Improving VCT services by reducing provider stigma and discrimination of vulnerable populations: A certification approach to building capacity

Stigma and discrimination by health providers can affect the quality of VCT services. Health providers do not receive training aimed at reducing stigma and discrimination. Behavioral research shows that training alone is not enough to effect a change in provider attitudes and behaviors in ways that will improve health services. A strategy to build provider capacity over time was developed to improve VCT services for vulnerable populations. The strategy entails strengthening provider knowledge and skills in VCT as well as improving the attitude of providers and clinic staff toward these groups. Provider behavior change is expected to be achieved through their participation in a four-stage process culminating in certification. The process starts with in-class training, followed by a sensitization session conducted by providers at their work place, followed by a supervision visit to reinforce information and assess skills, and last attendance of two continuing education sessions to reinforce topics covered in the initial training. Data collected before and after implementation of the strategy in Nicaragua and El Salvador will be presented. These include pre and post-tests, follow-up visits with 60 providers and 60 exit interviews with vulnerable clients. Results show a significant increase in providers' knowledge of the VCT protocol and quality of VCT services improved over time. These results demonstrate a feasible and effective strategy to address provider stigma and discrimination. Recommendations for program managers wanting to increase access to VCT services by vulnerable populations will be discussed, as well as implications for national policies regarding VCT service delivery.