Programme assessment of voluntary counseling and testing: quality service, client and counsellor satisfaction

Abstract

Voluntary HIV counselling and testing (VCT) is an entry point to a range of HIV prevention and care interventions. Given recent breakthrough to help people with HIV/AIDS, there is considerable reason to promote such services. Despite the particular need for VCT in developing countries with high prevalence of HIV infection (Kenya 6.7% in 2004), very little has been done to evaluate the programmes. Studies on evaluation of VCTs in Africa to date have focussed on measuring the efficacy of VCT in changing risk behaviours of study participants or clients at VCT centres: usually in environments where the services were usually new. They have not (at least directly) been concerned with what is the broader question of interest, the impacts on prevention behaviour and ultimately HIV incidence in the target population for VCT when the intervention is expanded to become widely accesible to this population. That is they have not evaluated what are variously called programme "outcomes" or "effectiveness" This study focussed on, an evaluation of VCT programme among PLWHAs in Kibera slums, Nairobi. To assess client and counsellor satisfaction and the quality of service. Existing community home based organizations (CHBC) were the point of entry as these represented PLWHAs who had gained more acceptances of their sereostatus and were willing to openly participate in the study. They were randomly sampled from these community based organizations. Included also were counsellors doing counselling in the CHBC organizations, and CHBC leader who were considered key informants in respect of their involvement with facilitating VCT for the PLWHAs. It was focussed on four main areas, VCT operational sites, counsellor requirement and satisfaction, counselling skills evaluation, and client satisfaction. A cross sectional study was carried out using UNAIDS and MoH modified tools, consisting of semi-structured interviews, and observation checklist. The interview schedules was used to evaluate the operational aspects of VCTs, interviews were used to assess client and counsellor's satisfaction. Observation checklists were used to observer the counselling sessions. 18 counsellors including volunteers were interviewed, 16 on-going sessions were observed, 75 client interviews were conducted and 10 key informants were interviewed. Generally counselling was rated very high by both clients (PLWHAs) and key informants. The counselors sited both reward and stress in their job. Study identified that most VCT counsellors have VCT training but no refresher training, most VCT services are inaccessible in terms of distance and were only operating during weekdays, majority of counsellors do not receive support and supervision from any designated supervisor and therefore suffer burnout. And that client raised concerns about confidentiality. The study identified areas where training need to be strengthened and suggested ways of improving the service. Data were analyzed using statistical package for social sciences (SPSS). Chi-square test of independence was used to establish relationship between variables. And data was presented using frequency tables, percentages, bar and pie charts.