Regional minimum standards for guidance on HIV testing and counselling (HTC) in the SADC region

The main aim of this project was to develop regional harmonized minimum standards for policies, protocols and guidelines for HIV testing and counselling (HTC) in the SADC region. This is consistent with Article 10 of the SADC Protocol on Health, which calls for the harmonization of policies on disease prevention and control. Several approaches were followed in developing these minimum standards. Firstly, an extensive literature review of both published and unpublished literature on HTC in the SADC region and globally was conducted as well as analysis of HTC policies, protocols and guidelines. Secondly, a technical meeting was held in Gaborone from 15-16 December 2008 with HTC experts and implementers from the region. The objective of the meeting was to discuss and share experiences on current national policies and programmes for HTC, and to give guidance on the approach for developing minimum standards. Thirdly, policy discussions were held in 14 SADC Member States with representatives of Ministries of Health and National AIDS authorities, and local and international stakeholders, to gain more understanding on how the programmes work, and to identify major achievements, challenges and best practices. Based on information collected from the Member States, individual HTC reports were developed for each of the Member States. These were subsequently sent back to the Member States for verification. Based on a review and assessment of current HTC policies, protocols and guidelines in the Member States and global recommendations, the following HTC minimum standards are proposed: 1. Availability and regulation of HIV testing: Member States must ensure that HIV testing facilities are available and accessible free of charge to the population. The responsible government department must also ensure that laboratory facilities providing tests such as CD4 count, viral load test and pap smear are available and accessible to all. 2. Routine offer of testing at health facilities: Member States must encourage providers to offer testing at all health facilities because of the magnitude of the HIV epidemic in the SADC region, and in order to ensure timely access to prevention, care and treatment. 3. Age of consent in HIV testing: Persons aged 12 years and above requesting HTC services are considered able to give full, informed consent. 4. Standards for service provision: To offer high-quality HTC services at any site, HTC programmes need to be guided by key principles of consent, confidentiality and counselling. 5. Capacity building for providers and task shifting: MS must decide must decide on what cadre of HTC service providers to have at institution and community levels. They must also employ culturally acceptable service providers and must explore the possibility of absorbing lay counsellors into the country's formal health care systems. 6. Accreditation of HTC sites: Accreditation must be done by a team of technical experts (including laboratory scientists/technologists, counsellors and administrators). Minimum requirements for accreditation are staff, space, equipment and supplies. 7. Quality assurance of HTC services: Strategies for quality counselling must address staff competency, follow-up training, supervision, monitoring of sessions, stress management, exchange visits and formation of a counsellor support network. Quality assurance for HIV testing must include adherence to laboratory protocol, quality control of samples and quality control of testing kits and supplies. 8. Handling of test results and referrals: In consultation with the client, appropriate referrals must be made to additional services as needed. These may include medical, social, legal, economical, spiritual and psychological support. Emphasis must be on simple-to-use referral forms and links must be established among the referring units. 9. Comprehensive HTC approaches: Comprehensive HTC approaches must be introduced, including stand-alone, mobile/outreach, private sector, periodic campaigns, door to door, integrated services, etc. Regional minimum standards for guidance on HTC in SADC. 10. Involvement of men and people living with HIV/AIDS: Men and people living with HIV/AIDS have been acknowledged as an important and missing link in HTC programmes and their involvement will increase uptake. The involvement of men will increase their support for female partners.