Sue-Ann Meehan
Blia Yang
Margaret van Niekerk
Jody Boffa
Rory Dunbar
Ricardo Felix
Anelet James
Nozizwe Makola
Nomtha Mandla
Jerry Molaolwa
Vikesh Naidoo
Zamikhaya Ndiki
Kerry Nel
Michelle Scheeper
Mark Theart
Lario Viljoen
Publication Date

This guidance document brings together lessons learned from the community-based HIV and tuberculosis programme implemented by the Desmond Tutu TB Centre, and provides practical information for others who are establishing community-based HIV prevention services as a component of an integrated public health response. In particular, the publication offers practical guidance on how to go into a community and start offering HIV-testing services (HTS) and how to get those diagnosed with HIV to link into HIV care and treatment services.

As explained in the guide, “It is widely acknowledged that HIV prevention and treatment cannot be realized in government healthcare facilities only. Tackling the HIV epidemic requires a joint response by government in partnership with civil society. Community-based HIV-prevention services can play an important role in the fight against HIV.” These initiatives are often led by local non-profit organisations (NPOs) and provide services outside of healthcare facilities, closer to where people live, work, and go to school. Community-based HIV services can reduce the cost and time expended on travelling to health services, as well as long waiting times in facilities for the client. They can potentially also help overcome some of the barriers that prevent people from accessing a healthcare facility for HIV testing and treatment, such as unfriendly staff and discrimination related to HIV stigma.

The guide is designed for a broad audience, including programme planners, clinicians, monitoring and evaluation personnel, and all stakeholders in the community-based HIV prevention response. It is based on the experiences and lessons learned during the past nine years, working in community-based HIV-prevention. Most of the contributions come from implementing three independent community-based HIV-prevention projects funded through the Centers for Disease Control (CDC) and implemented in the Western Cape province of South Africa. They were: a community-based TB-HIV Integration project (2008-2012), the Community HIV/AIDS Prevention Project (COMAPP) (2011-2017), and the intervention component of the HIV Prevention Trials Network (HPTN) 071 Population Effects of Antiretroviral Therapy to Reduce HIV Transmission Trial (PopART), which is a combination HIV-prevention package (2014-current).

Following an introduction explaining the purpose of the guide and how to use it, the guide contains the following chapters, which include case studies, helpful tips, and links to related websites:

Chapter 2: Stakeholder Engagement - aims to ensure that the reader understands how to engage with stakeholders, both before and during programme implementation, providing guidance and tools to ensure successful stakeholder collaboration. This includes guidance on how to successfully create demand for community-based HIV prevention services through, for example, street mobilisations using loudhailers, door-to-door mobilisation, large community engagement events, and media.

Chapter 3: Collaborating with not-for-profit organisations - provides information around how to collaborate with NPOs to provide HIV-prevention services, in a manner that also builds capacity within the NPO for programme sustainability. No programme can be successful without well-trained, highly motivated, and healthy staff.

Chapter 4: Creating, Equipping and Sustaining a Team - aims to give the reader insight into how to recruit, train, motivate, and support staff to build and sustain an effective team that can implement a successful HIV-prevention programme.

Chapter 5: Delivering Holistic Client-Centered Services - explores different community-based service delivery modalities, highlighting the advantages and the challenges posed by each modality, in terms of populations reached, HIV yield, and linkage to care. These modalities include standalone HIV-testing centres, mobile HIV-testing services, and door-to-door HIV-testing services. Sharing best practices and providing the reader with useful tips, this chapter also discusses how to integrate related health services into community-based HIV-testing services (CB HTS).

Chapter 6: Linkage to HIV Care and Treatment - addresses the aspect of linking people diagnosed with HIV in a community setting to HIV care and treatment provided within a healthcare facility. This chapter addresses why linkage to care is a crucial step within the HIV-testing process, it details many of the reasons why people do not link to care, and then it describes practical ways to improve linkage to HIV care from a CB HTS.

Chapter 7: Quality Assurance for HIV rapid testing - provides strategies and practical activities to enable community-based programmes to deliver HIV-testing services that are of high quality and consistently deliver accurate HIV-test results.

Chapter 8: Managing Data - provides the reader with information to make informed decisions to set up a data-management system that is appropriate and to ensure data collection that is relevant, of high quality, and timely. Using case studies, this chapter describes how geographical mapping can be used as an alternative way to represent the data visually.

Chapter 9: Monitoring and Evaluation - is dedicated to monitoring and evaluation (M&E), which forms an integral part of any programme. This chapter provides guidance to how to collect data to monitor HIV-prevention services and evaluate the outcomes.

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AIDSFree website on August 15 2017.

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