The development of harmonized minimum standards for guidance on HIV testing and counselling (HTC) in the SADC region: assessment report on HTC policy reviews

Abstract

Introduction: Southern Africa is the epicentre of the HIV and AIDS epidemic and has accounted for almost one-third (32%) of all new HIV infections and AIDS deaths globally in 2007, with national adult HIV prevalence exceeding 15% in seven Member States in 2007. Among the interventions which play a pivotal role both in treatment and prevention, HIV testing and counselling (HTC) stands out as paramount, and has become increasingly important in national and regional prevention and care efforts. Purpose: An assessment of HIV and AIDS in the SADC region was necessary to develop an understanding of the situation in the region and to inform the development and implementation of harmonized minimum standards for HTC. This assessment report reviewed approaches to HTC used by SADC Member States. It also reviewed the availability of HTC policies, protocols and guidelines; accessibility of HTC services; and quality assurance issues related to the provision of HIV testing and counselling services. Methods: The process of reviewing HTC policies and programmes was coordinated by the SADC Secretariat in collaboration with SADC Member States and international cooperating partners, and involved: * a review of regional, continental, and global literature on HTC practices and emerging issues; * a review and analysis of HTC policies, protocols and guidelines of the SADC Member States; * development of an inception report outlining the major issues from the literature and the initial assessment of documents from Member States; * field assessments and policy discussions with major stakeholders in the Member States to identify major achievements, challenges and best practices that would inform the development of the regional minimum standards on HTC and PMTCT; * a consensus-building workshop where all stakeholders reviewed the proposed regional minimum standards, endorsed and adopted them. Findings: All but one SADC Member State said they have approved national HTC policies and guidelines. The policies were approved between 2001 and 2009. Reports from SADC Member States show that HTC programmes are expanding in the region. Most Member States are offering HTC services at all public health facilities, and multiple approaches to HTC are being used in the region. These include provider-initiated testing and counselling (PITC) or routine HIV testing (RHT); voluntary counselling and testing (VCT); and, in selected cases, mandatory testing (e.g. for the armed forces). Generally, the common features of HTC service delivery in the SADC Member States include: pre and post-test counselling; voluntary nature of services; confidentiality is recognized as essential, although disclosure of HIV status to partners and family is promoted; services are anonymous; counselling sessions are tailored to the individual or couple attending; and continuity of counselling is emphasized. Most Member States do not have functional and effective monitoring and evaluation (M&E) systems specifically for HTC services. However, most Member States have adapted M&E frameworks developed for other HIV and AIDS services to monitor and evaluate HTC services. Assessment report for SADC HTC policies and guidelines 6 Recommendations for best and good practices: Using the SADC framework for developing and sharing best practices on HIV/AIDS (2006), two best practices have been identified. These are Botswana's policy of routine HIV testing (RHT) and Lesotho's 'Know Your Status' (KYS) campaign. The same framework was used to identify five good practice HTC interventions. These projects include the Demonstration of Antiretroviral Therapy (DART) project in Soweto, South Africa; the Ndola Demonstration Project in Zambia; the TB/HIV Pilot Project in the Western Cape, South Africa; the Kara Counseling and Training Trust (KCTT) in Lusaka and Choma, Zambia; and the Zimbabwe AIDS Prevention and Support Organisation (ZAPSO) in Harare and Chitungwiza.