Quality of HIV Counselling Services Offered in Public Health Facilities in Kampala, Uganda
Victo Kyobutungi1*, Anthony Ssebagereka1, Christine T Begumisa1, Christine Muhumuza1 and Joseph KB Matovu2
1Department of Epidemiology and Biostatistics, Makerere University College of Health Sciences, School of Public Health, P.O Box 7072, Kampala, Uganda
2Department of Community Health and Behavioral Sciences, Makerere University College of Health Sciences, School of Public Health, P.O Box 7072, Kampala, Uganda
*Corresponding Author: Victo Kyobutungi, Department of Epidemiology and Biostatistics, Makerere University College of Health Sciences, School of Public Health, P.O Box 7072, Kampala, Uganda.
December 22, 2021; Published: February 25, 2022
Background: HIV counselling is increasingly available in public health facilities in Uganda. Counselling is an entry point into care, treatment and support services of many HIV/AIDS prevention programs. Quality of HCT services have significant role on prognosis of HIV patients. This study assessed the quality of HIV counselling services offered in public health facilities in Kampala by reviewing adherence to the HIV Counselling and Testing (HCT) policy guidelines, content of counselling information offered to clients and health facility amenities.
Methods: This was a cross-sectional study conducted in 2016 utilizing quantitative methods of data collection. Quality of HIV counseling was defined in accordance with adherence to the HCT guidelines, offering ‘good’ content of counselling information and health facilities having adequate amenities. We used principal component analysis to obtain and reveal current composite scores of the variables. Data were summarized into frequencies and proportions using STATA, version 13.0. Scores below 70% were considered as ‘poor’ quality.
Results: In this study, 74 health workers offering HIV counselling services at five public health facilities were interviewed. The study revealed that quality of HIV counselling at the five public health facilities was ‘poor' as 74% of the health workers offered ‘poor’ quality HIV counselling and only one out of five health facilities was found to have adequate amenities. Majority (74.3%) of the health workers were found not to adhere to HCT guidelines. In addition, 67.6% of the health workers offered ‘poor’ content of counseling information.
Conclusion: Overall quality of HIV counselling was found to be poor. Improvements should be focused on mentorship programs for all health workers involved in HIV counselling. Provision of modest space for counselling is also required so as to ensure privacy during counselling sessions.
Keywords: HCT: HIV Counselling and Testing; PCA: Principal Component Analysis
- UNAIDS: Joint United Nations Programme on AIDS: UNAIDS World AIDS Day Report. In. Geneva; (2011).
- Matovu JK and Makumbi FE. “Expanding access to voluntary HIV counselling and testing in sub‐Saharan Africa: alternative approaches for improving uptake, 2001-2007”. Tropical Medicine and International Health11 (2007): 1315-1322.
- Bunnell R., et al. “Changes in sexual behavior and risk of HIV transmission after antiretroviral therapy and prevention interventions in rural Uganda”. Aids1 (2006): 85-92.
- Wolff B., et al. “Evaluation of a home-based voluntary counselling and testing intervention in rural Uganda”. Health Policy and Planning2 (2005): 109-116.
- Were WA., et al. “Undiagnosed HIV infection and couple HIV discordance among household members of HIV-infected people receiving antiretroviral therapy in Uganda”. JAIDS Journal of Acquired Immune Deficiency Syndromes1 (2006): 91-95.
- Wanyenze RK., et al. “Acceptability of routine HIV counselling and testing, and HIV seroprevalence in Ugandan hospitals”. Bulletin of the World Health Organization4 (2008): 302-309.
- Perez F., et al. “Acceptability of routine HIV testing (" opt-out") in antenatal services in two rural districts of Zimbabwe”. JAIDS Journal of Acquired Immune Deficiency Syndromes4 (2006): 514-520.
- Chandisarewa W., et al. “Routine offer of antenatal HIV testing (" opt-out" approach) to prevent mother-to-child transmission of HIV in urban Zimbabwe”. Bulletin of the World Health Organization11 (2007): 843-850.
- Mugore L., et al. “An assessment of the understanding of the offer of routine HIV testing among pregnant women in rural Zimbabwe 1”. AIDS Care 6 (2008): 660-666.
- Leon N., et al. “The impact of provider-initiated (opt-out) HIV testing and counseling of patients with sexually transmitted infection in Cape Town, South Africa: a controlled trial”. Implementation Science 8 (2010).
- Larsson EC., et al. “Opt-out HIV testing during antenatal care: experiences of pregnant women in rural Uganda”. Health Policy and Planning 1 (2012): 69-75.
- Kennedy CE., et al. “Provider-initiated HIV testing and counseling in low-and middle-income countries: a systematic review”. AIDS and Behavior 5 (2013): 1571-1590.
- Sherr L., et al. “Voluntary counselling and testing: uptake, impact on sexual behaviour, and HIV incidence in a rural Zimbabwean cohort”. Aids 7 (2007): 851-860.
- Wringe A., et al. “Uptake of HIV voluntary counselling and testing services in rural Tanzania: implications for effective HIV prevention and equitable access to treatment”. Tropical Medicine and International Health 3 (2008): 319-327.
- Song Y., et al. “HIV-testing behavior among young migrant men who have sex with men (MSM) in Beijing, China”. AIDS Care2 (2011): 179-186.
- Mlay R., et al. “Couple counselling and testing for HIV at antenatal clinics: views from men, women and counsellors”. AIDS Care3 (2008): 356-360.
- Meiberg AE., et al. “Fear of stigmatization as barrier to voluntary HIV counselling and testing in South Africa (2008).
- Njau B., et al. “Perceived acceptability of home-based couples voluntary HIV counseling and testing in Northern Tanzania”. AIDS Care4 (2012): 413-419.
- Jürgensen M., et al. “Effects of home-based voluntary counselling and testing on HIV-related stigma: findings from a cluster-randomized trial in Zambia”. Social Science and Medicine 81 (2013): 18-25.
- Zachariah R., et al. “Task shifting in HIV/AIDS: opportunities, challenges and proposed actions for sub-Saharan Africa”. Transactions of the Royal Society of Tropical Medicine and Hygiene6 (2009): 549-558.
- Delva W., et al. “Quality and quantity of antenatal HIV counselling in a PMTCT programme in Mombasa, Kenya”. AIDS Care3 (2006): 189-193.
- Njeru MK., et al. “A critical assessment of the WHO responsiveness tool: lessons from voluntary HIV testing and counselling services in Kenya”. BMC Health Services Research1 (2009): 243.
- Nguyen PH., et al. “Incorporating elements of social franchising in government health services improves the quality of infant and young child feeding counselling services at commune health centres in Vietnam”. Health Policy and Planning8 (2014): 1008-1020.
- Ngo AD., et al. “The impact of social franchising on the use of reproductive health and family planning services at public commune health stations in Vietnam”. BMC Health Services Research1 (2010): 54.
- Mayanja: Assessment Of The Quality Of Hiv Counseling And Testing Service Delivery In Private For Profit Health Units In Kampala District (2012).
- UNAIDS: Tools for evaluating HIV voluntary counseling and testing. UNAIDS BEST PRACTICE COLLECTION. In. Geneva (2007).
- Reeves D., et al. “Combining multiple indicators of clinical quality: an evaluation of different analytic approaches”. Medical Care6 (2007): 489-496.
- American Medical Association: Measures Development, Methodology, and Oversight Advisory Committee: Recommendations on Composite Measures”. Physician Consortium for Performance Improvement (PCPI) (2010).
- Chopra M., et al. “Preventing HIV transmission to children: quality of counselling of mothers in South Africa”. Acta Paediatrica3 (2005): 357-363.
- Held M and Brann M. “Recognizing HIV/AIDS volunteers’ stressors and desire for support”. AIDS Care2 (2007): 212-214.
- Ismail H and Ali A. “Status of ANC-linked HIV counseling and testing as an intervention for PMTCT in public health facilities in Addis Ababa: quality of HIV counseling given to pregnant women for PMTCT”. Ethiopian Journal of Health Development3 (2009).
- Machingura F., et al. “Evidence from participatory research on community health systems for HIV treatment and support in East and Southern Africa (2012).
- Dewing S., et al. “It’s Important to Take Your Medication Everyday Okay?” An Evaluation of Counselling by Lay Counsellors for ARV Adherence Support in the Western Cape, South Africa”. AIDS and Behavior1 (2013): 203-212.
- Petersen I., et al. “Optimizing lay counsellor services for chronic care in South Africa: a qualitative systematic review”. Patient Education and Counseling2 (2014): 201-210.
- Evans C and Ndirangu E. “The nursing implications of routine provider-initiated HIV testing and counselling in sub-Saharan Africa: a critical review of new policy guidance from WHO/UNAIDS”. International Journal of Nursing Studies5 (2009): 723-731.
- Peltzer K., et al. “Implementation of the national programme for prevention of mother-to-child transmission of HIV: A rapid assessment in Cacadu district, South Africa”. African Journal of AIDS Research1 (2010): 95-106.
- Bott S., et al. “Rewards and challenges of providing HIV testing and counselling services: health worker perspectives from Burkina Faso, Kenya and Uganda”. Health Policy and Planning (2014): czu100.
- Medley AM and Kennedy CE. “Provider challenges in implementing antenatal provider-initiated HIV testing and counseling programs in Uganda”. AIDS Education and Prevention2 (2010): 87-99.
- Dewing S., et al. “Behaviour change counselling for ARV adherence support within primary health care facilities in the Western Cape, South Africa”. AIDS and Behavior5 (2012): 1286-1294.
- White J. “Improving Access to Healthcare in Uganda. In (2012).
- Dinku F AG. “Assessment of Voluntary Counseling and Testing (VCT) service quality in terms of client satisfaction: A comparative study between public and private health institutions in Addis Ababa, Ethiopia”. Science Journal of Clinical Medicine1 (2013): 1-7.
- Callaghan M., et al. “A systematic review of task-shifting for HIV treatment and care in Africa”. Human Resources for Health1 (2010): 1.
- Leon N., et al. “The impact of provider-initiated (opt-out) HIV testing and counseling of patients with sexually transmitted infection in Cape Town, South Africa: a controlled trial”. Implementation Science1 (2010): 1.
- Alam N., et al. “Effect of single session counselling on partner referral for sexually transmitted infections management in Bangladesh”. Sexually Transmitted Infections1 (2011): 46-51.
- Aluisio A., et al. “Male antenatal attendance and HIV testing are associated with decreased infant HIV infection and increased HIV free survival”. Journal of Acquired Immune Deficiency Syndromes1 (1999): 76.
- Mugisha E., et al. “Providing integrated voluntary counselling and testing (VCT) services in Uganda”. Africa Journal of Nursing and Midwifery1 (2010): 52-63.
- Haffejee S., et al. “An assessment of counselling and support services for people living withHIV in Gauteng, South Africa: findings of a baseline study”. African Journal of AIDS Research4 (2010): 367-372.
- Nig AOFF., et al. “Clients' perceptions of the quality of antenatal care”. Journal of the National Medical Association 9 (2008): 1052.
- Agha S. “Changes in the proportion of facility-based deliveries and related maternal health services among the poor in rural Jhang, Pakistan: results from a demand-side financing intervention”. International Journal for Equity in Health 1 (2011): 1.
- Healthcare a major challenge for Uganda (2016).
- Okwero P., et al. “Fiscal Space for Health in Uganda–World Bank Working Paper No. 186. Washington, DC: The International Bank for Reconstruction and Development/The World Bank, Available: world bank (2011).
- Konde-Lule J., et al. “Private and public health care in rural areas of Uganda”. BMC International Health and Human Rights 1 (2010): 1.