Progress in expanding HIV testing and counselling in the Caribbean to achieve universal access
N. Jack1, S. Samiel2, S. Caffe1, A. Del Riego1, G. Hirnschall3
1Pan American Health Organization, PAHO HIV Caribbean Office, Port of Spain, Trinidad and Tobago, 2Pan American Health Organization, PAHO/WHO Representation-ECCS, Bridgetown, Barbados, 3Pan American Health Organization, HIV/STI Project, Washington DC, United States
Background: HIV testing and counseling is critical for the achievement of the goals of universal access. In the Caribbean, from 2006, PAHO/WHO has been promoting the expansion of HIV testing using the strategy of the provider initiated testing and counseling (PITC), rapid HIV testing and integration of HIV testing into primary care services.
Methods: The WHO one-day PITC training curriculum was adapted for the Caribbean and Trainer of Trainers (TOT) package developed and utilized for capacity building. The WHO/CDC rapid HIV testing training curriculum was also adapted and capacity building provided which included guidance on field validation of algorithms and procedures for quality assurance. Guidelines that focused on policy, programmatic and key operational issues were also developed and distributed to support programme implementation.
Results: Between 2007-2009, four sub-regional TOT workshops supported capacity building for more than 120 health care providers in 28 countries. In-country workshops, trained over 600 health care providers. Information was also provided on basic HIV, TB, STI and PMTCT; planning and M&E for HIV testing and stigma and discrimination. In 2007, six countries reported 369,991 persons tested and received results, increasing to 631,875 in nine countries in 2008. Use of rapid HIV testing in primary care clinics increased from three countries in 2006 to 2009 the eight countries with expansion occurring in the number of sites in each country.
Conclusions: Further expansion of HIV testing should focus on increasing access to most at risk populations and must be accompanied by enhanced post-HIV test support and referrals. PITC and rapid HIV testing methods are essential strategies, more health care and other providers must be trained in these methods and HIV testing must continue to be integrated into other services to provide access to all.
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