Jhpiego has pioneered an innovative strategy for HIV community counseling and testing (CCT), which relies on the geographical reach and skills of lay counselors to expand services to populations who do not regularly visit health facilities. First piloted in Mozambique in November 2006, the successful CCT approach was endorsed as a national strategy and has become a model for task shifting in Mozambique and other countries.
Originally intended as an aggressive scale-up strategy to help achieve national treatment goals for antiretroviral treatment coverage for HIV/AIDS, CCT began as a straightforward prevention intervention. It emphasized training lay counselors and equipping them with tools to reach their respective communities and refer HIV-positive individuals to the closest available treatment services. Theproject, implemented in Mozambique in partnership with the National AIDS Commission, the Ministry of Health (MOH), nongovernmental organizations and faith-based organizations, showed that the community task-shifting model reached significantly more rural and underserved populations than facility-based counseling and testing. From October 2008 to April 2013, the project counseled 1,242,225 people and tested 1,010,641 (81.4% acceptance rate) using the CCT approach; of those tested, 749,584 (74.2%) were aged 15 years and more; 546,089 (54%) were females; 34,035 (3.4%) were HIV-positive.116,475 couples were reached, with 2,192 positive concordant and 3,367 discordant couples. In addition, home-based CCT reached more children and couples and encouraged disclosure of test results among couples. The clear and immediate success of the demonstration project helped win MOH support for expanding the project from an HIV/AIDS prevention intervention to an extensive, basic health care management intervention that also includes screening for other prevalent diseases such as diabetes, malaria and tuberculosis. When the number of people tested by the lay counselors increased more rapidly than anticipated, the scope of the project was expanded further to cover other critical interventions. These included support for prevention of gender-based violence, management of pregnancy and childbirth, and voluntary medical male circumcision services.
The lay counselors also began to use community mapping, which enabled them to ensure appropriate and confidential follow-up after referrals, document the need to return to offer counseling and testing to family members who were not at home during the initial visit, and reinforce linkages to other prevention services and health care facilities. Not only have high-quality CCT services improved counseling and testing coverage for couples and children, they have also contributed to changing individual behavior, strengthening the human face of health services, reducing the stigma associated with disclosure and addressing gender-based violence.
The CCT approach is now integral to the provision of health services in Mozambique and has proven to be an important vehicle in bringing health services to the people, resulting in wider coverage of services—serving as a model for replication in other countries.
Scaling up the CCT approach in 25 villages of the Kirinyaga East district of Kenya resulted in 7,282 clients counseled and tested for HIV, 57% of whom were first time testers. Because the government of Kenya has prioritized first time testers in their new HIV strategy, Jhpiego will continue to integrate the CCT approach into additional communities nationwide as a proven strategy in HIV testing.