All people who seek treatment in health centres in Uganda will be offered HIV testing and counselling under a new plan to increase access to HIV prevention and treatment.
The acting programme manager of the AIDS Control Programme at the Ministry of Health, Alex Ario, says the campaign, 'Know your Status', will be rolled out in phases to accommodate the country's struggling health system and low health worker numbers.
The system has been tested, with promising results, in selected districts since 2006. The UN World Health Organization issued guidelines for healthcare provider-initiated counselling and testing in 2007.
"This is provider-initiating counselling and testing to a person attending healthcare facilities. The patient will be counselled and educated before the tests," Ario told IRIN/PlusNews. "I call upon Ugandans to embrace the campaign and accept it."
Uganda employs a number of testing strategies, including: routine HIV testing for pregnant women; client-initiated counselling and testing; home-based HIV testing; couples HIV testing; mobile HIV testing; and moonlight (night-time) testing for high-risk groups such as sex workers.
According to government statistics, HIV testing is available in 80 percent of county-level health centres but only 22 percent of sub-county-level health centres. The number of people tested for HIV annually has gone up from 1.1 million in 2008 to 5.5 million in 2011.
The new strategy is part of efforts to lower Uganda's HIV prevalence, which climbed from 6.4 percent to 7.3 percent between 2006 and 2011. Studies have shown that beyond the benefits of having HIV-positive people identified and referred for treatment, provider-initiated counselling and testing may also result in less risky sexual behaviour, reducing levels of HIV transmission.
|Those who are HIV-negative will be careful and avoid engaging in risky behaviours. They will carry out preventive options such as partner notification, abstinence and safer sex. Those who are HIV-positive will be enrolled in antiretroviral treatment and have increased opportunities for social support to live normally|
"There are so many benefits of knowing their HIV status. Those who are HIV-negative will be careful and avoid engaging in risky behaviours. They will carry out preventive options such as partner notification, abstinence and safer sex," Ario said. "Those who are HIV-positive will be enrolled in antiretroviral treatment and have increased opportunities for social support to live normally."
AIDS activists have welcomed the start of the new programme, but warn that the government must improve the health system in order to cope with the likely increase in treatment numbers.
"It's a good initiative. It will enable people to guard and take care of themselves. But our health system is struggling. It has not measured up. We have serious shortages of health workers in the health facilities," Florence Buluba, the executive director of the National Community of Women Living with AIDS (NACWOLA), told IRIN/PlusNews. "The government first needs to address the challenges the health sector is facing before rolling out the programme."
She also stressed the need for adequate health worker training to ensure patients' rights were respected. "How are they going to handle the repercussions of those found to be HIV-positive? How can they handle the blame or abandonment issues? They need to educate, persuade, encourage and prepare people before the results are released," she said.
The AIDS Control Programme is currently training health workers in routine HIV testing and counselling; the training involves pre-test information, counselling, testing, disclosure of results, post-test information, initiation on HIV care, treatment and follow-up. It is hoped that by December 2013, all public health facilities will offer routine HIV testing.
The Ministry of Health will have to conduct large-scale media campaigns to educate the public about the voluntary nature of the programme; already, a number of media outlets in Uganda have wrongly described the programme as "mandatory" or "forced" HIV testing.
An upcoming HIV prevention and control bill criminalizes the deliberate transmission of HIV, makes HIV testing mandatory for pregnant women and allows health workers to disclose one's HIV status to their sexual partner. Analysts worry that if this bill is passed, it could affect the uptake of provider-initiated HIV testing and counselling.
"Institutionalizing this practice is good, but it will not reduce the HIV/AIDS prevalence rate in Uganda unless it... makes use of other platforms like collaborating with the media and other networks to publicize the proposed strategy," said Joan Esther Kilande, administrative and programmes assistant for the NGO Action Group for Health, Human Rights and HIV/AIDS (AGHA) Uganda.
A 2010 study of the challenges of provider-initiated counselling and testing in Uganda found some of them to be: counselling HIV-discordant couples; poor follow-up of HIV-infected clients; low levels of male involvement; frequent stock-outs of supplies; and shortages of counsellors, lab personnel and referral services.
"These challenges must be addressed in order to optimize the success of [provider-initiated testing and counselling] programs at providing universal access to HIV testing and counselling services," the authors recommended.