CLOSING THE HIV TESTING GAP THROUGH WORKPLACE ACTION MARGHERITA LICATA ILO Human Sciences and Research Council SÀHARA: Social Aspect of HIV/AIDS and Health Research Alliance

Rationale Need for a study to identify what works with regards to achieving good outcomes in HIV workplace interventions What works is based on existing and proved evidence The study makes a business case for implementing HIV workplace programmes

What Works to achieve these GOOD OUTCOMES? Conducive Environment Level Individual/Enterprise Level 1. Reduced absenteeism 2. Reduced staff turnover 3. Reduced risky behaviour 4. Reduced stigma towards PLHIV 5. Increased VCT uptake 6. Increased knowledge on HIV 7. Reduced costs 8. Increased productivity What Works to achieve these GOOD OUTCOMES? Conducive Environment Level 1. Increased capacity of workers, employers and governments 2. Increased participation of WoW in the governance of National HIV interventions 3. Increased financial resources for HIV workplace programmes 4. Strengthened partnerships to facilitate workplace programmes

Geographical scope Geographical Scope: Desk Review (global) Multi-country survey (10 countries in Africa) Country selection criteria Hyper-endemic epidemics Generalized epidemics Concentrated epidemics Language balance (English, French & Portuguese) Countries with ILO support & countries without ILO support

Steps for data collection Identification and training of country researchers Securing the study approval from authorities and key stakeholders Identification of eligible workplaces based on availability of evidence Sectors encompassed private, public and informal Ranging from Agriculture, to construction, public services, transport etc

Evaluated HIV Workplace Interventions Scope of study PRIMARY FOCUS Evaluated HIV Workplace Interventions In 66 workplaces Data collected from these sources and existing records and documentation were transcribed, cleaned, processed, captured, triangulated and analysed using thematic content analysis at workplace and country levels. The purposeof this process was to find out “what works”, and what conducive factors contributed to achieving each “good outcome” at the workplace. Code lists were developed based on research questions, hypotheses, literature, key concepts and important themes in order to organize, assemble and reduce data into analysable units, i.e. code lists for workplace and stakeholder interviews, and workplace focus group discussions (Miles and Huberman, 1994). The researchers identified, grouped, and named themes and subthemes and came up with possible interpretations of the data to ensure accuracy (ibid.). Country reports were then generated. Thereafter, data from the country reports were meta-analysed to determine what works within each good outcome across the 10 countries as well as identify common and unique approaches within each good outcome and lessons learnt.

FOCUS HIV testing

Results 79 per cent of the 66 workplaces studied in 10 African countries had evidence that they had increased the uptake of VCT 100 per cent showed strong management commitment as essential to achieve this outcome 81 per cent used behaviour change approaches to influece attitudes on the need for testing and create demand for testing. 54 per cent ensured provision of onsite or offsite VCT and linkage to care to increase VCT uptake

Contributing Strategies Management commitment/ leadership Provision of VCT on-side or off-site/linkage to care Investment in behaviour change and education

Management commitment Workplace in Zambia: CEO testing, enabling environment and know your status campaign contributed to 80% of company employees aware of their HIV status Leadership in HIV testing Investment in resources for HIV testing 5 workplaces in Madagascar and 1 workplace in Senegal evidenced increase in testing uptake, after investing in HIV programmes and setting aside budget for HIV A workplace in Cote d’Ivoire reported that availability of rapid HIV test kits made in possible for employees to be tested during their medical consultations Quality services provision

Behaviour change/education Tailored peer education approach A workplace in Senegal– pool of peer educators trained on VCT counselling, contribute to an increased uptake of testing between 2011 and 2012 more than 27% Meaningful involvement of PLHIV South Africa workplace - VCT uptake increased from 72 per cent in 2009 to 82 per cent in 2010 as a result of engaging with PLHIV to provide testimonies and support Peer education approach: adapted to workplace settings, allowed reaching out to employees during work hours and leisure time. Trained peer educators played a key role in promoting VCT, helping workers move from knowledge to seeking HIV testing MIPA: In behaviour change programmes helped to alleviate fears about HIV testing and improved acceptability of testing. Targeted programmes for managers and workers: also empowered employees about the importance of knowing their HIV status and contributed to individual behaviour change. Targeted programmes for workers and employers Kenya workplace – managers and workers training, resulted in increased VCT uptake from 74.3 per cent (2010) to 96.8 per cent (2011)

Availability of VCT facilities/referrals A workplace in South Africa provided on-going HCT at two municipal occupational clinics, increasing update of 23% between 2011 and 2012 Making VCT available onsite A workplace in Cote d’Ivoire established referrals with external provider resulting in increase of 38% in testing between 2010 and 2013 Referrals off-site A workplace in Madagascar integrated VCT into other health services such as maternal and child health: VCT uptake increased 57% between 2011 and 2012 Wellness approach

What did we learn? Management commitment is a combination of actions (policy, funding and leadership) As for any community-based intervention: need to align testing to workforce size and HIV prevalence Workplace needs to ensure the balance between right places, right services and right people Need to combine awareness/demand creation with availability of onsite or offsite services Management commitment includes allocating resources – human, financial and material – to support the uptake of HIV testing. This is a clear demonstration of management’s commitment. • The most significant barrier to the uptake of VCT remains stigma and discrimination.

What did we learn? Focus on accessibility and acceptability that ensures privacy and confidentiality and ensuring feasibility of location and time. Uptake of VCT services needs to be sustained through linkages to health and support services to guarantee follow up for workers and dependants testing positive. Need to focus on normalizing HIV testing (MIPA and wellness approach) Workplace is an entry point for innovative testing moving away from highly medicalized testing In line with community based HIV testing recommended by WHO In line with lay provider delivered testing It can contribute to couple testing when workforce and their spouses are both targeted

Lessons applied: VCT@WORK INITIATIVE Build on existing workplace programmes Multi-disease testing De-stigmatize HIV testing and facilitate increased uptake of VCT services Strategic partnerships Ministries of Health, national AIDS councils, the private sector, VCT providers, ART centres, networks of PLHIV, civil society organizations, UN and others Social mobilization and private sector commitment In and through workplace structures Through the workplace…. Reach millions of workers in both the formal and informal economies Generate demand for and enhance access to HIV testing for millions of women and men workers Also, from available data: more women than men test. Workplace based testing can prove useful to reach men (VCT@Work Initiative shows a higher percentage of men tested)

Results Over 4 million workers reached (62.36 % male, 37.08% female, 0.66% other) Over 2.2 million workers tested (60.22% male, 38.77% female, 1.01% other) Over 72 thousand workers referred to treatment (60.88% male, 38.31% female, 0.81% other)

Thank you!