title: Challenges and successes of HIV voluntary counselling and testing programme in antenatal clinics in greater Kingston, Jamaica.
abstract: OBJECTIVE
  Voluntary counselling and testing (VCT) is a critical issue impacting HIV disease management from a national and global perspective. In Jamaica (population 2.6 million), 2% of women in antenatal clinics are HIV-positive and mother-to-child-transmission (MTCT) accounted for 7% of all reported cases in 2002. Notwithstanding this, VCT was ad hoc and not standardized. In 2003, a structured VCT programme was developed islandwide with over 300 VCT service providers and 16 qualified trainers.
  
  
  METHODS
  We describe the challenges and successes of VCT provided by five trained research nurses in the Perinatal HIV/AIDS Programme in Kingston which services 19,000 pregnant women per year in three major maternity centres and their 42 feeder antenatal clinics.
  
  
  CONCLUSIONS
  The VCT model used was group education, opt-out individual testing, individual post-test counselling for seropositives and informing seronegatives of their negative status. Major challenges encountered included lack of quality control of the counselling process and lost opportunities for un-booked women who presented in labour However successes enjoyed included client assessment of risk behaviours with appropriate lifestyle changes, increased uptake of HIV testing and adherence to care for themselves and their infants, as well as reduction in stigma.
  
  
  CONCLUSIONS
  VCT has proven to be an important intervention that enabled improvement in the awareness, prevention and control of HIV in Jamaican pregnant women. Nurses who are appropriately trained in VCT can play a pivotal role in successful provision of VCT services.
authors: The University of the West Indies, Kingston, Jamaica, West Indies.
authors: J
authors: J
authors: Moore
authors: P
authors: P
authors: Palmer
authors: M
authors: M
authors: Anderson-Allen
authors: C
authors: C
authors: Billings
authors: C
authors: C
authors: McDonald-Kerr
mesh_terms: D000223:Adaptation, Psychological; D037001:Directive Counseling; D005260:Female; D015658:HIV Infections / Q000175:diagnosis / Q000517:prevention & control* / Q000523:psychology* / Q000635:transmission; D015438:Health Behavior; D006266:Health Education; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D018445:Infectious Disease Transmission, Vertical / Q000517:prevention & control*; D007563:Jamaica / Q000453:epidemiology; D017060:Patient Satisfaction; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000175:diagnosis / Q000517:prevention & control* / Q000523:psychology*; D011295:Prenatal Care; D011613:Psychotherapy; D012309:Risk-Taking; D013315:Stress, Psychological; D011795:Surveys and Questionnaires; D055815:Young Adult