title: An assessment of quality of home-based HIV counseling and testing performed by lay counselors in a rural sub-district of KwaZulu-Natal, South Africa.
abstract: HIV counseling and testing (HCT) has been prioritized as one of the prevention strategies for HIV/AIDS, and promoted as an essential tool in scaling up and improving access to treatment, care and support especially in community settings. Home-based HCT (HBHCT) is a model that has consistently been found to be highly acceptable and has improved HCT coverage and uptake in low- and middle-income countries since 2002. It involves trained lay counselors going door-to-door offering pre-test counseling and providing HCT services to consenting eligible household members. Currently, there are few studies reporting on the quality of HBHCT services offered by lay counselors especially in Sub-Saharan Africa, including South Africa. This is a quantitative descriptive sub-study of a community randomized trial (Good Start HBHCT trial) which describes the quality of HBHCT provided by lay counselors. Quality of HBHCT was measured as scores comparing observed practice to prescribed protocols using direct observation. Data were collected through periodic observations of HCT sessions and exit interviews with clients. Counselor quality scores for pre-test counseling and post-test counseling sessions were created to determine the level of quality. For the client exit interviews a continuous score was created to assess how satisfied the clients were with the counseling session. A total of 196 (3%) observational assessments and 406 (6%) client exit interviews were completed. Overall, median scores for quality of counseling and testing were high for both HIV-negative and HIV-positive clients. For exit interviews all 406 (100%) clients had overall satisfaction with the counseling and testing services they received, however 11% were concerned about the counselor keeping their discussion confidential. Of all 406 clients, 393 (96.8%) intended to recommend the service to other people. In ensuring good quality HCT services, ongoing quality assessments are important to monitor quality of HCT after training.
authors: a Health Systems Research Unit, South African Medical Research Council , Francie van Zyl Drive, Parow valley, Tygerberg 7505 , South Africa.
authors: Vuyolwethu
authors: V
authors: Magasana
authors: a Health Systems Research Unit, South African Medical Research Council , Francie van Zyl Drive, Parow valley, Tygerberg 7505 , South Africa.
authors: Wanga
authors: W
authors: Zembe
authors: a Health Systems Research Unit, South African Medical Research Council , Francie van Zyl Drive, Parow valley, Tygerberg 7505 , South Africa.|b Department of Public Health Sciences , Karolinska Institutet , Stockholm , Sweden.|d School of Public Health, University of the Western Cape , Modderdam Road, Bellville 7535 , South Africa.
authors: Hanani
authors: H
authors: Tabana
authors: a Health Systems Research Unit, South African Medical Research Council , Francie van Zyl Drive, Parow valley, Tygerberg 7505 , South Africa.|c School of Public Health, Boston University , 715 Albany Street, Boston , MA 02118 , USA.
authors: Reshma
authors: R
authors: Naik
authors: d School of Public Health, University of the Western Cape , Modderdam Road, Bellville 7535 , South Africa.
authors: Debra
authors: D
authors: Jackson
authors: e Biostatistics Unit, South African Medical Research Council , Francie van Zyl Drive, Parow valley, Tygerberg 7505 , South Africa.
authors: Sonja
authors: S
authors: Swanevelder
authors: a Health Systems Research Unit, South African Medical Research Council , Francie van Zyl Drive, Parow valley, Tygerberg 7505 , South Africa.|d School of Public Health, University of the Western Cape , Modderdam Road, Bellville 7535 , South Africa.
authors: Tanya
authors: T
authors: Doherty
mesh_terms: D000293:Adolescent; D000328:Adult; D003219:Confidentiality; D003376:Counseling / Q000592:standards*; D005260:Female; D015658:HIV Infections / Q000175:diagnosis*; D006701:Home Nursing / Q000592:standards*; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D019370:Observation; D017060:Patient Satisfaction; D011785:Quality Assurance, Health Care; D013019:South Africa; D055815:Young Adult
keywords: Afrique du Sud; Conseillers volontaires; Conseils/tests VIH à domicile; Qualité des conseils; South Africa; Supervision; counseling quality; home-based HIV counseling and testing; lay counselors; supervision