Strategies for Successful HIV Counseling and Testing Services

JUNE 2009 — In just three years, the number of people in Malawi tested for HIV has increased nearly fourfold, from 400,000 in 2005 to 1.5 million in 2008. HIV counseling and testing is a priority for the government of Malawi, and one of the driving forces behind the country's success in this area is Philip Moses, FHI senior technical officer seconded to the Ministry of Health.

To tackle the problem of limited coverage and access to HIV counseling and testing services across the country, Moses came up with the idea of holding an annual National HIV Counseling and Testing Week, which debuted in 2006. "During the national testing weeks, we motivate the whole country to focus on one activity," Moses says.

In collaboration with the National AIDS Commission, development partners, NGOs, and the private sector, last year the Malawian government organized the third national HIV counseling and testing week. From November 10-16, more than 186,000 people were tested. Adolescents, couples, and pregnant or breastfeeding women were specifically encouraged to participate. HIV counseling and testing was available at nearly 1,600 static, outreach, and mobile sites, 60 percent of which were located in remote, rural, and hard-to-reach areas. "We have made huge progress increasing the number of people tested annually," Moses says.

Keeping Up the Momentum
As more and more Malawians seek HIV counseling and testing in response to effective outreach, demand often outpaces supply. A key part of Moses' job is to ensure the equitable distribution of services. "We are in touch on a daily basis with implementers at the district level," Moses says, "responding to problems that arise because of high demand."

Critical to meeting this demand are large numbers of well-trained and highly motivated counselors. Moses is closely involved with the three-week program that trains and certifies non-healthcare personnel to provide pre-test counseling, whole blood rapid HIV testing, and post-test supportive counseling. He also conducts training of trainers sessions and ensures that the training manuals for participants and facilitators are current, including input from policymakers, planners, counselors, lab technicians, physicians, and social workers.

A particular concern of the MOH is removing the barriers to effective counseling and testing of infants and children. As senior technical officer, Moses works on the policy level to establish and document guidelines and set standards for pediatric HIV counseling and testing. The guidelines promote the identification of HIV-infected children before they become critically ill, and provide guidance on referral of these children to care and treatment services.

Recently, Moses was involved in piloting a new initiative, "door-to-door" counseling and testing. Counselors on bikes or on foot move from one village to another, gathering residents for informational talks about HIV and offering HIV counseling and testing. From the national to the community level, the goal of universal access to HIV testing and counseling is never far from his mind.

PHOTO: Philip Moses, far right, in a June 2009 HIV counseling and testing supervision session with counselors at Martin Preuss Centre at Bwaila Government Hospital in Lilongwe, Malawi.