An assessment of quality of home-based HIV counseling and testing performed by lay counselors in a rural sub-district of KwaZulu-Natal, South Africa
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Date
2016
Journal Title
Journal ISSN
Volume Title
Publisher
Taylor & Francis Open
Abstract
HIV counseling and testing (HCT) has been prioritized as one of the prevention strategies for HIV/AIDS, and promoted
as an essential tool in scaling up and improving access to treatment, care and support especially in community settings.
Home-based HCT (HBHCT) is a model that has consistently been found to be highly acceptable and has improved HCT
coverage and uptake in low- and middle-income countries since 2002. It involves trained lay counselors going door-todoor
offering pre-test counseling and providing HCT services to consenting eligible household members. Currently, there
are few studies reporting on the quality of HBHCT services offered by lay counselors especially in Sub-Saharan Africa,
including South Africa. This is a quantitative descriptive sub-study of a community randomized trial (Good Start HBHCT
trial) which describes the quality of HBHCT provided by lay counselors. Quality of HBHCT was measured as scores
comparing observed practice to prescribed protocols using direct observation. Data were collected through periodic
observations of HCT sessions and exit interviews with clients. Counselor quality scores for pre-test counseling and
post-test counseling sessions were created to determine the level of quality. For the client exit interviews a continuous
score was created to assess how satisfied the clients were with the counseling session. A total of 196 (3%)
observational assessments and 406 (6%) client exit interviews were completed. Overall, median scores for quality of
counseling and testing were high for both HIV-negative and HIV-positive clients. For exit interviews all 406 (100%)
clients had overall satisfaction with the counseling and testing services they received, however 11% were concerned
about the counselor keeping their discussion confidential. Of all 406 clients, 393 (96.8%) intended to recommend the
service to other people. In ensuring good quality HCT services, ongoing quality assessments are important to monitor
quality of HCT after training.
Description
Keywords
Home-based HIV counseling and testing, Counseling quality, South Africa, Lay counselors, Supervision
Citation
Magasana, V. et al. (2016). An assessment of quality of home-based HIV counseling and testing performed by lay counselors in a rural sub-district of KwaZulu-Natal, South Africa. SAHARA-J: Journal of Social Aspects of HIV/AIDS, 13(1): 188 - 196