title: The role for government health centers in provision of same-day voluntary HIV counseling and testing in Kenya.
abstract: OBJECTIVE
  To explore the role of primary health centers in provision of voluntary counseling and testing (VCT) in Kenya.
  
  
  METHODS
  Prospective service evaluation at 3 (1 urban and 2 rural) government health centers.
  
  
  METHODS
  Consecutive adult clients.
  
  
  METHODS
  Uptake of services, user characteristics, quality of service.
  
  
  RESULTS
  Counseling services received 2315 new clients over 26 months. The last quarter averaged 101 clients per clinic. More than 80% of clients lived locally. Overall 93% opted to test, 91% receiving results, 82% on the same day. Most clients tested HIV negative (81%). Youth and men were well represented. Few couples (10%) attended. Seventeen percent of women were pregnant. Self-referral was common and illness was an uncommon reason for testing (<20%). Thirty-one percent of clients were referred from VCT to other health center services. Counseling was perceived as high quality by users and providers. Validation of the test algorithm showed a sensitivity of 98.0% and specificity of 98.7%.
  
  
  CONCLUSIONS
  Government health centers in Kenya can be appropriate providers of VCT. This pilot helped initiate a new strategy of health center-based VCT in Kenya and this has facilitated rapid expansion and more equitable provision for Kenyans.
authors.affiliation: Department of Genitourinary Medicine, Camden Primary Care Trust, The Mortimer Market Centre, London, UK. slandga@ntlworld.com
authors.forename: Gilly R
authors.initials: GR
authors.lastname: Arthur
authors.forename: Gilbert
authors.initials: G
authors.lastname: Ngatia
authors.forename: Cecilia
authors.initials: C
authors.lastname: Rachier
authors.forename: Roselyn
authors.initials: R
authors.lastname: Mutemi
authors.forename: Joseph
authors.initials: J
authors.lastname: Odhiambo
authors.forename: Charles F
authors.initials: CF
authors.lastname: Gilks
mesh_terms: D000367:Age Factors; D003151:Community Health Centers / Q000706:statistics & numerical data*; D003376:Counseling / Q000706:statistics & numerical data*; D005191:Family Characteristics; D005260:Female; D006077:Government Agencies / Q000706:statistics & numerical data*; D015483:HIV Antibodies / Q000097:blood; D015658:HIV Infections / Q000175:diagnosis / Q000453:epidemiology / Q000517:prevention & control*; D018023:HIV Seronegativity; D006801:Humans; D007630:Kenya / Q000453:epidemiology; D008297:Male; D037841:Pregnant People; D011320:Primary Health Care / Q000706:statistics & numerical data*; D011787:Quality of Health Care; D012648:Self Care; D012680:Sensitivity and Specificity; D016036:Seroepidemiologic Studies
chemical_list: D015483:HIV Antibodies