Draft Policy Guideline for HCT SANAC NGO SECTOR October, 2009 Thato Chidarikire

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OUTLINE

• PURPOSE • BACKGROUND • CURRENT NATIONAL GUIDELINES • RATIONALE • POLICY VISION, MISSION AND AIMS • ETHICAL PRINCIPLES • HCT PROGRAMME – HIV COUNSELLING AND TESTING – QUALITY ASSURANCE – SOCIAL MOBILISATION • KEY COMMUNICATION AREAS – MONITORING AND EVALUATION • CONCLUSION • WAY FORWARD 2

Purpose

• Guide the implementation of the HCT programme • Propose a new approach towards implementation of HCT 3

Background

• CT is the key entry point to HIV & AIDS Prevention, Treatment, Care, Management and Support • VCT was established in 1999 & implemented in 2000 – Introduction of HIV rapid testing – Training and placement of counsellors – Establishment of VCT service points 4

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Current National Situation

Development of guidelines: 2000, 2003.

– Low uptake of VCT in public facilities In FY 2007/2008 2.5 million people tested in public facilities – – NSP goals: Half incidence by 50% by 2011 Put 80% of HIV positive people on treatment by 2011 Increase the HCT uptake to reach NSP goals Entry point to CT : VCT Need to know status for ART, wellness, action Need to move beyond VCT in order to increase testing uptake.

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Rationale for Policy review…

• Change in political leadership: PICT • National Legislation – National Health Act No. 61 of 2003 • Ethical considerations – The Children’s Act No. 38 of 2005 • Age of consent – Criminal Law (Sexual Offences & Related Matters) Amendment Act No. 32 of 2007 • Testing of alleged sexual offenders • The development and adoption of the Comprehensive Plan and the NSP 2007-2011 alignment • Guiding Principles • Links to CD4 testing & clinical staging: ART management

These made it important to review & develop National Policy regarding HCT

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Policy Vision, Mission and Aim

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Vision:

An enabling environment for HIV counselling and testing, where the majority of people in South Africa are knowledgeable about their HIV status, able to act on this to ensure an AIDS free generation.

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Mission:

To expand access to and increase uptake of HCT services with the aim of appropriate referral for those in need of the continuum of care, treatment and support .

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Aim:

– To provide a National framework for provision of universal access to HCT services in the public and private sectors in South Africa for adults and children 7

Ethical Principles

• Counselling –

Must

precede and follow testing • Informed Consent – Must be obtained before testing – Should be available in Braille – Illiteracy- right thumb print – Inability to make a decision • Adults (National Health Act No. 61 of 2003) • Children (Children’s Act No. 38 of 2005 ) • Confidentiality upheld all the time – National Health Act No. 61, 2003 • Facilitate eradication of discrimination & reduction of stigma – Disclosure encouraged 8

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HCT Programme

Two major approaches to HCT: – CICT (VCT)& PICT • Ethical principles observed for both approaches • Social mobilization and Quality Assurance

Information Session to all service users All patients referred by provider: (PICT) with emphasis but not limited to TB, IMCI, ANC, FP, STI, OIs and PEP Self referred clients (CICT)/VCT Individual counselling session (Pre-Test Counselling) Clients deciding to test: Verbal and/or written IC obtained Clients tested Clients deciding not to take the test: Provide Counselling and encourage testing After Testing Post test Counselling, appropriate Referrals: (HIV positive) to TB screening, CD4, pre ART management and ongoing counselling. HIV negative: risk reduction plan

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HIV Testing: General population

• Ethical Principles observed • Recommended algorithm: Serial rapid HIV testing • Screening and confirmatory tests

– 2 different rapid test kits – Confirmatory test is performed based on the results of first test – If discordant: ELISA • Tie breaker 10

HIV Testing:Special groups

• • • • • Children: Children’s Act, No. 38 of 2005 as amended • Regulations on Sections 130-132 Consent: As in act.

– If child is abandoned or minor without parent, caregiver, placement agency • The provider may consult with another health care provider (in same facility or different) to consent for the child to facilitate PEP and management of the child HIV testing – For children<18 months: PCR – Alignment with new PMTCT guidelines – Alignment with the new Pediatric HIV & AIDS Management Guidelines – For children>18 months Rapid test PEP – Relevant Policy Survivors of sexual assault – Relevant Policy 11

Quality Assurance

• All training service providers should be accredited by SAQA • Mentoring of counsellors should be done regularly • Compliance to diagnostic procedures and SOPs – All suppliers of the approved rapid HIV test kits should provide training for all provinces on how to use the test kits • All test kits on National Tender are evaluated by NICD • All new batches are evaluated by NICD before distribution • Formal laboratory-based quality control for test kits – Internal (Product-specific) – External (Programme-driven) 12

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Social Mobilisation

Objectives – Integrate HCT services into the primary health care package (PICT).

– Create an enabling environment for HIV counselling and testing for all.

– Facilitate support for positive living, healthy lifestyle and nutrition.

– Expand access to HCT beyond formal health care settings such as community and non-health care settings.

• • Key Communication Areas – HCT Package • Importance and benefits of early HIV diagnosis • Implications of the test outcome • Information on referral services • How and where to access services Mechanisms: – Khomanani government campaign – Community-based activities – Papers at conferences and in journals – Mass media such as television and radio – Small media such as brochures and pamphlets – Interpersonal communication and peer education – Outreach in the workplace 13

Monitoring and Evaluation

AIM

: • • Ensure achievement of maximum health benefit for the population served as well as improve the quality of services offered.

OBJECTIVES:

– Monitor progress on the provision of HCT services and measure its effectiveness – Identify gaps and weaknesses in service provision and address them – Inform planning, prioritisation, allocation and management of resources for HCT services – Maintain data and referral tracking systems in accordance to existing systems 14

Conclusions

• C&T: key entry point to HIV & AIDS Programmes • Need to increase uptake of counselling and testing (NSP) • Need to move beyond VCT: PICT • Provide universal access of HCT services • Alignment to: – Ethical principles – NSP – Comprehensive Plan – Legislation – QA • Social mobilisation and M & E: crucial role 15