The Role for Government Health Centers in Provision of Same-Day Voluntary HIV Counseling and Testing in Kenya

Objective:To explore the role of primary health centers in provision of voluntary counseling and testing (VCT) in Kenya. Design and Setting:Prospective service evaluation at 3 (1 urban and 2 rural) government health centers. Subjects:Consecutive adult clients. Main Outcome Measures:Uptake of services, user characteristics, quality of service. Results:Counseling services received 2315 new clients over 26 months. The last quarter averaged 101 clients per clinic. More than 80% of clients lived locally. Overall 93% opted to test, 91% receiving results, 82% on the same day. Most clients tested HIV negative (81%). Youth and men were well represented. Few couples (10%) attended. Seventeen percent of women were pregnant. Self-referral was common and illness was an uncommon reason for testing (<20%). Thirty-one percent of clients were referred from VCT to other health center services. Counseling was perceived as high quality by users and providers. Validation of the test algorithm showed a sensitivity of 98.0% and specificity of 98.7%. Conclusion:Government health centers in Kenya can be appropriate providers of VCT. This pilot helped initiate a new strategy of health center-based VCT in Kenya and this has facilitated rapid expansion and more equitable provision for Kenyans.

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