivery of a VCT service

STAGES OF BEHAVIOUR CHANGE Precontemplation Contemplation Preparation Action Maintenance