Preparedness for diagnostic testing and counseling (DTC): A national survey of Kenyan health workers

Background: WHO suggests that symptomatic individuals presenting at clinical settings in areas with generalized epidemics receive opt-out HIV counseling and testing (CT) for diagnostic accuracy. But the extent to which health care systems are prepared for DTC is unknown. We present results of a national study assessing the degree to which Kenyan health care workers (HCWs) are positioned to offer DTC. Methods: A cross-sectional survey was conducted in 2005 among 1,897 clinicians in 247 facilities nationwide. The sample comprised of doctors, clinical officers, nurses, laboratory staff, VCT counselors and social workers. Data were gathered using guided self-administered questionnaires after ethical approvals, and were weighted to reflect the national distribution of HCWs. Results: Half the HCWs surveyed said they conduct some aspect of HIV CT, and 72% of these had been trained to do so. Among those who offer CT, doctors (45%) and clinical officers (40%) were the least likely to have been trained in this procedure. Half of the HCWs trained in CT had been trained in PMCT, 36% in VCT and 18% in DTC. Less than 15% of the entire sample had received CT training as part of pre-service education. Conclusions: With the rolling out of DTC, there is need to build the capacity of the many HCWs who could provide this service but presently do not, and to train the 25% who presently offer it without appropriate preparation, especially doctors and clinical officers.