title: Introduction of voluntary counselling and rapid testing for HIV in rural South Africa: from theory to practice.
abstract: Expanding access to voluntary counselling and testing (VCT) for HIV is an important first step in the development of a comprehensive package of HIV services. This article describes the introduction of VCT among five primary health care (PHC) facilities in a rural South African setting, alongside a multidimensional impact assessment as part of a national pilot programme. A baseline review of services demonstrated low levels of VCT, which were predominantly hospital-based. Twenty health workers in five PHC facilities were trained to provide VCT using rapid-testing assays. The feasibility of VCT introduction and its overall acceptability to clients and providers were evaluated using clinic testing registers, semi-structured interviews with counsellors and mock client encounters. One year after its introduction, a major increase in the quantity of HIV testing, the proportion of clients who receive their results, and the proportion who present voluntarily was observed. The majority of those presenting were women, and 20-40 year olds predominated. There was a high level of acceptance among health workers, and the quality of VCT was rated very good in mock client encounters. This work demonstrates one effective model for improving access to VCT through existing primary health care services in a rural South African context.
authors.affiliation: Rural AIDS and Development Action Research Programme, School of Public Health, University of the Witwatersrand/London School of Hygiene and Tropical Medicine, South Africa. pronyk@soft.co.za
authors.forename: P M
authors.initials: PM
authors.lastname: Pronyk
authors.forename: J C
authors.initials: JC
authors.lastname: Kim
authors.forename: M B
authors.initials: MB
authors.lastname: Makhubele
authors.forename: J R
authors.initials: JR
authors.lastname: Hargreaves
authors.forename: R
authors.initials: R
authors.lastname: Mohlala
authors.forename: H P
authors.initials: HP
authors.lastname: Hausler
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D003376:Counseling / Q000592:standards*; D005260:Female; D015658:HIV Infections / Q000175:diagnosis* / Q000453:epidemiology; D006297:Health Services Accessibility; D006801:Humans; D008297:Male; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D017060:Patient Satisfaction; D011320:Primary Health Care / Q000592:standards*; D011787:Quality of Health Care; D012423:Rural Health; D013019:South Africa / Q000453:epidemiology