The state of VCT services at PHC clinics in SA

[HIV Ethics & Policy]

In the context of different HIV testing approaches being debated, the SEAD report on point-of-care-testing is useful.

Strategic Evaluation, Advisory and Development (SEAD) "Analysis of POCT/VCT performed at South African primary health care clinics"

Report available: http://www.sead.co.za/downloads/POCT-clinics-2011.pdf 

Extract:

"Overall process compliance  at national level was 3.4%. KwaZulu-Natal had the highest 

provincial level compliance (9.7%) followed by Limpopo (8.6%), North-West (7.1%) and the 

Western Cape (2.2%). The other provinces had 0% overall process compliance. Rural facilities 

(6.9%) did better than urban facilities (1.7%). Clinics with higher workloads (>600 

patients/HCW) performed better (11.5% compliance) compared to other clinics. "

SUMMARY OF CONCLUSIONS AND RECOMMENDATIONS

Overall VCT process compliance was poor. Specific areas of concern include specimen collection method, wrong staff performing collection, requirement availability (procurement), usage of available consumables, short incubation time before reading HIV rapid test results, lack of staff training, compromised HCW safety, post-test counseling, and inconsistent or absent quality assurance practices. A system.s approach is essential for addressing the issues identified. Staff training and mentoring, clear responsibilities, ongoing monitoring, effective and efficient procurement systems, ongoing quality assurance and an emphasis on the value of rigor are critical components to be addressed.

Specific recommendations include implementation of parallel vs. sequential testing to improve efficiencies and quality of rapid testing; as well as further studies to assess the impact of short incubation on test result, and biological significance of swiping the first drop of blood and using second drop on the test kit.