Evaluation of the HIV lay counselling and testing profession in South Africa

Abstract

BackgroundWith 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.MethodsThe 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.ResultsNinety-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.ConclusionsThis 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.

Challenges in the delivery of public HIV testing and counselling (HTC) in Douala, Cameroon: providers perspectives and implications on quality of HTC services

“…Hence, the majority of participants in these PVTCCs have raised the issue of lack of privacy and confidentiality during counselling sessions. This is a health system concern, as the lack of privacy compromises confidentiality and contributes to making HIV counselling sessions less effective [8, 28]. This issue is particularly important when it concerns countries with stigmatization and discrimination against HIV positive persons [29, 30].…”

“…However, in the absence of a specific curriculum and national training standards, the counsellors’ training varied in duration and content, depending on the training organization and there is also a variation of training among lay counsellors in the same health facility. This situation calls into question the quality of the training and the counselling [7, 8]. …”

The Experiences of Lay Counsellors Regarding Hiv and Aids Care and Support in Tshwane Clinics

“…In addition, they do not receive a sufficient salary (Woolman, Sprague and Black, 2009). Mwisongo et al (2015) further support that low morale and motivation of counsellors is partly affected by poor remuneration. A majority of lay counsellors serve as volunteers with the hope of finding stable employment (Schneider et al, 2008).…”

“…They provide care and support to clients with limited knowledge and skills related to counselling and testing. Mwisongo et al (2015) confirm that lay counsellors have limited counselling for specific vulnerable groups such as children, older clients, discordant couples, homo-sexuals and children. These counsellors work with a team of health care providers, alongside the professional health nurses (Rohleder and Swartz, 2005).…”

“…According to Mwisongo, Mehlomakhulu, Mohlabane, Peltzer, Mthembu and Van Rooyen (2015), HIV Counselling and Testing (HTC) services in South Africa are commonly performed by health care providers including lay counsellors and testers. Dlamini (2011) states that nurses used to be responsible for providing HIV and AIDS education, counselling, testing and support in hospitals and clinics around the country.…”