Abstract
HIV counseling and testing (HCT) has been prioritized as one of the prevention strategies for HIV/AIDS, and promoted as an essential tool in scaling up and improving access to treatment, care and support especially in community settings. Home-based HCT (HBHCT) is a model that has consistently been found to be highly acceptable and has improved HCT coverage and uptake in low- and middle-income countries since 2002. It involves trained lay counselors going door-to-door offering pre-test counseling and providing HCT services to consenting eligible household members. Currently, there are few studies reporting on the quality of HBHCT services offered by lay counselors especially in Sub-Saharan Africa, including South Africa. This is a quantitative descriptive sub-study of a community randomized trial (Good Start HBHCT trial) which describes the quality of HBHCT provided by lay counselors. Quality of HBHCT was measured as scores comparing observed practice to prescribed protocols using direct observation. Data were collected through periodic observations of HCT sessions and exit interviews with clients. Counselor quality scores for pre-test counseling and post-test counseling sessions were created to determine the level of quality. For the client exit interviews a continuous score was created to assess how satisfied the clients were with the counseling session. A total of 196 (3%) observational assessments and 406 (6%) client exit interviews were completed. Overall, median scores for quality of counseling and testing were high for both HIV-negative and HIV-positive clients. For exit interviews all 406 (100%) clients had overall satisfaction with the counseling and testing services they received, however 11% were concerned about the counselor keeping their discussion confidential. Of all 406 clients, 393 (96.8%) intended to recommend the service to other people. In ensuring good quality HCT services, ongoing quality assessments are important to monitor quality of HCT after training.
Highlights
Many developing countries are providing antiretroviral therapy (ART) for the management and treatment of HIV/ AIDS
Of all 406 clients, 393 (96.8%) intended to recommend the service to other people. To our knowledge this is the first study to report on the quality of home-based HCT (HBHCT) services offered by lay counselors in South Africa
The remarkable performance of several counselors who achieved 100% compliance with HIV testing and post-test counseling standards is indicative of the adequate training and supportive supervision the counselors received
Summary
Many developing countries are providing antiretroviral therapy (ART) for the management and treatment of HIV/ AIDS. HCT is promoted as a cost-effective prevention strategy in most developing countries (Grabbe et al, 2010) because it provides people with the opportunity to receive information on HIV/AIDS and may facilitate reduction of HIV risk behavior (WHO, 2013). Client-initiated HCT and provider-initiated HCT are the traditionally known models of HCT and they are usually incorporated into existing health settings (Alcorn & Smart, 2006). Both these models have limitations in terms of coverage (WHO, 2012b). The HBHCT model was developed as an alternative to these two models, in response to the challenges associated with them
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