title: Evaluation of the HIV lay counselling and testing profession in South Africa.
abstract: BACKGROUND
  With the launch of the national HIV Counselling and Testing (HCT) campaign in South Africa (SA), lay HIV counsellors, who had been trained in blood withdrawal, have taken up the role of HIV testing. This study evaluated the experiences, training, motivation, support, supervision, and workload of HIV lay counsellors and testers in South Africa. The aim was to identify gaps in their resources, training, supervision, motivation, and workload related to HCT services. In addition it explored their experiences with providing HIV testing under the task shifting context.
  
  
  METHODS
  The study was conducted in eight of South Africa's nine provinces. 32 lay counsellors were recruited from 67 HCT sites, and were interviewed using two questionnaires that included structured and semi-structured questions. One questionnaire focused on their role as HIV counsellors and the other on their role as HIV testers.
  
  
  RESULTS
  Ninety-seven percent of counsellors reported that they have received training in counselling and testing. Many rated their training as more than adequate or adequate, with 15.6% rating it as not adequate. Respondents reported a lack of standardised counselling and testing training, and revealed gaps in counselling skills for specific groups such as discordant couples, homosexuals, older clients and children. They indicated health system barriers, including inadequate designated space for counselling, which compromises privacy and confidentiality. Lay counsellors carry the burden of counselling and testing nationally, and have other tasks such as administration and auxiliary duties due to staff shortages.
  
  
  CONCLUSIONS
  This study demonstrates that HCT counselling and testing services in South Africa are mainly performed by lay counsellors and testers. They are challenged by inadequate work space, limited counselling skills for specific groups, a lack of standardised training policies and considerable administrative and auxiliary duties. To improve HCT services, there needs to be training needs with a standardised curriculum and refresher courses, for HIV counselling and testing, specifically for specific elderly clients, discordant couples, homosexuals and children. The Department of Health should formally integrate lay counsellors into the health care system with proper allocation of tasks under the task shifting policy.
authors.affiliation: School of Public Health, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa. aziza.mwisongo2@wits.ac.za.|Wits Health Consortium-Clinical HIV Research Unit (CHRU), Department of Medicine, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa. aziza.mwisongo2@wits.ac.za.
authors.forename: Aziza
authors.initials: A
authors.lastname: Mwisongo
authors.affiliation: HIV/AIDS, STIs, and TB (HAST) Research Programme, Human Sciences Research Council (HSRC), Pretoria, Cape Town, Durban, Port Elizabeth, South Africa. vmehlomakhulu@hsrc.ac.za.
authors.forename: Vuyelwa
authors.initials: V
authors.lastname: Mehlomakhulu
authors.affiliation: HIV/AIDS, STIs, and TB (HAST) Research Programme, Human Sciences Research Council (HSRC), Pretoria, Cape Town, Durban, Port Elizabeth, South Africa. nmohlabane@hsrc.ac.za.
authors.forename: Neo
authors.initials: N
authors.lastname: Mohlabane
authors.affiliation: HIV/AIDS, STIs, and TB (HAST) Research Programme, Human Sciences Research Council (HSRC), Pretoria, Cape Town, Durban, Port Elizabeth, South Africa. kpeltzer@hsrc.ac.za.|Department of Research & Innovation, University of Limpopo, Turfloop, South Africa. kpeltzer@hsrc.ac.za.|ASEAN Institute for Health Development, Madidol University, Salaya, Phutthamonthon, Nakhonpathom, 73170, Thailand. kpeltzer@hsrc.ac.za.
authors.forename: Karl
authors.initials: K
authors.lastname: Peltzer
authors.affiliation: HIV/AIDS, STIs, and TB (HAST) Research Programme, Human Sciences Research Council (HSRC), Pretoria, Cape Town, Durban, Port Elizabeth, South Africa. jmthembu@hsrc.ac.za.
authors.forename: Jacque
authors.initials: J
authors.lastname: Mthembu
authors.affiliation: HIV/AIDS, STIs, and TB (HAST) Research Programme, Human Sciences Research Council (HSRC), Pretoria, Cape Town, Durban, Port Elizabeth, South Africa. hvanrooyen@hsrc.ac.za.
authors.forename: Heidi
authors.initials: H
authors.lastname: Van Rooyen
mesh_terms: D000328:Adult; D003376:Counseling / Q000706:statistics & numerical data; D003695:Delivery of Health Care; D005191:Family Characteristics; D005260:Female; D015658:HIV Infections; D006679:HIV Seropositivity / Q000175:diagnosis*; D006301:Health Services Needs and Demand; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008403:Mass Screening; D009042:Motivation; D010342:Patient Acceptance of Health Care / Q000523:psychology*; D036301:Qualitative Research; D013019:South Africa; D011795:Surveys and Questionnaires; D055815:Young Adult