Seminar paper on effictiveness and utilization of htc service in nepal 2014

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Seminar paper on effictiveness and utilization of htc service in nepal 2014

  1. 1. ‘‘Effectiveness and Utilization of HIV Testing and Counseling (HTC) Service in Nepal’’ A Health Seminar Paper submitted to fulfill the partial requirement of BPH Seventh Semester [HES 405.1Health Seminar in Special Topics] Submitted To Department of Public Health LA GRANDEE International College Simalchour, Pokhara March,2014 Submitted By SAgun PAudel Roll No. 22
  2. 2. I ACKNOWLEDGEMENT I like to express my humbly thanks to all those who have supported and helped for accomplishing this Seminar paper in the topic ‘‘Effectiveness and Utilization of HIV Testing and Counseling (HTC) Service in Nepal’’. First of all i would like to thank my respected BPH Program coordinator Mr. NandrajGahatraj for giving opportunity to prepare this seminar paper. I am fully indebted to him for expert guidance, regular supervision, untiring encouragement, inspiration and valuable suggestion and full support during preparation of term paper. I would like to convey our heartfelt thanks to all those who were directly or indirectly concerned with this and to all my well-wishers. This term paper is written in simple language, with every bit of necessary information related to the topic so that studying independently also would not find any difficulties. i think that this effort will help every individual to understand about the information of the related topic. SAgun PAudel Student of Public Health
  3. 3. II TABLE OF CONTENT ACKNOWLEDGEMENT......................................................................................................................i TABLE OF CONTENT ........................................................................................................................2 1. INTRODUCTION...........................................................................................................................1 2. OBJECTIVES .................................................................................................................................2 2.1. General objectives....................................................................................................................2 2.2. Specific objectives ...................................................................................................................2 3. METHODOLOGY..........................................................................................................................3 4. CURRENT SITUATION AND COMPARISON..............................................................................4 4.1. Situation of HIV/AIDS.............................................................................................................4 4.2. HIV Testing and Counseling Center in Nepal ...........................................................................4 4.3. The essential elements of VCT services in Nepal:.....................................................................5 4.4. Process of Voluntary Testing and Counseling...........................................................................6 4.5. Effectiveness and Service Utilization Trend .............................................................................6 5. Conclusion ......................................................................................................................................8 6. Recommendations ...........................................................................................................................9 7. REFERENCES.............................................................................................................................. 10
  4. 4. 1 1. INTRODUCTION HIV counseling is an interaction in which the counselor offers another person the time, attention and respect necessary to explore, discover, and clarify ways of living more resourcefully. Counseling is an issue-centered and goal-oriented interaction. Counseling is DIALOGING and helping to provide options for decision-making and BEHAVIOUR CHANGE. Good counseling helps another person to be AUTONOMOUS, meaning able to explore options, make decisions, and take responsibility for his or her own actions. In 1994, WHO defined counseling as follows: A confidential dialogue between a person and a care provider aimed at enabling the person to cope with stress and make personal decisions related to HIV/AIDS. The counseling process includes an evaluation of personal risk of HIV transmission and facilitation of preventive behaviors and appropriate referrals for care and support services. Voluntary Counseling and Testing (VCT) allows individuals to learn their HIV status through pre- and post-test counseling and HIV test. VCT is client-initiated, as opposed to provider- initiated testing and counseling (PITC) when health care providers initiate discussion of HIV testing with clients who are seeking health care for other reasons. VCT can be provided through stand-alone clinics or offered through community-based approaches, such as mobile or home- based HIV testing. In addition, counseling for VCT may take place at the individual, couple, or group level. VCT was originally implemented as an individual-level, clinic-based procedure.1 Voluntary HIV/AIDS counseling, testing and referral (VCT) is a major strategy in HIV/AIDS prevention and care. Nepal’s National HIV/AIDS Strategy 2002 emphasizes the need to “establish a non-discriminatory, accessible, voluntary, confidential HIV testing system with pre- and post-test counseling and urges the MoHP “to develop a policy and quality framework for government and private institutions including NGOs” as a basis for expansion of services.2 Voluntary Counseling and Testing VCT was used initially to support people diagnosed with HIV/AIDS in the clinical setting, but has developed over years to become a main entrance point to wider prevention, care, prophylaxis and treatment of HIV related illness, psycho-emotional and legal support for people tested positive and negative. 1. Voluntary Counseling and Testing Rigorous Evidence – Usable Results, Research for Prevention, June, 2012 2. NATIONAL GUIDELINES FOR VOLUNTARY HIV/AIDS COUNSELINGAND TESTING, Ministry of Health National Center for AIDS and STD Control ,Teku, Kathmandu, Nepal, July 2003
  5. 5. 2 2. OBJECTIVES 2.1.General objectives  To study the Effectiveness and Utilization of HIV Testing and Counseling Service in Nepal. 2.2.Specific objectives  To study the current situation of HIV/AIDS in Nepal.  To study the HIV Testing and Counseling Center in Nepal.  To study the process of HIV testing and Counseling in Nepal.  To study the essential elements of HTC services in Nepal.
  6. 6. 3 3. METHODOLOGY To prepare this Seminar paper Google was used to retrieve journal and articles. Google Scholar, EndNote was used to retrieve the articles. The articles related to VCT are downloaded and studied. To collect the further information advanced Google search was also done and various books from library were also studied for the Preparation of this paper. This report was prepared by using various secondary data sources Available on internet, journals, and articles.
  7. 7. 4 4. CURRENT SITUATION AND COMPARISON 4.1.Situation of HIV/AIDS Nepal faces increasing HIV prevalence among most at-risk populations (MARPs) such as sex workers, injecting drug users (IDUs), men who have sex with men (MSM), and migrants. Effective prevention interventions need to be scaled up, especially among IDUs. Nepal's poverty, political instability, and gender inequality, combined with low levels of education and literacy, make the task challenging, as do the denial, stigma, and discrimination that surround HIV and AIDS.3 HIV in Nepal is characterized as concentrated epidemic. More than 80 percent HIV infections spreadthrough heterosexual transmission. People who inject drugs, female sex workers (FSWs) and menhaving sex with other men (MSM) are the key populations at higher risk spreading the epidemic.Male labour migrants (particularly to HIV prevalence areas in India, where labour migrants often visit female sex workers) and clients of female sex workers in Nepal are acting as bridging populations that transmit infections from higher risk groups to lower risk general population. As the epidemic ismaturing (after the first HIV case reported in 1988), increased number of infections are beingrecorded among low risk general men and women. However, the epidemic has never maintainedthrough heterosexual transmission in the general population in Nepal, rather driven by theinfections among higher risk populations and their sexual partners.It is estimated that about 55,626 people are living with HIV in Nepal in2010. Majority of infectionsare occurred among adult (15‐49) male (58%) women of reproductive age group (28%) populations,while 8% of infections are occurred among children under 15 years of age. The key populations athigher risk (IDUs, FSWs, MSM, male labour migrants and clients of FSWs) shared 58% of all adult HIVinfections. Highest number of infections is estimated is in the age group of 25‐49 years who areeconomically productive and sexually active. The younger stratum of population below the age of 15has lowest number of infections and most are due to mother to child transmission. The HIV prevalence is moving to a downward trend and it is at 0.33% in 2011.4 4.2.HIV Testing and Counseling Center in Nepal The growth in the number of testing and counseling service provision sites has been rapid and overtwo hundred sites now offer HIV counseling and testing nationwide. However, there the peopleserved by different sites indicating underutilization at some sites due to higher concentration ofservice sites in some places. There is need for harmonization and coordination in the HTC sites runby different programs, at the same time integrating into the health system. Provider initiatedcounseling and testing is being initiated from ANC, STI and TB clinics. 3.HIV/AIDS in Nepal,WORLD BANK(August 2008)www.worldbank.org/np 4.NATIONAL HIV/AIDS STRATEGY 2011-2016, Government of Nepal,Ministry of Health and Population, National Centre for AIDS and STD Control,Teku, Kathmandu,November 2011
  8. 8. 5 A review of the NHSP 2006‐2011 found considerable gaps in reaching migrant workers to India andtheir spouses, low rates of utilization of VCT services and PMTCT services, policy variations ininitiation of ART, lack of mainstreaming of HIV into other sectoral plans, lack of coordination andunclear roles at the highest levels of government as well as the national coordinating bodies in theHIV response, limitations in civil society capacities, continuing discrimination against transgenderpersons, and almost complete dependence on external sources of funding for HIV/AIDS.5 4.3.The essential elements of VCT services in Nepal: VCT services are an important part of an expanded National HIV/AIDS Prevention and Care Strategy In Nepal because they:  Determining the clients knowledge  Providing information  Conducting a personalized risk assessment  Developing a personalized risk reduction plan  Demonstrating appropriate condom use  Counseling about test results  Counseling about making the decision to take the test  Assessing the client’s capacity and ability to cope  Counseling on how to inform partners of results and how to refer partners for testing  Providing psychological and emotional support and referrals, as appropriate. 5.Nepal Health Sector Programme –II ,2010-2015, Government of Nepal, Ministry of Health and Population.
  9. 9. 6 4.4.Process of Voluntary Testing and Counseling 4.5.Effectiveness and Service Utilization Trend The effectiveness of the current HIV programs must be improved. HIV testing, a key programelement is not being undertaken on a large enough scale, and in spite of statistics showing high condom use rates, the STI rates amongst KAP tell another story.the testing rates in Nepal are far from adequate: 54% test in a year, and even fewer street-based FSW test, as only 45% has ever been tested for HIV. Testing levels among KAP are low; for most, alarmingly low. Of PWID, in Kathmandu valley, only a low 21% has ever had an HIV test (IBBS 2011).As the June 2013 review of the Nepal HIV response shows, services are not always delivered in the most effective and efficient way. There is duplication and fragmentation of services at district and village levels, and much could be gained by improved cooperation between providers of services.
  10. 10. 7 The cooperation between NGOs working towards preventing HIV in key affected populations is non-existent or limited. Keythe lack of effective dialogue may be a key barrier for KAP to test.6 various barriers including socio-cultural issues, geography, the presence of stigma and discrimination faced by people with HIV/AIDS and a lack of knowledge and awareness were identified as important factors limiting the utilization of VCT services. Current government efforts to improve VCT service provision, although promising, require ongoing development. Systemic barriers included the sustainability of the temporary NGO VCT services, lack of staff and training, inadequate monitoring and evaluation and limited access to services for people living in rural areas.7
  11. 11. 8 5. Conclusion Voluntary Counseling and Testing (VCT) is a proven strategy for the prevention and management of HIV/AIDS especially in developing countries. The utilization of VCT is low in Nepal. There are various barriers and challenges for VCT services in Nepal. it is important to understand the barriers and challenges that Nepal is facing in the provision and utilization of these services. In order to increase the utilization and effectiveness of the VCT services, collective action from Government, private, NGO/INGOS, and community should be established.
  12. 12. 9 6. Recommendations The government could intervene in a number of areas such as  The integration of VCT services with sexual health and primary health care offers the possibility of more referrals and easier access to services for people with HIV.  staffing recruitment, retention and training  Better collaboration between government, service providers, and NGOs.  Identification of alternative strategies for the prevention and management of HIV/AIDS apart from the VCT services,  VCT services access, sustainability and stigma and discrimination in Nepali society. Cooperation between governments, private, NGO, and community service provider’s needs to be established and improved urgently to address the Public health Burden of HIV/AIDS and its consequences. 6.The Nepal HIV Investment Plan 2014-2016, October 2013 7.Mahato et al. VCT services and HIV/AIDS prevention and management in Nepal, South East Asia Journal Of Public Health,ISSN: 2220-9476
  13. 13. 10 7. REFERENCES 1. Voluntary Counseling and Testing Rigorous Evidence – Usable Results, Research for Prevention, June, 2012 2. NATIONAL GUIDELINES FOR VOLUNTARY HIV/AIDS COUNSELING AND TESTING, Ministry of Health National Center for AIDS and STD Control ,Teku, Kathmandu, Nepal, July 2003 3. HIV/AIDS in Nepal,WORLD BANK(August 2008)www.worldbank.org/np 4. NATIONAL HIV/AIDS STRATEGY 2011-2016, Government of Nepal,Ministry of Health and Population, National Centre for AIDS and STD Control,Teku, Kathmandu,November 2011 5. Nepal Health Sector Programme –II ,2010-2015, Government of Nepal, Ministry of Health and Population. 6. The Nepal HIV Investment Plan 2014-2016, October 2013 7. Mahato et al. VCT services and HIV/AIDS prevention and management in Nepal, South East Asia Journal Of Public Health,ISSN: 2220-9476 [Available at www.slideshare.net/sagunpaudel] THANKYOU!

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