1. Evaluating the Impact of Adding HIV Counseling and Testing to the Routine Package of Health Extension Services: A Study of Health Extension Workers in Ethiopia M. Nowakowski 1, F. Walsh 1, A. Zerihun 2, H.Tezera 2, H. Seyoum 2, L. Ahmed 2, Y. Abebe 2 1 Clinton Health Access Initiative, Applied Analytics Team, Boston, United States 2 Clinton Health Access Initiative, CHAI Ethiopia, Addis Ababa, Ethiopia Presenter: Michelle Nowakowski

2. Background The Ethiopian Ministry of Health (MOH) and the Clinton Health Access Initiative (CHAI) were interested in assessing the impact of a pilot that added HCT services to the routine Health Service Extension Programme (HSEP) provided by Health Extension Workers (HEWs). HCT was piloted at 83 rural health posts from September’09 through August’10 and integrated with HSEP services. The aim was to demonstrate that decentralizing HCT services to the lowest tier in the health care delivery system can greatly expand and improve access and uptake of voluntary counseling and testing.

3. This study set out to determine whether the addition of HCT hindered the HEWs’ ability to provide the existing HSEP services across three periods of time: Using trend analysis, we compared the provision of nine health indicators (e.g. number of ANC visits, number of health education sessions) at 15 HCT and 15 control facilities across 20 months. Retrospective data was collected 10 months before and 10 months after the intervention was introduced (September’09). Methods November 2008 September 2009 June 2010 Across the entire study period, was there a significant difference in the number of monthly services provided at HCT versus control sites? Before the intervention, was there a significant difference in the number of monthly services provided at HCT versus control sites? HCT intervention starts After the intervention, was there a significant difference in the number of monthly services provided at HCT versus control sites?

4. Service utilization at both HCT and control facilities increased steadily over time. While more services on average were provided at HCT facilities, no significant differences were found between HCT and control facilities across the entire study period for the selected health indicators (all p-values >0.05). Results

5. The number of family planning and health education services provided at HCT sites even grew after the start of the intervention. Adding HCT services did not negatively impact the provision of existing HSEP services being delivered by HEWs. Results Conclusion: