Abstract
Background Despite the substantial investment for providing HIV counselling and testing (VCT) services in Zambia, there has been little effort to systematically evaluate the quality of VCT services provided by various types of health providers. This study, conducted in 2009, examines VCT in the public and private sectors including private for-profit and NGO/faith-based sectors in Copperbelt and Luapula.Methods The study used five primary data collection methods to gauge quality of VCT services: closed-ended client interviews with clients exiting VCT sites; open-ended client interviews; interviews with facility managers; review of service statistics; and an observation of the physical environment for VCT by site. Over 400 clients and 87 facility managers were interviewed from almost 90 facilities. Sites were randomly selected and results are generalizable at the provincial level.Results The study shows concerning levels of underperformance in VCT services across the sectors. It reveals serious underperformance in counselling about key risk-reduction methods. Less than one-third of clients received counselling on reducing number of sexual partners and only approximately 5% of clients received counselling about disclosing test results to partners. In terms of client profiles, the NGO sector attracts the most educated clients and less educated Zambians seek VCT services at very low rates (7%). The private for-profit performs equally or sometimes better than other sectors even though this sector is not adequately integrated into the Zambian national response to HIV.Conclusion The private for-profit sector provides VCT services on par in quality with the other sectors. Most clients did not receive counselling on partner reduction or disclosure of HIV test results to partners. In a generalized HIV epidemic where multiple concurrent sexual partners are a significant problem for transmitting the disease, risk-reduction methods and discussion should be a main focus of pre-test and post-test counselling.
Highlights
Zambia’s HIV epidemic is significant and generalized, with an adult prevalence rate of 14.3% (ZDHS 2007)
As of 2004, the government of Zambia owns about 86% of all health facilities (Mudenda et al 2008), but there is a growing number of private sector options, including 524 private forprofit facilities registered with the Medical Council of Zambia
Given the increasing demands for HIV prevention and resources needed for HIV treatment in many high prevalence countries, the private for-profit sector may be increasingly called upon to contribute to Zambia’s national AIDS response (Wang et al 2011)
Summary
Zambia’s HIV epidemic is significant and generalized, with an adult prevalence rate of 14.3% (ZDHS 2007). Despite the substantial investment for providing VCT in Zambia, there has been little effort to systematically evaluate the quality of VCT services provided by various types of health providers. The private sector in Zambia, including for-profit, not-forprofit and faith-based actors, is an important provider of health services in Zambia, there is less information about both the size and quality of the private sector than the public. It is important to understand both the role and the quality of VCT services in the private sector in order to further incorporate private providers into national HIV prevention efforts. Despite the substantial investment for providing HIV counselling and testing (VCT) services in Zambia, there has been little effort to systematically evaluate the quality of VCT services provided by various types of health providers. This study, conducted in 2009, examines VCT in the public and private sectors including private for-profit and NGO/faith-based sectors in Copperbelt and Luapula
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