Abstract
BackgroundWith the launch of the national HIV Counselling and Testing (HCT) campaign in South Africa (SA), lay HIV counsellors, who had been trained in blood withdrawal, have taken up the role of HIV testing. This study evaluated the experiences, training, motivation, support, supervision, and workload of HIV lay counsellors and testers in South Africa. The aim was to identify gaps in their resources, training, supervision, motivation, and workload related to HCT services. In addition it explored their experiences with providing HIV testing under the task shifting context.MethodsThe study was conducted in eight of South Africa’s nine provinces. 32 lay counsellors were recruited from 67 HCT sites, and were interviewed using two questionnaires that included structured and semi-structured questions. One questionnaire focused on their role as HIV counsellors and the other on their role as HIV testers.ResultsNinety-seven percent of counsellors reported that they have received training in counselling and testing. Many rated their training as more than adequate or adequate, with 15.6 % rating it as not adequate. Respondents reported a lack of standardised counselling and testing training, and revealed gaps in counselling skills for specific groups such as discordant couples, homosexuals, older clients and children. They indicated health system barriers, including inadequate designated space for counselling, which compromises privacy and confidentiality. Lay counsellors carry the burden of counselling and testing nationally, and have other tasks such as administration and auxiliary duties due to staff shortages.ConclusionsThis study demonstrates that HCT counselling and testing services in South Africa are mainly performed by lay counsellors and testers. They are challenged by inadequate work space, limited counselling skills for specific groups, a lack of standardised training policies and considerable administrative and auxiliary duties. To improve HCT services, there needs to be training needs with a standardised curriculum and refresher courses, for HIV counselling and testing, specifically for specific elderly clients, discordant couples, homosexuals and children. The Department of Health should formally integrate lay counsellors into the health care system with proper allocation of tasks under the task shifting policy.
Highlights
With the launch of the national Human Immunodeficiency Virus (HIV) Counselling and Testing (HCT) campaign in South Africa (SA), lay HIV counsellors, who had been trained in blood withdrawal, have taken up the role of HIV testing
South Africa has the largest number of people living with HIV in the world [1], with an estimated 5.6 million people were living with the disease in 2011 [1]
A total of 7 (21.8 %) lay counsellors worked in hospitals, 19 (59.4 %) in primary health care clinics, 3 (9.4 %) in stand-alone HIV Counselling and Testing (HCT) sites, 2 (6.3 %) in mobile HCT service, and 1(3 %) in community centres
Summary
With the launch of the national HIV Counselling and Testing (HCT) campaign in South Africa (SA), lay HIV counsellors, who had been trained in blood withdrawal, have taken up the role of HIV testing. There has been considerable success in making HCT accessible in South Africa, a shortage of trained HIV counsellors and trainers restricts the provision of HIV services, Mwisongo et al BMC Health Services Research (2015) 15:278 in resource limited settings [5]. This is in contrast to the context of an increasing demand for HCT prompted by the rapid expansion of Antiretroviral (ART) services [6,7,8]
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