title: Unravelling the quality of HIV counselling and testing services in the private and public sectors in Zambia.
abstract: BACKGROUND
  Despite the substantial investment for providing HIV counselling and testing (VCT) services in Zambia, there has been little effort to systematically evaluate the quality of VCT services provided by various types of health providers. This study, conducted in 2009, examines VCT in the public and private sectors including private for-profit and NGO/faith-based sectors in Copperbelt and Luapula.
  
  
  METHODS
  The study used five primary data collection methods to gauge quality of VCT services: closed-ended client interviews with clients exiting VCT sites; open-ended client interviews; interviews with facility managers; review of service statistics; and an observation of the physical environment for VCT by site. Over 400 clients and 87 facility managers were interviewed from almost 90 facilities. Sites were randomly selected and results are generalizable at the provincial level.
  
  
  RESULTS
  The study shows concerning levels of underperformance in VCT services across the sectors. It reveals serious underperformance in counselling about key risk-reduction methods. Less than one-third of clients received counselling on reducing number of sexual partners and only approximately 5% of clients received counselling about disclosing test results to partners. In terms of client profiles, the NGO sector attracts the most educated clients and less educated Zambians seek VCT services at very low rates (7%). The private for-profit performs equally or sometimes better than other sectors even though this sector is not adequately integrated into the Zambian national response to HIV.
  
  
  CONCLUSIONS
  The private for-profit sector provides VCT services on par in quality with the other sectors. Most clients did not receive counselling on partner reduction or disclosure of HIV test results to partners. In a generalized HIV epidemic where multiple concurrent sexual partners are a significant problem for transmitting the disease, risk-reduction methods and discussion should be a main focus of pre-test and post-test counselling.
authors.affiliation: International Health Division, Abt Associates Inc., 4550 Montgomery Avenue, Suite 800N, Bethesda, MD 20814, USA and International Health and Development Division, ICF Macro, 11785 Beltsville Drive, Calverton, Maryland, MD 20705, USA Ilana_Ron@Abtassoc.com.
authors.forename: Ilana
authors.initials: I
authors.lastname: Ron Levey
authors.affiliation: International Health Division, Abt Associates Inc., 4550 Montgomery Avenue, Suite 800N, Bethesda, MD 20814, USA and International Health and Development Division, ICF Macro, 11785 Beltsville Drive, Calverton, Maryland, MD 20705, USA.
authors.forename: Wenjuan
authors.initials: W
authors.lastname: Wang
mesh_terms: D000293:Adolescent; D000328:Adult; D003376:Counseling / Q000379:methods* / Q000592:standards; D005260:Female; D015658:HIV Infections / Q000517:prevention & control* / Q000523:psychology; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D010342:Patient Acceptance of Health Care; D017149:Private Sector / Q000592:standards*; D017150:Public Sector / Q000592:standards*; D040242:Risk Reduction Behavior; D012747:Sexual Partners; D047568:Unsafe Sex / Q000517:prevention & control / Q000523:psychology; D055815:Young Adult; D015024:Zambia
keywords: HIV counselling and testing; HIV prevention services; Zambia; private sector