SOUTH AFRICA: Counsellors to give "the prick"
Finger prick HIV test
Johannesburg, 9 July 2010 (IRIN) - Lay counsellors in South Africa can now legally perform HIV tests, but delays in paying them and shortages of test kits are threatening a national campaign to scale up voluntary HIV testing and counselling (VCT).
Before new regulations
came into effect in May 2010 only nurses were allowed to administer finger-prick HIV tests, but AIDS activists had long argued that this not only added to an already heavy work load, but could also hamstring the VCT campaign aiming to test 15 million South Africans by 2011.
"The way it used to work, if I wanted an HIV test, a counsellor would have to sit down and do all the pre-test counselling ... and then that counsellor would have to go hunt down a nurse to do something that takes 10 minutes to teach a diabetic [how to do]," said Dr Francois Venter, president of the Southern African HIV Clinicians Society and head of the HIV management cluster at Johannesburg's Reproductive Health and HIV Research Unit (RHRU).
"It was ridiculous that one of our most important diagnostic tools be held hostage to our human resources crises," he told IRIN/PlusNews.
Task-shifting the prick
South Africa's public health system is struggling to cope with one of the world's worst HIV epidemics, as well as a shortage of doctors and nurses. The South African Nursing Council estimates that the country has about one registered nurse for every 440 patients, but according to the Human Sciences Research Council
, up to 20 percent of nurses are not practicing.
Malawi and Zambia, faced with even worse health worker shortages, have put HIV testing in the hands of trained lay counsellors, a strategy known as "task-shifting".
South Africa's new legislation requires counsellors to undergo three hours of training before being added to a database of healthcare providers allowed to perform "the prick". Dr Thobile Mbengashe, chief director of HIV and AIDS in the Department of Health, said they would not be allowed to perform other tasks, such as drawing blood.
The departments of health and social development are partnering with organizations funded by the US President's Emergency Plan for AIDS Relief (PEPFAR) to conduct the training. Venter said a handful of organizations, including RHRU, had started training their lay counsellors, but most clinics had not yet begun.
Civil society groups, including the Southern African HIV Clinicians Society, the Treatment Action Campaign (TAC), a local AIDS lobby group, and the Democratic Nursing Organisation of South Africa, have welcomed the new legislation.
"This is really the second extremely important task-shifting move we've seen this year," said Catherine Tomlinson, a senior researcher at the TAC. The first was the announcement in the new guidelines
released in April 2010 of government's goal to trains nurses to initiate and manage antiretroviral (ARV) treatment. "With the new [VCT] campaign, we needed another level of task-shifting and that’s what we’re seeing with this second move."
Tomlinson cautioned that despite the strides made in task-shifting, challenges remain for the VCT campaign. The TAC has documented shortages of HIV testing materials, and counsellors going unpaid in Eastern Cape and Limpopo provinces.
"People are coming in numbers to do HIV testing, but ... we don't have lancets [a pricking needle used to obtain blood for testing], so we are using needles to do the tests," said Noloyiso Ntamehlo, a TAC coordinator in the Eastern Cape district of Lusikisiki.
The payment of monthly stipends for counsellors had also been delayed, and the off-road utility vehicles to take VCT to the district's largely rural population have not arrived.
Mbengashe said the health department was aware of the stipend delays and was working with the South African National AIDS Council to prioritise payment.