1. Ensuring Access to Quality Voluntary Counseling and Testing services. Dr. Gloria Sangiwa. Family Health International email:gsangiwa@fhi.org

2. OUTLINE VCT as entry point. VCT guiding principles. Models of Service delivery. Key steps to developing national VCT and testing guidelines. Lessons learned.

3. Voluntary Counseling Testing Acceptance of Serostatus and coping Preventive therapy (TB and OI’s) and contraceptive advice Early management of OIs and STDs; Eligibility for ARV Reduces mother- to-child transmission Normalizes HIV/AIDS Facilitates behavioral change Planning for future orphan care; Will preparation Referral to social and peer support

4. VCT Guiding Principles Work with the community, including PLHAs, to develop culturally appropriate services. Advocate for sustainable and cost-efficient service Establish effective referral systems Build-in quality assurance mechanisms Promote equity and make services easily accessible –Models : stand-alone, integrated,mobile, private, private/public.

5. Standalone vs Integrated VCT Standalone vs Integrated VCT sites Standalone : Pros: High quality Increased access – Flexible Hours, Focused Staff Increased coverage Cons: Expensive Poor linkages Stigmatized Limited geographical accessibility Integrated : Pros: VCT as part of other health or care and support services. Linked to other e.g TB and MTCT Potential for expansion Less costly Cons: Staff – low motivation and overload Difficulty to enforce quality May not allow use of non HCW Dilute quality of other services.

6. Key issues to address so as to offer high- quality VCT services National policy issues and plans regarding VCT services e.g. Development of national VCT standards and guidelines. Training of appropriate staff Design and implementation of VCT services VCT communication strategies Quality assurance Monitoring and Evaluation of services Community Support and linkages with other services Formation of post test clubs Care for counselors

7. Key steps for establishing National VCT guidelines Political commitment and donor support Stakeholders meeting to identify key elements. Regular meetings to review the process. Launching by Government official. Distribution of the guidelines Dissemination Develop user friendly version. Train administrators and Service Providers.

8. HIV TESTING PROTOCOLS Depend on: Local HIV epidemiology e.g in ANE- adopt Strategy III. Existing laboratory infrastructure and capacity. The volume of HIV testing. The quality assurance capacity. Clients’ preference. Impact of the chosen protocol on the provision of the service Cost implication. Government regulatory bodies (MOH or NACP) are responsible to formulate the most feasible testing strategies for the country.

9. FHI/Kenya VCT activities Technical Consultative meeting in Sept 2000. –Plan for roll out of VCT services Feb 2001 VCT started in IMPACT project sites and in the first year: –46 VCT sites mostly integrated into health services – > 21,000 received VCT –National VCT Guidelines developed and launched

10. FHI/Kenya VCT -ctd Other components of FHI efforts with VCT Taskforce: –VCT task-force formed under NASCOP with all partners –VCT communication strategy and campaign launched –184 counsellors trained. –Established Quality assurance system for HIV testing and counselling. – Logistics management – JSI deliver project

11. How unique are VCT activities in low prevalence settings? Integrating VCT into model STI clinics. Modeling possibility of Behavioral and Biological Surveillance coupled with VCT. Linking VCT with Case management. Primarily targeting Injecting drug users. VCT in conjunction with 2002 DHS. Voucher system is used to encourage clients to come for tests and results. Exploring on the private/public sector partnership model. –E.g In Asia- Indonesia, and China and LAC-DR and Haiti

12. Lessons Learned Partnering enhances rapid expansion of VCT services Integrated sites are attracting all types of clients. Integrating VCT in health care facilities does not guarantee access to care and support. In VCT linked with PMTCT, mothers find same day test results very stressful.

13. Lessons Learned Cont’d There is an increasing demand for VCT. Orientation of health care workers helps - In general understanding of VCT -Referral - Reduction in stigma by HCW

14. CHALLENGES « Flavor of the month » syndrome: VCT developed in the absence of care and support VCT sites are not evenly distributed causing under utilisation of some and overcrowding in others Competing priorities for service provision. Limited support services for a comprehensive continuum of care. Translating lessons learned to government VCT roll up plans.? Combating stigma and discrimination.

15. Comprehensive Response HIV/AIDS People seeking or needing care in site of concentrated vulnerability BCC Legal support VCT peer support Homecare Clinical services incl. TB & STI care Support to Families & children Community Mobilization PMTCT Commodities Links to other services SW empowerment Youth empowerment Male sexual health OVC support M&E

16. VCT is only an entry point and not the end point!