# Presentation: 263337

## HIV Voluntary Counseling and Testing

- Centers for Disease Control and Prevention

- 12 May 2003

## VCT Background

**VCT Background**

- VCT is an entry point for early access to prevention, care and support services
- counseling helps reduce risk
- serostatus knowledge helps focus personal risk reduction strategy
- HIV+ clients can be referred for needed services
- CDC/GAP-Atlanta has focused on a Prevention Intervention Model of VCT that includes client-focused risk reduction counseling, HIV testing, and referrals to additional support services

## GAP VCT Team Program Areas

**Five Major Program Areas:**
- 	1)  Counseling
- 	2)  Laboratory
- 	3)  Information management system
- 	4)  Linkages to care and support services
- 	5)  Community sensitization to raise awareness about VCT, increase access to VCT, and encourage people to seek VCT

## VCT Implementation Activities

- Establish a standard testing algorithm with quality assurance (rapid tests)
- Establish standard VCT guidelines, procedures, counseling, training, and quality assurance measures
- Train counselors and trainers, establish site operations and QA procedures
- Establish monitoring and evaluation components to document the process, outcome, operational soundness, and share lessons learned

## GAP HQ VCT Team

- _Team_
- Michael Iatesta (Leader)
- Michele Evering-Watley
- Edmund Gumisiriza
- Vel McKleroy
- Tonica Gleaton
- Jenny Albertini

- _Liaisons_
- Lab
- Informatics
- Training

## Current CDC/GAP-Atlanta VCT Team Activities

- VCT Training Curriculum
- VCT Training of Trainers (TOT)
- VCT Implementation Manual
- Couples Counseling Protocol
- Counseling Quality Assurance and Supervision Guidelines

- Burnout Prevention Workshop
- Post Test Club (PTC) Guidelines
- Partnership Development
- VCT Support Network
- Laboratory and Data MIS Guidelines
- Communication about Sexual Health (CASH) Module

## VCT Training Curriculum

- Merged an evidence-based model of VCT with the reality of African settings to develop curriculum
- Successfully pre-tested curriculum in South Africa and field tested it in Kenya
- Received recommendations on curriculum from representatives from South Africa, Malawi, Kenya, Botswana, Uganda, and Zimbabwe
- Finalized curriculum and distributed it in hardcopy and in CD-ROM format

## VCT Training of Trainers (TOT)

- Held TOT in Atlanta February 17 – 21, 2003
- 20 participants chosen from 13 countries who will return to their respective countries and conduct subsequent trainings with support by VCT team during first training
- Assisted in the development of VCT TOT courses in Angola, Brazil, Botswana, Kenya, Malawi, Namibia, Senegal, South Africa, Tanzania, Trinidad, Uganda, Vietnam, and Zimbabwe

## VCT Implementation Manual 

**VCT Implementation Manual**

- Developed guidelines for implementing, monitoring, and evaluating a VCT program
- Held an Implementation Manual Workshop in Botswana August 12 – 16, 2002
- Reviewed content internally and externally
- Following CDC clearance, will make hardcopies and CD-ROM copies of the Implementation Manual available

## Quality Assurance and Supervision Guidelines

- Currently developing a set of protocols and tools for ongoing counselor support and quality assurance (QA)
- Pre-tested tools in Mozambique, Ethiopia, and Malawi February 24 – March 21, 2003 to incorporate best practices and recommendations from all stakeholders
- Will field test tools in South Africa in July 2003

## Burnout Prevention Workshop

- Developed preliminary materials for a workshop to deal with staff burnout
- Pre-tested 1-day counselor stress and burnout prevention workshops in Mozambique, Ethiopia, Malawi, Namibia, and Newark, NJ
- Will revise tools and subsequently field test them

*Namibia, January 2003*

## Post Test Club (PTC) Guidelines

- Completed literature review of PTCs, which revealed a lack of documented knowledge on the implementation process, evaluation outcomes, and overall effectiveness of PTCs
- Developed project to identify best practices, lessons learned, barriers and challenges, and implementation strategies of PTCs
- Will conduct site-visits in Malawi, Zimbabwe, Uganda, Kenya, and Zambia during June and July, 2003
- Will use results to develop guidelines for the implementation of PTCs

## VCT Support Network

- Maintaining a VCT Information Exchange E-mail Group
- Contact Michael Iatesta to be included on this network: _[miatesta@cdc.gov](mailto:miatesta@cdc.gov)__ _
- VCT library at GAP includes articles, abstracts, publications, and on-line database of 58 resources
- Planning a VCT Coordinators Meeting for the fall of 2003
- Compiling directory of experts in the field to encourage regional capacity and technical assistance

**Notes:**
Exploring mechanisms so that VCT coordinators, technical experts, and GAP staff can exchange ideas, problem-solve and support VCT activities

## Laboratory and Management Information Systems Guidelines

- Through liaisons with laboratory and informatics teams, developing guidelines and recommendations for laboratory and information systems for VCT programs
- In Angola, Botswana, Ethiopia, Malawi, Namibia, South Africa, and Vietnam the VCT team helped to develop data entry and management systems for VCT

## Some Laboratory Challenges

- Evaluating rapid tests—when are country-specific evaluations needed?
- Scaling up—who will do all the needed testing?
- can non-laboratorians do rapid testing?
- will this change role of lab staff?

*Uganda – September 2002*

## Tebelopele VCT Center Network Botswana, Apr 2000 – Feb 2003(n = 56,648)

## Comparing Accuracy of HIV Rapid Testing Results Done by Counselors and Laboratory Technicians in the Tebelopele VCT Centers, Botswana 

**Objectives**: To determine whether there is variation in the accuracy of results when rapid HIV tests are performed in a VCT setting by trained counselors compared with a laboratory technician

-  Kenyon T, et al. XII ICASA; 2001; Ouagadougou

## Accuracy of HIV Rapid Testing Results Done by Counselors

**Methodology**: Data were collected from the Tebelopele VCT Center laboratory logbooks in Gaborone and Francistown from April 2000 - March 2001. Data collected included who did the test (counselor or lab technician), results of the rapid two-test algorithm (Determine-Unigold or Determine-Oraquick), and routine quality assurance results of ELISA testing performed on clients who had concordant rapid test results as performed by a counselor.

-  Kenyon T, et al. XII ICASA; 2001; Ouagadougou

## Concordance of Double Rapid HIV Test AlgorithmCounselor vs Lab TechnicianTebelopele VCT Centres 

| Person Who Did the Rapid Tests | HIV Rapid Tests Concordant
(n = 5947) | HIV Rapid Tests Discordant
(n = 6)  | Total Rapid Tests Performed
(n = 5953) |
| --- | --- | --- | --- |
| 
Counselor

Lab technician | 
4115 (99.9%)

1832  (100%) | 
6 (0.1%)

0 * | 
4121 (100%)

1832 (100%) |

- * 0.1% vs 0%, P=0.2

-  Kenyon T, et al. XII ICASA; 2001; Ouagadougou