As most of us know, South Africa has the largest burden of HIV/AIDS with approximately 7 million people living with HIV by 2015, which included 240 000 children under 15.
We also have the largest antiretroviral treatment (ART) programme in the world, which works in concert with counselling and testing, which builds risk awareness for those not infected and links care and treatment for those who test HIV positive.
Increasing the number of people tested for HIV in South Africa has become a national priority following the UNAIDS pronouncement of the 90-90-90 targets that countries need to strive to achieve by 2020.
The gap between current HIV counselling and treatment and the 90% target clearly demonstrates the need to rapidly expand HIV testing and the frequency of testing including strategic targeting of testing services.
Nonetheless stigma is still a major barrier to testing, particularly in marginalised and vulnerable groups. For many – particularly men – the idea of going for an HIV test at a public clinic or mobile testing event is too intimidating or embarrassing.
In order to ensure a wider range of options are available to the public for testing HST is implementing "The VCTII Power of Knowing" project to complement the public health sector services - including in rural areas and peri-urban informal settlements – in Limpopo and the Northern Cape.
The South African government acknowledges that it is not feasible to increase the number of tested persons by relying only on public health sector facilities.
This innovative project is ensuring wider access to testing and treatment through collaboration with private-sector medical providers. This assures clients that their privacy is being respected and allows them to choose a medical practitioner they are comfortable with.
Feedback from clients bears out that his approach is bearing fruit: "My partner wanted to get tested but all the time when I said we should go to the public facility, he wasn't keen because he wasn't comfortable... When I said we are going to this private place, he had no problem."
Through this collaboration with private and non-governmental service providers, such as general practitioners, nurses, NGOs and pharmacists, the project has been able to provide efficient and effective HIV counselling and testing (HCT) as well as supplemental services such as TB screening. Private providers, who are part of this franchise model, use visible branding with the logo clearly displayed on the front of their practice so that people can recognise that free testing is available there.
The HCT Franchise Model also facilitates continuous training and quality control for all service providers enrolled in the project to ensure that they provide a high quality service in line with the national HIV testing guidelines.
Community outreach campaigns which offered on-the-spot testing, either at home or at events such as community dialogues, were extremely successful in educating clients about HIV and how the community can respond to the effects of the epidemic.
Service providers in this project provide testing for free, and refer positive clients who do not have private medical insurance to the public sector for ART initiation and treatment.
The results to date have been encouraging: over the last 5 months (to December 2017) the percentage of people who tested for the first time ever in the Northern Cape is 25% and 46% of all people who have tested through this project are men. Clients reported an improved attitude to testing and awareness of high-risk behaviours.
The project has been a fruitful initiative for private sector health care personnel too: "Clients would call me to say 'I am coping because of you' and that is an achievement for me" said one doctor.
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