Abstract Book Vol. 2 [International Conference on AIDS (14th: 2002: Barcelona, Spain)]

XIV International AIDS Conference

Abstracts ThPeF8030-ThPeF8033 597

Recommendations: The use of lay counsellors and rapid tests should be expanded to all health facilities in South Africa. Consideration should be given to
improving access for men and teenagers, possibly through free-standing VCT
sites.
Presenting author: Laura Campbell, P/B 504, Port Shepstone, KwaZulu-Natal,
South Africa, Tel.: [phone], Fax: [phone], E-mail: schospkz
@venturenet.co.za
ThPeF8030 Quality with quantity - challenges of scaling-up
voluntary counselling and testing for HIV in rural
Kenya
M. TaegtmeVer1, G. Ngatia1, A.I. Muchiril, C. Ngare2, J.M. Chakaya3, C. Gilks4.
I Liverpool VCT Project, PO BOx 43640, Nairobi, Kenya; 2NAtional AIDS Control
Programme, Nairobi, Kenya; 3Kenya Medical Research Institute, Nairobi, Kenya;
4Liverpool School of Tropical Medicine, Liverpool, United Kingdom
Issues: The government of Kenya is committed to the large-scale introduction of
voluntary counselling and testing (VCT) for HIV in its primary health care centres. At least 250 sites are planned. However, over-burdened health-care workers
rarely have the time or skills to give approriate HIV counselling to their patients.
A major concern is that the proposed scale-up of VCT could compromise quality,
thereby defeating the purpose of the intervention.
Description: An operational research programme between the government,
Kenya Medical Research Institute and the Liverpool School of Tropical Medicine
is currently piloting affordable ways of integrating VCT into rural health facilities whilst maintaining quality 18 new integrated sites have opened since April
2001 and over 6000 clients seen.
Lessons learned:
1. The priority for service users in the public sector is still a confidential clientcentred service.
2. The training of counsellors does not include enough practice and supervision.
3. Counsellors burn-out rapidly if not adequately supported.
4. Clients sent to a lab or asked to return at a later date are less likely to receive
their result than those undergoing rapid testing.
5. Community mobilisation does not attract clients if the HIV messages are negative.
Recommendations: Integrating VCT at health centre level is feasible, however
maintaining a service requires commitment to the support of counsellors and to
quality assurance systems.
1. Client exit interviews to be carried out 6 monthly and results shared with other
health facility workers.
2. Certification of counsellors to follow a standardized training manual which
closely reflects the job requirements.
2. Counsellors to attend regular support sessions with an experienced counsellor
trainer.
3. 2 rapid tests to be performed on every client. Once trained counsellors can
perform tests in the counselling room.
4. Community mobilsation should be sensitive and appropriate.
Presenting author: Miriam Taegtmeyer, PO BOx 43640, Nairobi, Kenya, Tel.:
[phone], Fax: [phone] c/o Wellcome Trust, E-mail: MTaegtmeyer
@wtnairobi.mimcom.net
ThPeF8031 Rehabilitation of counselling services in a rural
area of Zambia
E. Hart, C.P. Situmbeko. Mddecins Sans Frontibres, Mddecins Sans Frontibres,
Zambezi Road 609, Roma - Lusaka, Zambia
Issues: Nchelenge district in Northern Zambia is a rural area whose people survive on the fishing trade and agriculture. Prior to the arrival of Medecins sans
Frontieres (MSF), the local District Task Force trained counsellors to work in the
hospital within a system that was no longer effective.
Description: A health education centre was opened to provide education on a
number of illnesses and to give voluntary counselling and testing services (VCT)
to decrease the stigma of going to hospital for HIV testing. 15 counsellors from
different backgrounds were trained to provide VCT services.
Lessons learned: The presence of a testing centre away from the hospital increased the number of people coming for VCT. It also highlighted certain problems: 1. Clients were mainly from the local town and environs. 2. There is a
distinct gender imbalance in clients visiting the centre, with males outnumbering females more than two to one. 3. Counsellors require incentives to continue
working. 4. Counselling is required around "sexual cleansing", a practice by which
a relation of the deceased has sexual intercourse with the living spouse to get rid
of the ghost "haunting" him or her. 5. Multiple rumours that the centre is only for
HIV positive people who will be locked up. 6. A financial solution is needed to
make the centre self-sufficient.
Recommendations: 1. More counselors will be trained to draw blood so that

testing and VCT will be in the community to improve access. 2. There will be
women-only days at the centre combined with cookery demonstrations. 3. An
incentive scheme is being developed which includes free medical care for the
counsellor and immediate family. 4. Further investigation of sexual cleansing. 5.
Regular community sensitisation about the purpose of the centre through drama,
megaphone and public education. 6. Formation of income generating schemes

based at the centre to allow community-based teams to be able to raise funds to
sustain themselves and the clients.
Presenting author: Elizabeth Hart, Medecins Sans Frontibres, Zambezi Road
609, Roma - Lusaka, Zambia, Tel.: [phone], Fax: [phone], E-mail:
[email protected]
ThPeF8032 The role of the HIV-related technical assistance
given to health workers in charge of pre and post
counseling (VCT) to pregnant women
A.J. Nuila Ceballos. Mddecins Sans Fronti6res, Mddecins Sans Frontibres, Calle
Los Abetos #11, Colonia San Francisco, San Salvador, El Salvador
Issues: Although the prevalence of HIV/AIDS in El Salvador is low, those with the
virus are stigmatised and recent laws have seriously impeded human rights. The
infrastructure of the country and education levels are high, thereby increasing the
likelihood of successful interventions.
Description: Medecins sans Frontieres (MSF) has started an MTCT prevention
program that highlights, among other things, Voluntary Counselling and Testing
(VCT) training given to health workers. MSF has been giving workshops to the
personnel of the maternity hospital and 11 health units in the area. The ongoing training has been vital to verify the quality of VCT given to pregnant women.
The training was held during the VCT sessions themselves and regular meetings have taken place to exchange experiences and to receive feedback from
counselors. This follow-up process verifies the achievements and difficulties encountered daily among the women who attended. It also assures the respect of
the confidentiality and human rights of the women within the program.
Lessons learned: 1. Giving training without a planned follow-up does not achieve
the desired impact. 2. The constant and continuous technical assistance in situ
assures the quality of the counseling and health workers become aware of patient
needs. 3. The quality of the counseling brings satisfaction to the patients and at
the same time promotes the creation of support groups. 4. The emotional support
of the counselor allows the handling of stress and facilitates the expression of
feelings. This ensures the mental health of the counselor and at the same time
the possibilty to offer good counseling.
Recommendations: 1. Provide training programs for counselors that comply with
their corresponding technical, continuous, and in situ assistance plan. 2. Promote
and support the creation of a counselor network within the institutions in order to
facilitate their own expression of feelings, as well as the exchange of experiences.
Presenting author: Ana Josefina Nuila Ceballos, Medecins Sans Frontibres,
Calle Los Abetos #11, Colonia San Francisco, San Salvador, El Salvador, Tel.:
[phone], Fax: [phone], E-mail: [email protected].
org
ThPeF8033I Using moh-ngo partnerships to implement
voluntary counseling and testing in Mozambique
L. Gibier de Souza1, A. Vergara1, J. Cardoso', R.M. Manjate2, A. Barreto2.
1 CDC - MOH, [email protected], Mozambique; 2MOH, Maputo, Mozambique
Issues: In May 2001 the National AIDS Control Program defined Voluntarily
Counseling and Testing (VCT) a main prevention strategy in Mozambique. By
January 2002, seven VCT facilities opened in five provinces, and by April 2002
fifteen VCT facilities are scheduled to open throughout Mozambique.
Description: A team led by the Ministry of Health developed partnerships, operation guidelines, training curricula, education materials, and a data collection
and reporting system. Non-governmental organizations NGOs operate the VCT
facilities in partnership with local health services. The MOH is currently drafting a
mass marketing campaign, an IEC strategy, and a plan to evaluate performance
of these facilities. Data to monitor operations and effectiveness of the initiative
is collected regularly and analyzed at the central level. Long term financial and
technical support agreements with NGOs and donors were sought to promote
sustainability of the program.
Results: The VCT program in Mozambique is growing rapidly. Working VCT facilities report great demand for their services. One of the first sites to open in
Maputo, reports counseling and testing 400 clients during December of 2001, of
which 40% were HIV positive. These numbers do not represent Mozambique's
rate of infection, which is estimated to be 12%, but show that there is high demand for previously unavailable VCT services. By June 2002 the evaluation of
the first phase of the VCT program will be complete.
Conclusions: VCT services in Mozambique are in high demand. The MOH strategy used to establish these services in the context of low resource levels, by
partnering with NGOs and donors in long-term agreements, has thus far proven
to be effective. More work needs to be done to study the effectiveness of these
services and strategies to target hard-to-reach sectors of the population, and to
establish services to provide support for those attending VCT centers.
Presenting author: Luiz Gibier de Souza, [email protected], Mozambique,

E-mail: [email protected]