CHAA Joins Forces to Expand Rapid Testing Services
Expanding HIV testing and counselling services is crucial to ensuring that people have the knowledge to manage their sexual and reproductive lives. This is particularly true for most at risk populations (MARP), including sex workers (SWs) and men who have sex with men (MSM). In the Eastern Caribbean, there is a stark absence of prevalence data for MARP, however recent studies from other islands in the Caribbean region, such as Jamaica, show that 31.8% of MSM are HIV positive (Jamaica Ministry of Health and Environment, 2009). A major barrier to testing for MSM continues to be discrimination from health care providers and the general population as well as, laws that criminalise homosexuality. In Antigua, SWs continue to request rapid testing from MARP friendly organisations, and while feedback from peer educators working in the field shows SWs typically test regularly, they do so in private laboratories where they do not receive pre and post counselling and testing, raising serious concerns for those who test HIV positive.
There is a global move towards using the rapid test, which can provide same day diagnosis in less than 30 minutes and can be done using either a finger prick or an oral swab. Additional benefits of the test are increased numbers of testing sites, and the test can be conducted by trained lay people which in turn frees up limited health care providers to focus on care and support giving.
With this background, between 16th and 20th March 2009 the Caribbean HIV&AIDS Alliance (CHAA) joined forces with the US Centers for Disease Control and Prevention (CDC) and funding partner USAID, to train three of its programme staff, the Deputy Manager of the Antigua National AIDS Programme, a representative from the Ministry of Health and a community-based organisation supporting people living with HIV and AIDS. CDC's Global AIDS Programme (GAP), which brings global experience in training and supporting national programmes to rollout rapid testing, trained implementing partners over five days to the highest standard in performing the rapid test and ensuring quality assurance. CDC also introduced participants to its new technology for Proficiency Testing, Dried Tube Specimens, which can help to reduce false positives.
This training was the first in a series that CHAA and CDC will deliver jointly with government and community based organisations in Antigua for health care workers, lab technicians and ultimately lay persons drawn from MARP peer bases. More training will follow in upcoming months, prior to the government rollout of rapid testing, including a national training in counselling MARPS and hard to access sub-cultures, a harm-reduction training for HIV counsellors working with drug and substance users as well as, stigma and discrimination trainings for Voluntary Counselling and Testing (VCT) Counsellors.
Antigua is one of the first countries in the Eastern Caribbean poised to roll out rapid testing. Recent media reports coming from other countries using the rapid test, such as Kenya, have shown that inadequate training and quality assurance can lead to reduced trust in the rapid test, highlighting the importance of working closely with countries to ensure quality assurance systems are in place (Kaiser Daily HIV/AIDS Report, 18/3/2009). This makes CHAA's and CDC's partnership and collaboration with the Antigua Ministry of Health all the more important and timely. Further aims of the training will be to reduce stigma and discrimination from health care workers and increase sensitivity to the key issues of MARP. Both the roll-out of the HIV rapid test and the development of a core of community peer educators trained in MARP specific counselling and rapid testing are pioneering steps in the Eastern Caribbean's response to HIV and AIDS.
"You having trained one person will not only benefit the AIDS Secretariat but will benefit all nine sites where rapid testing will be rolled out, because I will be training all health workers at these sites. This collaboration allows for the forward movement of the programme in Antigua and Barbuda because we will be rolling out rapid HIV testing later this month. The CDC training was excellent and has allowed me to improve on my practical and theoretical knowledge, clear up grey areas, and now I'm moving forward even more confidently to roll out our rapid testing programme."
Delcora Williams, Deputy Manager
Antigua National AIDS Programme
Participant in the CDC Training in Atlanta