Building Partnerships, transforming lives

1. Experiences from the Home Based HIV Testing and Counseling Programme [HBTC]Lucy NjukiLiverpool VCT Care & TreatmentHENNET Launch 14th May 2009 Building Partnerships, transforming lives 1

2. Overview • Background • HBTC rationale • LVCT HBTC programme • Planning phase • Strategies used • Successes • Lessons learnt • Conclusion Building Partnerships, transforming lives 2

3. Background Building Partnerships, transforming lives • HBTC is an innovative approach to access of HTC services addressing the testing gap. • Its a PITC approach with an opt out option. • Pilots in Kenya, and else where have shown that HBTC is feasible and acceptable . • Involves additional skills for, level 1 implementers, counsellors. • Development of guidelines, tools, curriculum and operational manual is critical for implementation of this approach 3

4. Rationale Building Partnerships, transforming lives • High level of coverage – community based • Access for family and couples • enhances disclosure • promotes family and social support e.g. for adherence to medication, and emotional support • Target high risk population in relation to the prevalence • Reach children under 5 yrs and emancipated minors 4

5. LVCT HBTC Programme Building Partnerships, transforming lives • Pilot sites for LVCT were in two districts Thika and Nyando. • Piloted for eight months • Pilot supported through PEPFAR/CDC Kenya • Total number of 35,000 clients were reached for HTC services • 3111 couples • 20641 newly tested • 1085 Children • 1243clients tracked • Four strategies were used: -Densely populated, sparsely populated, semi urban, workplaces and slams and rural. • There was shift from anonymity to confidentiality 5

6. What we did in thePlanning phase Building Partnerships, transforming lives At GoK level • Collaborative planning meetings with NASCOP,PHMT,DHMT and LVCT • Formulation of an MOU with MOH • Selection of CHWs and counselors. At community level • Community feasibility/situation analysis & systematic area mapping • CORPS /CHWs sensitized • HBTC counselors trained • Community entry meeting conducted - with community leaders • Community mobilization • Weekly field supervision by DHMT • Regular stakeholders progress review meetings • Regular technical support by CDC • Regular counselor support supervision by LVCT and MoH 6

7. Service delivery strategies • General population:-counsellors visit all the homes in a specified geographical area. (door to door HTC) • Index client:- visits to homes of ART patients to provide HTC to their families. • HBTC uses community based approach as set out in level one strategy- focus on effective communication on behaviour change and prevention strategies. • CORPS/CHWs are key actors, who link the individuals, families and community to HTC service providers under the supervision of District Health Management Team. 7 Building Partnerships, transforming lives

8. Successes • Strong collaboration with the 2 ministries of health • strengthened level 1 strategy – enhanced ownership of service • Time was maximized when Couple/Family test together • Quality assurance systems in place- supervision, client feedback interviews,DBS collection • Feasibility study • Different mobilization strategies • Working with MoH counselors and building their capacity for continuity of services • Supervision by DHMT- created ownership of the services • Reaching elderly and physically challenged people in their households • Majority of client referred accessed care/HIV related service Building Partnerships, transforming lives 8

9. Lessons learnt There is a need for • harmonized HBTC operational guidelines • tools for data collection • standard operating procedures and QA mechanisms. • Strengthen referral linkages among those who are HIV infected • Need to establish support system within the community for client who test HIV positive • Referral for positive clients should be done on a regular basics to avoid delays in referral tracking- Involve LEVEL 1 implementers • Involve local people in creating awareness- promote ownership • HBTC is best practiced in high density areas as it is not cost effective in terms of counselor time and client yield in low density areas. Other approaches should be utilized to serve such areas Building Partnerships, transforming lives 9

10. Lessons learnt cont…… • Most clients and families find HBTC to be confidential • Convenient and cost effective for clients e.g. for travel to VCT • HBTC reduces HIV stigma within the community • It is feasible to form community based support groups. • Additional counseling skills for couples, families, children are critical for HBTC implementation. • QA systems need to be considered for HBTC implementation • Feasibility study is necessarily for uptake coverage measurement. • Adherence to proper community/Home entry process is necessary to service acceptance. 10 Building Partnerships, transforming lives

11. In conclusion: Building Partnerships, transforming lives Scaling-up HBTC is feasible A National HBTC Operational manual is critical for implementation of HBTC program Implement HBTC plus can be explored for areas without HIV care clinics. Strengthening referral linkages between other partners, families and CCCs is critical Support systems for CHWs and CORPS – monthly supervision , incentives need consideration. 11

12. Thank You! • Contacts Website:www.liverpoolvct.org Email: enquiries@liverpoolvct.org Building Partnerships, transforming lives 12