This study aimed to review the use of lay counselors and rapid HIV tests in a voluntary testing and counseling (VCT) service in the UGU South health district of KwaZulu Natal. The decision to use lay counselors at UGU South was based on a review of the capacity of existing health care workers to expand a CTV service. Make recommendations for the use of lay counselors and rapid HIV testing in an expanded integrated HIV/TB control program.
The lay advisors were acceptable to health staff, but no assessment of clients' views of the lay advisors took place. Before expanding the use of lay counselors, further research should be conducted into the capacity of other health care professionals to provide VCT. Issues such as employment conditions, salaries and job description for lay advisors need to be clarified.
There should be an independent assessment of the quality of the advice offered and a review of the costs of the lay advisers. Consideration should be given to lay counselors performing the rapid HIV test or an alternative testing method (not involving blood) should be introduced.
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The survey was conducted at the UGU South ProTEST pilot site and geographical and demographic details are summarized on this site. The study assessed the use of lay advisors in a VET service and the rationale for the use of lay advisors is presented. This study aimed to assess the impact of the use of lay counselors and rapid HN testing in a vocational education and training service at the UGU South ProTEST pilot site, KwaZulu Natal.
Develop a training, mentoring and support program for lay counselors and determine the effectiveness of this program. Make recommendations for the use of lay counselors and rapid HIV testing in an expanded, integrated HN ITB control program. This site was unique among the South African sites in using lay counselors in the VCT service.
South Coast Hospice paid the lay counselors R 1200 per month (with no pension or medical aid). The task force decided that the lay counselors should wear a blue apron to distinguish them from nurses.
LITERA TURE REVIEW
Description of the study population and methods used to determine the selection of study sites are provided. In line with the aim of the study, methods used to assess the capacity of existing health workers to provide an expanded VCT service and the need for rapid HIV tests are described. A limitation of the study was that it was conducted at a ProTEST pilot site and the available resources may not have been available elsewhere.
The number of tests performed was determined by analyzing the number of returned questionnaires. In November 1999, the researcher conducted an exploratory quantitative study of available nursing time per client in clinics. A limitation of this method was that it was very specific to the requirements of the ProTEST pilot site.
In June 2000, a researcher conducted a survey of nurses' opinions about lay counsellors. In another assessment of the effectiveness of training, mentoring and support programs, the perceptions of lay counselors were determined. A limitation of the study may be that the researcher facilitated the discussion and that lay counselors may have provided answers that they believed the researcher wanted to hear.
The designation of the counselor was also included on the guidance questionnaire (e.g., nurse, doctor, lay counselor).
RESULTS
The researcher did not determine the number of nurses who had ever received the questionnaire, nor the number who had completed and reposted it (some questionnaires may have been misplaced by the postal service). -respondents and their perceptions may have changed from those who responded. 34; A full-time counselor would have more time available to counsel and educate waiting clients and resolve clients' feelings." The use of rapid HIV tests would increase the number of people who gain access to their HIV test result.
In the remaining institutions, the head nurse was not available on the day of the interview. The content of the training program was understood and adopted by lay counselors. All interviewed nurses had a positive opinion of lay counselors and were grateful to have them in their institution.
All nurses perceived that the number of clients being tested had increased and that the quality of counseling provided had improved following the introduction of lay counsellors. At the end of the day you realize that they need me to advise them". 34;A doctor asked me to start at one end of the ward and work at the other.
They felt that there would be less disruption in communication if they could use rapid HIV tests. The results of the number of people tested by type of counselor and the average number counseled per counselor in the South African ProTEST sites are summarized in Table iv. Langa also hired lay counselors after the first three months of the study period (lay counselors started at Langa in January 2000).
The percentage of referrals who self-referred for testing increased over time from less than 20% in the first quarter of the study to between 40 and 50% in the final quarters of the study. Results are presented from a retrospective review of the TB registries used by the National TB Control Program for study sites. The numbers (%) of the above cases recorded as having completed treatment are summarized in Table
Overall, just over half of people diagnosed with TB during the study period were recorded as having completed their treatment. A person was no more likely to complete treatment at the end of the study period than at the beginning, p=O.l6.
DISCUSSION CONCLUSIONS
RECOMMENDATIONS
Recommendations for the use of lay counselors and rapid HIV tests in expanded and integrated HIV ITB control. Further research may be indicated on the maximum number of clients that should be seen by lay counselors. A review of client opinions of lay counselors was not undertaken, nor was client preference for counseling assessed.
The suggestions of lay advisors should be taken into account and their experiences used in updating the training curriculum. Lay counselors mentioned specific aspects of counseling that were not covered in the training curriculum (managing discordant couple outcomes, rape, and counseling men). If the nurse was employed, the support and mentoring of lay counselors could be an additional burden.
However, the increase in the number of clients may have occurred independently of the presence of lay counselors. The change in the number of tuberculosis cases diagnosed could not be directly attributed to the presence of lay counselors. A cost analysis of lay advisors should be conducted and clients' opinions of the lay advisors assessed.
There should be an independent review of the quality of advice provided by lay advisers. The impact of using male and younger lay counselors in DCT services should be investigated. A review is needed to measure the specific impact of lay counselors on the number of TB cases diagnosed and the proportion of clients completing TB treatment.
The study strongly demonstrated that the presence of lay counselors increased access to VCT services. Cost-effectiveness of the use of lay consultants compared to the use of other categories of health professionals. A review of the lay counselor training curriculum considering the experiences of the lay counselors involved in this study.
Progress with the ProTEST initiative: a combined approach to the combined epidemics of tuberculosis and HIV. Managing the twin epidemics of tuberculosis and mV/AIDS - An overview of the challenge and response in five countries. The majority of the population lives in rural areas, but there is also a large suburban settlement (Gamalake).
The UGU South district generally corresponds to the old magisterial districts of Port Shepstone/Port Alfred, so this data will be used to represent UGU South. Local sources state that this data is an underestimate of the population size and does not take into account the cross-border use of services by customers in the Eastern Cape. As part of the ANC national survey of HIV prevalence, blood samples are tested anonymously in health facilities.
When you have received pre-test counseling, you will decide whether or not you want to be tested. Sometimes, if the nurse is worried about the test, she will take blood from your arm and send it to the hospital. If the sample contains HIV antibodies, they mix with the antigen conjugated within the pad; when this happens a chromatographic reaction occurs producing a red line in the patient window.
Remove the protective foil cover from the test strip and place the strip on a surface with a sticker. Apply a drop of chase buffer to the sample pad and record the time on the label. If the kit has been left for more than 2 hours before reading, the test must be repeated.
Make sure the control strip is positive to confirm the validity of the test. Take the test after the results have been recorded. Remember the "window period" - this reflects the time needed for the individual to start producing antibodies and the ability of the test to detect these antibodies in the blood. Band intensity does not correlate with antibody titer; even a faint bar in the patient window indicates a positive test.
1 minute
Smart Check HIV 1 & 2 Rapid Cassette
I am interested in health education or awareness campaigns. I am interested in receiving preventive therapy against tuberculosis, prophylaxis with leo trimoxazole. Other (specify). Concerned that others will find out their HIV status (lack of confidentiality) Warned of partner's reaction if HIV positive. Concerned that there will be no benefit from knowing one's HIV status due to the belief that nothing can be done for HIV positive people.
Warned that knowing about being HIV positive could hasten disease and death. Warned about the attitude of health workers if they are HIV positive.
IF THE TEST IS POSITIVE
