Home based HIV testing ti and counseling Towards Universal Access to HTC; The Aphia II Western experience By Beth Barasa KAPC 10 th Conference;Safari Park Hotel 1 st to 3rd Sept.2009
Introduction Counselling and testing(ct) an important component of HIV prevention and care Kenya committed to achieving universal access to HCT services by the end of 2010 Home based HIV testing and counselling (HBHTC) is one of the innovative approaches towards increasing access
Introduction Aphia II Western supports CT in all the districts of Western Province with 239 out 320 health facilities offering either VCT or PITC services. The project introduced HBTC in four districts( Kakamega Central, Bungoma South, Butere and Hamisi) early this year.
Rationale There was low uptake of HTC in Province 30 % knowledge of status (KAIS 2007) Few couples accessed HTC services To assess the acceptability of HTC services among different communities in Western Province.
Preparation Joint Consultative meetings with the relevant DHMTS and the PHMT. An exchange visit to Mbeere District where Aphia II Eastern was already implementing community based HTC. 52 VCT counsellors were recruited both medical and non-medical. Three days update training and preparation p meetings was conducted.
Community Entry Process Joint planning meeting with community leaders, the Provincial Administration, the DHMTS, representatives from other Government ministries, other key stake holders and development partners.
Community mapping The local public health officer(pho) and community own resource persons were involved in community mapping. A total number of 17,616 households were mapped with an eligible population for CT of 77,143 persons in the first phase.
Community Mobilization Done under the leadership of the location PHO. All available avenues for community mobilization were employed ( barazas, women s groups, religious gatherings, markets and West FM radio)
Actual CT Activities The team comprised VCT counsellors, counsellor supervisors, p, p, DASCOs, Laboratory supervisors, CHWs and village elders.
TARGET GROUP All persons (adult) who wish to take a test voluntarily. All children and adolescents with consent of the parents or legal guardians. All youths willing to take test
Exclusion criteria Those who already know that they are HIV positive Clients who decline HIV testing Children without parents or legal guardians. Children whose parents declined the test.
Results A total 43,972 (57%) clients received Home based HTC services (April-July 2009) of whom 1034 (4%) tested positive. Children Tested 13,362, 362 165(1,2%) tested HIV positive. The total number of children tested in the same period was 24,167 meaning HBTC accounted for > 55%.
Results Cont 2688 couples were tested 156 were both positive (5.8%) 124 were discordant couples(4.6%) 177 pregnant mothers were tested -16 mothers tested HIV positive.
Counselling children for HIV Testing Mostly done through PITC both at the facility and community level. In addition, Special out-reaches are organised for OVC s to know their HIV status during children's clubs meetings.
OVC TESTED POSITIVE YEAR QUAERTER CUM M F T TOTAL M F T CUM TOTAL BASELINE 23 32 55 55 5 6 11 11 FY 07 JAN-MAR 36 39 75 130 11 11 22 33 APR-JUN 126 106 232 362 18 14 32 65 JUL-SEP 173 193 366 728 33 29 62 127 OCT-DEC 97 126 223 951 10 4 14 141 FY 08 JAN-MAR 1,266 1,328 2,594 3,545 60 56 116 257 APR-JUN 219 317 536 4,081 12 16 28 285 JUL-SEP 495 642 1,137137 5,218 30 35 65 350 OCT-DEC 1,810 1,704 3,514 8,732 21 20 41 391 JAN-MAR 2,424 1,947 4,371 13,103 23 29 52 443 FY 09 APR-JUN 3,579 3,043 6,622622 19,725 16 7 23 466 10,24 TOTAL 8 9,477 19,725 213 216 466
Continuous advocacy for buy in by parents/guardians Opt-out testing (not compulsory) All testing opportunities i Integrated outreaches Children clubs/activities days CT outreaches for OVC* Home CT
Lessons Learnt Home-based testing is a viable strategy toward achieving universal access HTC Engagement gg of community structures from the very beginning is critical. Referral to care and availability of essential commodities is crucial to success of the initiative Home testing is key towards testing children and early identification of those needing care.
Challenges Staff shortages Stocks out of test kits Weak referral networks Limited funding to conduct home-testing on a larger scale
Way Forward To continue with home based HTC. Strengthen referral system and follow up. Scale up Home based HTC to 6 more Districts
Acknowledgements USAID APHIA II Western Project management Jhpiego Jp Kenya MINISTRIES OF HEALTH- MOMS AND MOPHS Conference Organizers
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