Pilot encourages people to take HIV test

A two-year pilot project aimed at encouraging hospital and clinic patients to go for HIV tests has managed to almost triple the demand for tests at the four test sites.

The Health Department’s Dr Harry Hausler said the number of people tested at the pilot sites – which were run in Ugu South (Port Shepstone), Cape Town’s central district, Bushbuckridge and East London – increased from 1 703 to 4 963 per quarter.

Some 17 826 people were tested in the two year period which ended last month, and 6 398 of these were HIV-positive.

The pilots also introduced rapid HIV tests. Prior to these rapid tests, only about 10% of people ever went back to get their HIV test results. However, with the rapid HIV tests, which take about 15 minutes to process, over 97% of people tested got their results

By hiring lay counsellors to explain the importance of people knowing their HIV status, Ugu South and Cape Town managed to increase the proportion of people asking to be tested (rather than being referred by a health worker) from less than 10% to over 60%.

However, the process of persuading people to be tested was lengthy. Lay counsellors in Ugu South spent an average of 25 minutes on pre-test counselling and 20 minutes on post-test counselling per person. However, overburdened nurses only have about 10 minutes to spend on each patient.

“We would recommend that lay counsellors are introduced to clinics, particularly those that are offering mother-to-child treatment programmes,” said Dr Laura Campbell, who co-ordinated the pilot in Ugu South. “It is unfair to rely on nurses to counsel people, as they simply don’t have the time.”

However, the pilot had mixed success in persuading HIV positive people to take prophylactic drugs aimed at reducing their chances of getting opportunistic infections. Patients were offered Isoniazid (INH) and Bactrim. INH substantially reduces a person’s chances of developing TB for two years if it is taken once a day for six months. TB is the major killer of those with HIV.

Bactrim helps prevent pneumonia and gastro-intestinal infections, and needs to be taken once a day for life. Both of these drugs work most effectively if they are taken regularly, as prescribed.

However, only 27% of people in the semi-rural Ugu South took INH for the required six months while only 7% of a total of 241 people were still taking Bactrim after six months

Results from the predominately urban Cape Town were significantly better. Some 59% of people took INH for six months, and 71% of people were still taking Bactrim after 6 months.

Hausler, who co-ordinated the pilots, said many reasons may account for poor adherence to the treatment, including “denial of HIV status, migrancy, poverty, perceived side effects, long clinic waiting times and dissatisfaction with health providers”.

Hausler said more research was needed to understand the adherence patterns so that “support systems” could be developed for HIV-positive clients to ensure that they took the drugs and stayed healthy.

“If antiretroviral drugs are introduced in the country, systems must be put in place to ensure good adherence to treatment and avoid the development of resistance to those drugs,” added Hausler.

The pilots were part of a global initiative sponsored by the World Health Organisation and UN AIDS called ProTest, aimed at promoting voluntary HIV counselling and testing and improving TB and HIV care. —

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