1. RAPID RESULT INITIATIVE Western Area -Sierra Leone VOLUNTARY CONFIDENTIAL COUNSELLING & TESTING Presented by: Dr. Amara Jambai MD MSc DLSHTM

2. Situation before the inception of RRI: Three Hospital-based VCCT centres existed. Three Hospital-based VCCT centres existed. Few people used these centres. Few people used these centres. An average of 60 clients per month utilised hospital-based VCCT services An average of 60 clients per month utilised hospital-based VCCT services

3. RRI SPECIFIC GOAL: Establish 25 VCCT service sites at community level to attend to minimum 40 clients per month per site within 100 days. Establish 25 VCCT service sites at community level to attend to minimum 40 clients per month per site within 100 days.

4. Community Based Strategy The focus was directed at a community- based mobilization drive. The focus was directed at a community- based mobilization drive. 25 Health Facilities were selected from among Government, Private and NGOs. 25 Health Facilities were selected from among Government, Private and NGOs. 50 Health Workers were chosen and trained 50 Health Workers were chosen and trained The Health Workers also trained 10 Community Health Promoters at each health facility. The Health Workers also trained 10 Community Health Promoters at each health facility.

5. The use of Community Members The Community Health Promoters mobilized clients for VCCT services on fixed days arranged at different locations. The Community Health Promoters mobilized clients for VCCT services on fixed days arranged at different locations. Based on this schedule, counsellors served five communities on a daily basis. Based on this schedule, counsellors served five communities on a daily basis.

6. Community based approach

7. Other community related activities Community meetings: traditional leaders, youths, TBAs, Volunteers and Women’s groups Community meetings: traditional leaders, youths, TBAs, Volunteers and Women’s groups Formation of post-test clubs Formation of post-test clubs Provision of promotional materials Provision of promotional materials Street to street mobilization drive Street to street mobilization drive

8. VCCT STEPS 1. Group Counseling 2. Individual counseling 3. Testing – Rapid Test Kits (Abbot Determine, Unigold and confirmation with SD Bioline further confirmation in the lab using ELISA) 4. Post-test counseling

9. THE RRI RESULTS

10. RESULTS

11. Lessons Learnt (Positive) VCCT shifting from hospital- based to Community-based is a major boost for HIV/AIDS activities. VCCT shifting from hospital- based to Community-based is a major boost for HIV/AIDS activities. Utilization of the services of Community Health Promoters has made marked improvement in VCCT services. Utilization of the services of Community Health Promoters has made marked improvement in VCCT services. Use of rapid test kits encourages high turnout. Use of rapid test kits encourages high turnout. Community participation is a prerequisite in achieving results. Community participation is a prerequisite in achieving results. The RRI Approach cuts across bureaucracy at all levels. The RRI Approach cuts across bureaucracy at all levels.

12. Lessons Learnt (Negative) Insufficient test kit is a de-motivating factor for clients and service providers.Insufficient test kit is a de-motivating factor for clients and service providers. Acceptance of off site bleeding of clients is minimal and yields low participation.

13. RRI’s Main Insights People are now willing to know their HIV status more than ever before People are now willing to know their HIV status more than ever before The prevalence of the disease in the community is better appreciated. The prevalence of the disease in the community is better appreciated.

14. Scale up plans VCCT should be added into Primary Health Care’s routine activities VCCT should be added into Primary Health Care’s routine activities In-charges of health units should be given a comprehensive training on VCCT In-charges of health units should be given a comprehensive training on VCCT Rapid test kits be made available at health units with trained counsellors as In- charges Rapid test kits be made available at health units with trained counsellors as In- charges Community Health Promoters (CHPs) should be encouraged to continue with community sensitization drive. Community Health Promoters (CHPs) should be encouraged to continue with community sensitization drive.

15. Situation at the end of RRI Request continue to be made for VCCT services at health facilities. Request continue to be made for VCCT services at health facilities. Attendance at Hospital based VCCT sites stands at approximately 295 clients per month per site. Attendance at Hospital based VCCT sites stands at approximately 295 clients per month per site.

16. RECOMMENDATION VCCT community approach should be integrated into routine health care activities. VCCT community approach should be integrated into routine health care activities. Adequate support for PLWHAs should be put in place. Adequate support for PLWHAs should be put in place. Rapid Test kits be made available to meet demands. Rapid Test kits be made available to meet demands.

17. Thank you