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Review
. 2016 May 13;19(1):20751.
doi: 10.7448/IAS.19.1.20751. eCollection 2016.

Sustaining the future of HIV counselling to reach 90-90-90: a regional country analysis

Marielle Bemelmans  1 , Saar Baert  2 , Eyerusalem Negussie  3 , Helen Bygrave  2 , Marc Biot  4 , Christine Jamet  5 , Tom Ellman  2 , Amanda Banda  4 , Thomas van den Akker  6 , Nathan Ford  3
Affiliations
Review

Sustaining the future of HIV counselling to reach 90-90-90: a regional country analysis

Marielle Bemelmans et al. J Int AIDS Soc. .

Abstract

Introduction: Counselling services are recommended by the World Health Organization and have been partially adopted by national HIV guidelines. In settings with a high HIV burden, patient education and counselling is often performed by lay workers, mainly supported with international funding. There are few examples where ministries of health have been able to absorb lay counsellors into their health systems or otherwise sustain their work. We document the role of lay cadres involved in HIV testing and counselling and adherence support and discuss approaches to sustainability.

Methods: We focused on a purposive sample of eight sub-Saharan African countries where Médecins Sans Frontières supports HIV programmes: Guinea, Lesotho, Malawi, Mozambique, South Africa, Swaziland, Zambia and Zimbabwe. We reviewed both published and grey literature, including national policies and donor proposals, and interviewed key informants, including relevant government staff, donors and non-governmental organizations.

Results and discussion: Lay counsellors play a critical role in scaling up HIV services and addressing gaps in the HIV testing and treatment cascade by providing HIV testing and counselling and adherence support at both the facility and community levels. Countries have taken various steps in recognizing lay counsellors, including harmonizing training, job descriptions and support structures. However, formal integration of this cadre into national health systems is limited, as lay counsellors are usually not included in national strategies or budgeting.

Conclusions: The current trend of reduced donor support for lay counsellors, combined with lack of national prioritization, threatens the sustainability of this cadre and thereby quality HIV service delivery.

Keywords: HIV testing and counselling; HIV/AIDS; adherence support; antiretroviral therapy; community health workers; human resources for health; lay counsellors; lay workers; patient education and counselling; retention in care; sub-Saharan Africa; task shifting.

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Figures

Figure 1
Figure 1
Recognition framework for lay counsellors [38].
See this image and copyright information in PMC

References

    1. UNAIDS. How AIDS changed everything. Geneva, Switzerland: UNAIDS; 2015. [cited 2015 Sep 25]. Available from: http://www.unaids.org/sites/default/files/media_asset/MDG6Report_en.pdf.
    1. Lundgren JD, Babiker AG, Gordin F, Emery S, Grund B, Sharma S, et al. Initiation of antiretroviral therapy in early asymptomatic HIV infection. N Engl J Med. 2015;373(9):795–807. - PMC - PubMed
    1. Danel C, Moh R, Gabillard D, Badje A, Le Carrou J, Ouassa T, et al. A trial of early antiretrovirals and isoniazid preventive therapy in Africa. N Engl J Med. 2015;373(9):808–22. - PubMed
    1. WHO. Guideline on when to start antiretroviral therapy and pre-exposure prophylaxis. Geneva, Switzerland: World Health Organization; 2015. [cited 2015 Sep 30]. Available from: http://www.who.int/hiv/pub/guidelines/earlyrelease-arv/en/ - PubMed
    1. UNAIDS. 90-90-90 The ambitious target to help end the AIDS epidemic. Geneva, Switzerland: UNAIDS; 2014. [cited 2015 Aug 16]. Available from: http://www.unaids.org/sites/default/files/media_asset/90-90-90_en_0.pdf.

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