SAfAIDS Discussion Forum Review

NEW START VCT SERVICES
· Voluntary and anonymous testing
· Clients pay $Z50
· Free promotion weeks
· Client centred counselling
· Same day results
· Do not issue written results to clients
· Emphasis on quality

Background
Zimbabwe has among the highest HIV prevalence in southern Africa. Many Zimbabweans are aware of HIV and AIDS in both urban and rural areas. A significant number of Zimbabweans feel that they are already infected, yet they have never been tested. Current statistics show that the reverse is true. Around 70 % of Zimbabweans are HIV negative.

Before VCT was introduced in Zimbabwe, an HIV test was costly and required a physician’s referral. As a result, few people were tested. Due to the inaccessibility of HIV testing, individuals soon recognised that they could use blood donation as a way of getting tested. The National Blood Service would accept them as a regular donor if they were negative on two consecutive occasions. However, it could be a lengthy and stressful process for someone waiting for results. Individuals needed an easier process with greater access to HIV testing—hence the New Start initiative

VCT Delivery Models
Several models exist for the delivery of VCT services. For example, VCT services can be implemented as a service provided in public sector clinics or in partnership with non-governmental organisations (NGOs). Another option would be to establish a clinic that deals only with HIV counselling and testing. Uncertain which option was best for Zimbabwe, the New Start initiative implemented several different VCT delivery models.

1. Public Sector Clinic
Opportunities
· Clinics are in high density areas
· High volume of clients
· Some staff have counselling experience
· Less stigma
· Mobilisation of community resources
· Low price for services
· High potential for replication

Challenges
· Staff perceive services as additional burden
· Low motivation of staff - low salary
· Limited staff
· Long waiting periods
· Inconvenient clinic hours
· Lack of space for expansion

2.NGO Provider
· Opportunities
· Specialised
· Quality standards easily enforced
· Long tradition of working with communities
· Employ staff according to demand and resources
· Flexible hours

Challenges
· Weak management support system
· Diversion from core activities
· Potential for stigma
· Donor dependent

3.Public Sector/NGO Partnership
Opportunities
· Increased absorptive capacity
· Reduce waiting time
· Clinics continue to focus on core activities
· Additional resources
· Community mobilisation/target population

Challenges
· Lack of space
· Unwillingness to accept outside providers
· Management of relationship

4. Private sector model
Opportunities
· Commitment to quality
· Perceived to be private and confidential
· Respond to client needs
· Complementary to other services

Challenges
· Expensive and inaccessible
· Limited absorptive capacity
· Resist quality control—operate under limited supervision

The New Start programme was integrated with the services of public sector clinics or in partnership with NGOs throughout the country. The newest clinic was developed as a direct walk-in site that only provides VCT services. Through an evaluation of the various delivery models, it was found that clients preferred the programmes in public sector clinics. Clients felt that the purpose of their visit would remain anonymous by visiting a clinic where there was a high volume of clients and numerous health services were provided. However, the clinic staff found VCT was a further duty and service that put additional burden on an already overworked staff. The evaluation found that the quality of the programme was more efficient in clinics where staff were devoted only to providing VCT services.

Quality Assurance of the New Star Programme
· Weekly group supervision meetings are conducted
· Counselling session reflection
· Periodic visits by site facilitators
· Direct observation
· Mystery clients (anonymous observation of service)
· In-service training
· Stress management workshops
· Exchange visits
· 10% of specimens for Quality Assurance at laboratory

Challenges
The New Start programme continues to face several challenges, with both the staff and the clients. The programme strives to maintain country and regional standards as well as to develop criteria for hiring counsellors. There is a high risk of staff burnout from the increasing number of clients attending the clinics. The programme is examining various options such as training lay counsellors and/or peer educators. Additionally, the New Start Initiative is continually exploring various strategies to encourage follow-up counselling, the mobilisation of communities and partner notification.

Characteristics of New Start Clients
· 56% male: 44% female
· 50% have never married while 36% are married. 5% are widowed
· 78% are HIV negative while 22% are HIV positive
· More female clients are positive than male clients
· More married clinics are positive that never married or widowed clinics
· The majority of HIV+ clients are between the age of 25-29
· Between the ages of 20-24, there are approximately 5 times more women who test positive as compared to men in a similar age group.
· 66% of clients come to be tested because they are curious

The Next Steps
The New Start Initiative is examining methods to develop:

· A mobile VCT programme to high density and rural areas
· Linkage with support groups
· Linkage with other services
· Youth Friendly VCT sites
· Communication Campaign
· Linkage with pilot treatment initiatives
For more information, please contact:
SAfAIDS

Southern Africa AIDS Information Dissemination Service
17 Beveridge Rd,
PO Box A509, Avondale
Harare, Zimbabwe
Tel: 263-04-336193/4
Fax: 263-04-336193/4
Email: [email protected]
Web: www.safaids.org.zw

For Information about the New Start Centres
Tel: 263-04-572600 or702446 (Harare)