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Increasing access to HIV testing and counseling through integration with primary health care services: Lessons learned from Jamaica

Kelly A. Curran, MHS1, Peter Figueroa, BSC, MBBS, DPH2, Rachele Evelyn Vernon, PhD3, Catherine Schenck-Yglesias, MHS4, Jennifer Stuart-Dixon, MA3, and Melisa Schuette, MPH5. (1) Office of HIV/AIDS, JHPIEGO, 1615 Thames Street, Suite 300, Baltimore, MD 21231, 410.537.1826, kcurran@jhpiego.net, (2) Ministry of Health, 2-4 King Street, Fourth Floor, Kingston, Jamaica, (3) Comprehensive Health Center, 55 Slipe Pen Road, Kingston 5, Jamaica, (4) Research & Evaluation Office, JHPIEGO Corporation, 1615 Thames Street, Suite 200, Baltimore, MD 21231, (5) Latin America and Caribbean Office, JHPIEGO, 1615 Thames Street, Suite 200, Baltimore, MD 21231

Limited access to HIV testing and counseling (T&C) is a major barrier to HIV/AIDS prevention and care interventions in Jamaica. The development of stand-alone T&C sites is not feasible given resource constraints that preclude hiring additional counselors. The authors and colleagues worked with the Jamaican Ministry of Health (MOH) to promote the integration of HIV T&C with primary health care services as part of a Caribbean regional program. The Testing and Counseling Program has focused on training nurses who give antenatal care, STI contact investigators, and peer educators in HIV counseling. The MOH has decentralized testing to the clinic level by adopting a rapid-test algorithm. Local teams have developed and are implementing T&C performance standards for group education, pre- and post-test counseling, HIV testing and management systems. From June 2002 - December 2003, 546 counselors representing 212 service delivery sites were trained and 28 local trainers developed, using materials adapted to the Caribbean context. T&C is now available nationwide in at least one clinic in each of the 13 parishes in Jamaica. Uptake of T&C has increased markedly as access improved; the number of ANC clients tested for HIV in only one quarter in 2003 was 3,638, almost the same as the annual total of 3,723 for 2002. Integration of T&C with primary care services is an effective strategy for increasing access to and use of T&C. Because integration means additional work for clinic staff, strategies such as the use of group education sessions and peer educators to support counseling are essential.

Learning Objectives: At the conclusion of this session, participants will be able to

Presenting author's disclosure statement:
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.

HIV/AIDS Prevention Poster Session

The 132nd Annual Meeting (November 6-10, 2004) of APHA