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Increasing Counseling and Testing and Enhancing HIV/AIDS Communications in South Africa and Swaziland

Client: Centers for Disease Control

The HIV disease burden in Swaziland and South Africa presents an enormous challenge to the two Southern African countries in their social and economic development. Adult HIV prevalence rates in the two countries are among Sub-Saharan Africa’s highest: 33.4% in Swaziland, and 18.8% in South Africa, according to UNAIDS’ 2006 Report on the Global AIDS epidemic. Currently, only a small proportion of people know their HIV status, and most clinic attendees are not offered HIV counseling and testing (C&T). In addition, the quality of counseling and testing often does not meet national standards.

To assist in addressing these obstacles, the U.S. Centers for Disease Control (CDC) awarded URC the five-year project. "Increasing Access to HIV Confidential Voluntary Counseling and Testing (VCT) and Enhancing HIV/AIDS Communications, Prevention and Care in Swaziland and South Africa.” The project, valued at $30 million, is building progressively an indigenous, sustainable response to the national HIV epidemics in the two countries through the rapid expansion of innovative, culturally appropriate, high-quality HIV/AIDS prevention and care interventions.

The project promotes provider-initiated HIV counseling and testing with option to opt out in the two target countries. As part of this strategy, URC is helping the local health service delivery programs in integrating HIV C&T with various high-priority clinical services including: antenatal care, TB, STI, FP, among others. URC, is working along local stakeholders to strengthen the capacity of public, community and private health care organizations to increase uptake of high quality counseling and testing and other HIV/AIDS services. Under the program, referral and case management for HIV+ is also being enhanced.

URC Services

A two-phased strategy is being employed to increase utilization of provider-initiated C&T: 1) through integration of C&T with ANC and other health services the project is reducing missed opportunities and increasing uptake of C&T; 2) the project will increase in Project Year 3 onwards the uptake of C&T further by implementing behavior change and social marketing interventions to create demand for provider-initiated C&T services in communities and specific target groups. The strategy is being implemented through the following methods and services:

• Integrate C&T and HIV prevention services with high-volume and problem-prone services (e.g., antenatal care, sexually transmitted infection services, tuberculosis services, etc.)
• Expand C&T services using district-based collaborative improvement model
• Strengthen local capacity for C&T and HIV prevention service delivery
• Build demand for C&T and HIV prevention services through community outreach and social mobilization
• Expand C&T prevention, care, and support services through public, private, and community- and faith-based groups
• Improve supervision and mentoring to enhance the quality of counseling, referral, and follow-up of HIV patients
• Establish referral and follow-up mechanisms to ensure that HIV-positive persons receive appropriate treatment and psycho-social support
• Strengthen and improve program performance monitoring and reporting systems
• Strengthen data-driven quality assurance and supervision
• Work in partnership with community- and faith-based organizations and public institutions to develop mobile and community-based C&T services as well as to establish referral and follow-up mechanisms to ensure that HIV-positive clients receive appropriate treatment and psycho-social support.

Partners

• Health Systems Trust
• The project team plans to draw upon other local groups (universities, C&T providers, other community- and faith-based organization providing HIV services) to build and strengthen their capacity in HIV/AIDS prevention, treatment and care.

Geographic Focus

Swaziland and South Africa

For more information contact

Ms. Aruni Liyanage at aliyanage@urc-chs.com or Dr. Nondumiso Makhunga-Ramfolo at NondumisoM@urc-sa.com

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