This past week, the GROW team attended a VCT (Volunteer Counseling and Testing) in Amuru sub-county. At a VCT, community members are able to be tested for HIV, find out their results immediately, and receive counseling from community-based health workers. VCTs are a very important part of the GWED-G and GlobeMed project; knowing one’s status is the first step in securing a healthy lifestyle and curtailing the spread of HIV. VHTs (Village Health Teams) are responsible for informing communities of VCTs and mobilizing members to a central location determined by GWED-G.
Before testing began, those that were there participated in a pre-counseling dialogue conducted by a staff member from Olwal Health Center. During this discussion, participants were informed of the testing procedure and the counseling options available after receiving test results. Next, each member registered with a second staff member who recorded their name, age, gender, and place of residence and assigned each person a number as to ensure their confidentiality throughout the testing process. Patients then got tested in numerical order and waited ten minutes for results. The location for VCTs is strategically chosen to be close to a Health Center so that patients can walk to the center one-by-one to find out their test results in private.
Protocol for VCTs involves a series of three different test kits. The first test used is a basic rapid test. If the first result is negative, testing stops there. However, if the first test shows a positive or unclear result, a second test is used—a Determinant Stat-Pak kit. According to guidelines set by the Ministry of Health of Uganda, a positive reading from the second kit confirms that a person is HIV+ and should be referred to a health clinic to enroll in treatment. If the second test result is negative, or again produces an unclear result, a third test called Unogo is then used. In the case that a person does test positive, they are informed in the same manner as individuals who test negative.
Those who test positive first receive brief counseling on-site. They then are referred to a HealthCenter in order to begin treatment for HIV. A VHT records the person’s name and address so that follow-up visits can start immediately. If the person in question is an HIV + mother, they are also enrolled in the GWED-G/GlobeMed project in order to receive home visits and additional support from GWED-G staff.
At a health center, patients undergo further testing—specifically, CD4 count and liver and renal function is determined. If a CD4 count reflects a high enough number (low is considered 200 compared to a normal 500-1000), patients are first given Septrin Prophylaxis before beginning antiretroviral (ARV) treatment 6 months later to receive ARVs. Franny explained to us that 3 months is an appropriate period to delay antiretroviral treatment after administering prophylactics, but due to limited capacity of local health facilities, patients wait an additional 3 months to get treatment. Cases in which patients unfortunately die during this 6 month delay are not uncommon, Franny told us. In other cases, however, she said that CD4 counts increase over this period, meaning that patients are relatively healthy when they first receive ARVs, as is desired.
Observing a VCT was an incredible and emotional experience for the GROW team. Even Franny, who has overseen VCTs for years, explained that telling a person they have HIV will never be easy. We all noticed the atmosphere of tension introduced when a secondary test kit was taken out to confirm a positive result. We, too, eyed the tests along with community health workers until results were determined. In total, 2 out of 100 people who partook in this VCT tested positive, representing a percentage less than the national average of around 7%. Stephen, the lab technician in charge of testing, told us that in recent VCTs the numbers of individuals who test HIV+ are significantly lower than numbers from only 6 years ago. In 2006, he worked with Médecins Sans Frontières (Doctors Without Borders), during the period after the civil war’s end wherein violence persisted. At this time, he told us that, on average, he saw 1 out of every 10 people testing positive. He thinks reasons for this were probably the conditions within Internally Displaced Persons camps during the war, specifically crowding and increase of alcohol abuse associated with hopelessness. Stephen recognized that HIV/AIDS is a major difficulty that his country faces, but is pleased that the prevalence of the virus appears to be decreasing. His reason for returning to school in order to get his bachelor’s degree was to “serve his own people, and assist them in their health.”
It became increasingly clear throughout the day that VCTs are essential for the communities in Northern Uganda. Franny recognized a woman who brought her child to get tested and told us the woman had brought her baby, aged 13 months, to get tested at 3 different health facilities over the past several months, including at centers as far away as Kampala, but has yet to receive the test results. Outcomes of HIV tests can take up to 6 months to be determined and delivered to the person getting tested because of inadequate numbers of lab technicians, long distances between labs and health centers, and a lack of transportation. Attending last week’s VCT allowed this mother to be informed of her child’s status immediately, meaning that she will now be able to make appropriate decisions to ensure her health.
This VCT was made possible by the donation of testing kits from Olwal Health Center. The health staff recognized the importance of community-based testing and accordingly granted GWED-G 100 out of their 300 test kits for the cause. For the past several months, GWED-G has been unable to obtain testing kits at an affordable cost. Labongogali Health Center has run out of testing kits altogether and has been unable to procure more, and due to a limited supply, Olwal Health Center has chosen to only use kits to test pregnant women seeking antenatal care. Thus, the majority of those who attended the VCT would not have been able to get tested otherwise, as their closest health facilities lack supplies.
As we have learned, there are many reasons to avoid getting tested in Northern Uganda, including the potential to be alienated from one’s community and estranged from one’s family. Yet even so, we were able to meet 100 people – both men and women, young and old – who made the brave decision to get tested. Hearing from both the attendees and the health staff allowed us to understand that, despite fears and worries, the knowledge of one’s HIV status is of paramount importance in how one shapes his or her life. Thus, we bore witness the impact of VCTs as part of our project with GWED-G.
GROW team out.
– Jess Northridge