Hiv Voluntary Counseling and Testing

Cyber-VCT Program The 2010 UNAIDS report on the global AIDS epidemic states that based on the 2009 data, 33. 3 million people are living with HIV worldwide and Sub-Saharan Africa makes up 68% of the global total with 22. 5 million people living with HIV. 1 In an effort to address this epidemic, voluntary counseling and testing (VCT) programs have been implemented in many of rural and remote areas. VCT serves as the gateway to HIV prevention, treatment, care and support by allowing people to learn their HIV status.
According to World Health Organization (WHO), knowledge of one’s HIV status benefits the individuals, community, and population through awareness and education. 2 Therefore, there have been great efforts to expand VCT services since inception over 20 years ago. Unfortunately, global participation remains low, especially in the remote areas. 3 Studies show that there are various reasons why people do not participate. Some of the main reasons are stigma, lack of awareness, lack of access, cost of the test, and test-related fears. Several VCT models have been implemented to address these concerns but research suggests that further work needs to be done. Organic Health Response (OHR) has piloted an innovative Cyber-VCT Program in Mfangano Island by using technology to attract residents to participate. The Cyber-VCT Program uses access to solar-powered internet as an incentive to attract people to do HIV testing. The people who participate become part of the Post-Test Club and have free access to the labs in the Cyber-VCT facility called Ekialo Kiona Center (EKC).
The facility has confidential VCT rooms, solar-powered computer lab with satellite Internet, radio studio, seminar rooms, and an                                                              “Global report: UNAIDS report on the global AIDS epidemic 2010” (UNAIDS, 2010: http://www. unaids. org/globalreport/documents/20101123_GlobalReport_full_en. pdf). 2 World Health Organization, “Scaling-up HIV testing and counselling services: a toolkit for programme managers. ” (WHO Press, 2005: http://www. who. nt/hiv/pub/vct/counsellingtestingtoolkit. pdf) 3 Information from World Health Organization on HIV testing and counselling accessed May 4, 2011: http://www. who. int/hiv/topics/vct/en/ 4 Joseph K. B. Matovu and Frederick E. Makumbi, “Expanding access to voluntary HIV counselling and testing in sub-Saharan Africa: alternative approaches for improving uptake, 2001–2007,” Tropical Medicine and International Health, 12:2 (November 2007), pp. 1315-1322. Page 1 of 6  1 Cyber-VCT Program open-air amphitheater.

The program provides access to the only internet / library facility on the island and according to OHR, needs assessment and ethnographic research have shown that residents are enthusiastic about having access to technology, which suggest the potential for program effectiveness. 5 There is a bi-annual membership renewal process where residents need to do individualized VCT session with a counselor from the International Medical Corps. This renewal process will provide the structure for more longitudinal effects.
The ultimate goal of Cyber-VCT Program is to encourage voluntary counseling and testing, facilitate the process of referrals to Ministry of Health and FACES treatment programs, connect those who are HIV positive with locally formed psycho-social support, and improve dissemination of HIV education. It is more comprehensive and effective than community stand-alone VCT centers, mobile VCT, Routine offer of VCT or better known as provider-initiated HIV testing and counseling (PITC), and home-based VCT. These other VCT models have increased uptake but they have limitations that the Cyber-VCT program helps address.
Stand-alone VCT centers values client initiation – people have to travel and access the services on their own but the stigma associated with it is a huge barrier that limits people from utilizing the services at the centers. The mobile VCT provides services with a mobile team traveling to communities in a van equipped with HIV-testing facilities. It addresses the issue of cost and accessibility but stigma and fears related to testing were not addressed. 6 PITC has proven to be effective in increasing participation through recommendations by providers to those attending health facilities.
These patients are provided with the options to opt out but there were ethical concerns as to whether testing was actually voluntary because providers were not consistently counseling the patients Information from Organic Health Response website: http://organichealthresponse. org/cyber-vct-pilot. Jan Ostermann et al. , “Who tests, who doesn’t, and why? Uptake of mobile HIV counseling and testing in the Kilimanjaro Region of Tanzania,” PLoS One 6:1 (January 2011) e16488. 6 5 Page 2 of 6 Cyber-VCT Program 7 thoroughly.
Home-based VCT provides services at residents’ homes which addresses accessibility and cost concerns, in addition to eliminates the stigma resulting from being seen at a testing site, but it does not eliminate people’s fear of being stigmatized and rejected by their own family members. 8 The Cyber-VCT program is superior to these models because it helps to eliminate the stigma attached to getting HIV testing, ensures confidentiality, provide proper education, and focuses on sustainability through micro-clinic networks. The Cyber-VCT program has been pilot tested in Mfangano Island in Suba District Lake Victoria (West Kenya).
OHR’s vision is to implement an effective comprehensive model starting with Mfangano Island and expanding it to the entire Lake Victoria through micro-clinic networks in hopes that the model can be implemented in other rural impoverished areas to continue fighting the HIV/AIDS epidemic worldwide. Mfangano Island is the appropriate pilot site because it has a population of 19,000 people with an estimate of over 30% local prevalence of HIV/AIDS. One of the major threats of the HIV/AIDS epidemic in the island is the possible extinction of the indigenous Suba language and way of life.
In addition, the neglected people of the island face various health, economic, political, environmental, and social issues. The island has no electricity and there is one road that circles the base of the island. The primary occupation is fishing and subsistence farming. The impoverished people rely on the Nile perch stock that has been the source of many other issues. The industrial Nile perch export fishery has resulted in unsafe “fish-for-sex” practices and natural resource depletion. The Nile perch stock has also caused interstate resource conflicts between Kenya and Uganda.
Even worse is that                                                              Mercy K. Njeru et al. , “Practicing provider-initiated HIV testing in high prevalence settings: Consent concerns and missed preventive opportunities,” BMC Health Services Research, 11:87 (April 2011): http://www. biomedcentral. com/1472-6963/11/87. 8 Edgar M. Mulogo et al. , “Facility and home based HIV Counseling and Testing: a comparative analysis of uptake of services by rural communities in southwestern Uganda,” BMC Health Services Research, 11:54 (March 2011): http://www. iomedcentral. com/1472-6963/11/54. Page 3 of 6  7 Cyber-VCT Program overfishing and the environmental issues are endangering the existence of the Nile perch stock. Overpopulation, deforestation, and unsustainable farming practices are the cause of these environmental issues. 9 OHR is taking a comprehensive multi-step approach starting with the Cyber-VCT program to address the complex interconnected issues feeding into the HIV/AIDS problem. OHR plans to sustain the program by building a local infrastructure with micro-clinic networks that empowers the communities.
The Cyber-VCT program is the first layer that serves as the gateway to these networks. The networks are formed to encourage people to support each other in an organic way and make the program attractive to residents. Interested participants will go through a five-week social solidarity program to receive education and training on tools to address the HIV/AIDS epidemic. The workshops will take place at EKC. The goal is for the program participants to provide continuous support to their communities in micro-clinic teams of 5-25 people.
In this way, an infrastructure is established for future innovation, such as organic farm plots, composting bio-gas latrines, solar cooking ovens, youth radio, and other sustainable projects, to occur. Most importantly, the infrastructure empowers local communities rather than merely looking “western. ” The objective is to develop a mutually beneficial connection between the local community-based organizations and the international health governance systems rather than having the impoverished rural communities depend only on international assistance.
Global scalability will depend on proving the effectiveness of the comprehensive model because the model required a great amount of resources. Obtaining support and acquiring funding from various entities will be crucial. The cost of building the center (sustainable ferro                                                             “Ripples of Dispute Surround Tiny Island in East Africa,” New York Times, August 16, 2009 (http://www. nytimes. com/2009/08/17/world/africa/17victoria. html). Page 4 of 6  9 Cyber-VCT Program ement design), research, program design, curriculum development, program staffing, implementation (community mobilization, training workshops) is estimated to be $339,000. This amount does not include the cost of land because it was donated by a community leader so the estimated cost for implementation at other areas may be higher. In addition, the $339,000 includes mostly upfront cost and further detailing of maintenance cost will need to be considered. Some of the maintenance cost will be related to technological equipment or systems, security, and infrastructure sustainability.
A comparative study is necessary to show improvements in VCT uptake and HIV prevention, treatment, care and support, to attract funding for implementation in other remote impoverish areas that are affected by the HIV/AIDS epidemic. Furthermore, each workshop within the solidarity program will need to be closely evaluated to make improvements or eliminate any ineffective training and education. Beyond funding, the mutual beneficial relationship between the local communities and international organizations will also play an important role in scalability for resource stability.
Strong local ownership of the program will also be invaluable. The networks will likely serve to engage residents organically because the micro-teams will consist of residents’ neighbors, friends, family members. Perhaps, to further encourage local ownership and stabilize the infrastructure, it may be effective to consider creating jobs for local residents to maintain the EKC and microclinics networks. Another layer to the program can be to train local residents to take on positions that may be initially be filled by international partners.
OHR’s Cyber-VCT program strives to provide an innovation solution to address the HIV/AIDS epidemic in remote impoverished areas by using technology. The program is more innovative than other VCT models in that people are incentivized to participate and become part of a network that is intended to build itself in an organic way. Furthermore, Cyber-VCT Page 5 of 6 Cyber-VCT Program program uses access to technology as cover and ensures confidentiality to address the people’s concern of being stigmatized, which is on the top of list of the many reasons why VCT participate rate remains low.
Another way the program is more innovative is that it has a high chance of sustainability because of OHR’s focus on building a local infrastructure. The added benefit of establishing a local infrastructure is that it allows for further innovations to address other social, environmental, economic, political issues that are connected to the HIV/AIDS problem. In regards to scalability, securing funding by proving the effectiveness of the program, maintaining the mutually beneficial relationship between the local and nternational organizations, encouraging strong local empowerment, and other considerations such as creating local job opportunities for residents can help drive down cost and make the program scalable. As detailed in this paper, OHR’s Cyber-VCT program incorporated in the comprehensive model meets the five Tech Award evaluation criteria outlined on their website10 and is a great candidate for the award. 10 The Tech Awards Criteria: http://www. techawards. thetech. org/nominate/criteria/. Page 6 of 6