Challenges of Scaling Up Provider-Initiated HIV Testing and Counseling in Kenya

Issue „ HIV testing and counseling services are the cornerstone of HIV prevention, care and treatment programs. In 2005, the Kenya Ministry of Health (MOH) developed national policy guidelines to mainstream Provider-Initiated Testing and Counseling (PITC) services in clinical settings. However, uptake of PITC at public hospitals has remained low (30%). Description „ Dissemination of PITC guidelines and training of health workers have been conducted nationally by MOH and partners. Jhpiego and the MOH evaluated the PITC program two years after its introduction. PITC services were assessed in all eight provincial hospitals and two teaching and referral hospitals using structured interviews and focus group discussions. „ Identifi ed challenges to PITC uptake included: staff shortages, limited number of PITC-trained personnel, lack of ownership of the PITC approach among health care workers, lack of tools to properly capture data, and supply chain and other logistical issues. In addition, overcrowding in outpatient and inpatient departments, lack of adequate space, and low staff morale were noted. Health workers' negative attitudes were an added stumbling block as some doctors viewed counseling as the role of non- medical personnel. Lessons Learned „ Regular, multi-disciplinary team meetings at facilities to address gaps are important. Continuous supportive supervision and on- site mentorship are crucial in strengthening knowledge and skills.