The program “Scaling Up Voluntary Testing and Counseling Services for the General Population (VCT)” started in October 2004 and was concluded in December 2008 as part of the programs implemented by Romanian Angel Appeal, being integrated to a great extent into the public health system.
Sponsor: The Global Fund to Fight AIDS, Tuberculosis and Malaria (the Global Fund), Round 2;
Partner: the Ministry of Health through the County Departments for Public Health in Suceava, Bacau, Constanta, Galati, Braila, Prahova, Dambovita, Sibiu, Brasov, Olt, Dolj, Timis, Caras-Severin, Hunedoara, Bihor, Cluj and Bucharest.
The objectives of the program were as follows:
The program was tightly connected in implementation with the Program for Prevention of Mother to Child Transmission (PMTCT). Within these two programs, the PMTCT / VCT coordination teams evaluated the implementation locations and selected those that met the eligibility criteria. The centers for voluntary counseling and testing were later established in those specific locations.
In 2004, the RAA team designed and completed a VCT Methodology in line with the National HIV/AIDS Strategy 2004 – 2007 and with international recommendations in the field. Subsequently, this methodology was amended and brought up to date in 2006. Special attention was paid to HIV counseling and testing for people from vulnerable groups as defined by the National HIV/AIDS Strategy 2004 – 2007.
Between October 2004 and august 2005, 18 voluntary counseling and testing centers (VCTC) were set up in 16 counties and in Bucharest.
Romanian Angel Appeal fully equipped the centers with the necessary materials, furniture, medical and office supplies, including vehicles for the outreach activities in the rural areas or in isolated places, far from the county seats.
A database was developed to allow statistical data to be centralized and analyzed in accordance with international guidelines. This database also allows a large amount of data related to risk factors incidence and high risk behaviors to be collected and interpreted.
Once developed, Romanian Angel Appeal donated the database to all the partners, at the end of the program, thus allowing for an important amount of data to be collected and interpreted, related to risky behaviors, risk factors association, trends in HIV epidemics etc. Further studies on HIV incidence / prevalence and behavior surveys of particular importance to epidemiological surveillance will be possible by using the RAA database.
35 HIV counselor nurses worked in the VCT centers network. People with medical training were selected for these positions in order to be in charge both with counseling for HIV testing and with collecting and transporting the blood samples in line with current epidemiologic regulations.
Local implementation of the PMTCT/VCT programs was supervised by 17 local coordinators assigned by the heads of the county departments for public health involved.
RAA coordination team organized and carried out initial training sessions, on site or on-line, for the local teams (counselors and coordinators). The sessions focused on case-centered counseling, risk evaluation and developing a plan to reduce high HIV risk. Later on, annual follow-up sessions were organized (in 205, 2006 and 2007) focused on group counseling techniques and on counseling for people who belong to vulnerable groups (commercial sex workers, injecting drug users, young people, street children etc).
Through the partnership between Romanian Angel Appeal and the Ministry of Health, two HIV tests per year per person from the general population were provided for free. This was a strong incentive for individuals accessing the HIV counseling and testing services.
The RAA coordination team considered the IEC (Information, Education, Communication) activities as very important. In this respect, 2.100.000 flyers, 67.000 brochures for teenagers, 65.000 brochures for adults, 16.000 posters and 2.800 promotional packages were distributed.
The motto of the campaigns was “HIV cannot be seen but it’s there! Take a test!”.
The content and presentation form of the IEC materials were adapted to the target groups.
In organizing and developing promotion activities for the VCT centers, the local partners and collaborators had a significant contribution.
Partnerships that had as consequence the development in best conditions of these activities were concluded with departments for health promotion within county authorities for public health, school first aid cabinets, county school inspectorates, county centers for psycho-pedagogical assistance, general county directorates for social assistance and child protection, university rectors’ offices, mayoralties, local and county councils, student associations, centers for family planning, local NGOs and associations active in the field of HIV/AIDS.
The VCT program implemented by Romanian Angel Appeal introduced into practice the concept of pre and post-test counseling as well as the written consent of the person counseled for HIV testing.
For the first time, in many counties, the VCT centers’ clients had the chance to receive accurate and complete information on the HIV infection, ways of transmission and prevention, personalized evaluation of the risk factors and an adapted plan for reducing the frequency of the high-risk behaviors.
Between October 2004 and December 2008, over 40.000 people from the general population were counseled and tested at the VCT centers. Over 80% of the individuals counseled pre-test received post-test counseling as well. The newly diagnosed cases of HIV were referred to services for medical assistance and psychosocial support established by Romanian Angel Appeal (within the Day Clinics).
Another innovative concept of the VCT program was, as in the case of the PMTCT program, the multidisciplinary support provided by the local intervention groups. These were made of doctors of various specializations (family medicine, infectious diseases, family planning, obstetrics-gynecology, STD and dermatology, epidemiology) as well as of social workers and psychologists.
The “Sunflower” Day Clinics Network provided medical care and psychosocial support for the people tested HIV positive and their families. Most of the cases diagnosed in the VCT centers were taken over by the Day Clinics staff.
Thus, RAA put the basis of equal and non-discriminatory access of HIV positive people to quality medical and support services.
In order to continuously improve the services and to ensure best conditions for program implementation, RAA requested an international evaluation for the PMTCT and VCT programs.
In her report drawn up at the end of her visit, international evaluator Dr. Katinka de Vries outlined the results achieved by Romanian Angel Appeal and recommended these results to be replicated in all Romanian counties but also in the region.
Republic of Moldova, Ukraine and Serbia benefited from RAA’s experience and expertise and the intervention models we developed were highly regarded.
The quality of the services provided by the VCT centers was a constant concern for Romanian Angel Appeal. In this respect, the RAA team designed a set on M&E tools to asses the quality (counselor abilities evaluation files, evaluation charts of the pre-test and post-test counseling sessions for positive or negative results, evaluation questionnaires to asses client satisfaction).
The tools for quality assessment were endorsed and certified by local partners (county pubic health authorities) and their implementation started during the third quarter of 2006.
The appreciation towards the counseling services provided by the VCT centers was significant:
“I liked very much the counseling session… I believe that many people would come to the center, would receive important information on the test, on the result… I was surprised to be counseled when I went for my result, but I was not afraid to talk to the counselor…”
(Male, 23, VCT client, focus-group participant)
“The counselors were friendly, I felt comfortable talking to them…”
“[The VCT service] is much better than other services! […] and I was surprised to see it’s free”
(Female, 21, VCT client, focus-group participant)
“It is very important for the RAA counseling and testing centers to continue to run. Testing has been proven to be an essential strategy in HIV prevention. The RAA centers work efficiently, professionally, have trained and devoted staff. At the same time, they are part of the not so many such centers that are fully equipped and prepared to provide testing and counseling to vulnerable groups. As far as the men who have sex with men are concerned, the staff from the RAA centers is trained to provide proper counseling to this group and thus contributes, in the most precise way, to limiting the number of new HIV cases. This in turns has good outcomes on the general population state of health. With relatively low costs as compared to the funds and work and energy volume invested in these centers, the ministry can continue a project with high impact in HIV prevention. I sincerely hope that this will be the course of action in the future.”
T.K., member of partner NGO