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AFRO-NETS> SAfAIDS Discussion Forum Review

SAfAIDS Discussion Forum Review 
Dear Colleagues

Please find attached yet another of our Newsflashes: New Start HIV 
Counselling & Testing Initiative in Zimbabwe. We hope you find it in-
We would greatly appreciate any feedback on the Newsflashes. If you 
find them useful, we would be glad to know how you are putting the 
information into use.
Happy reading

Juliet Mkaronda

New Start HIV Counselling & Testing Initiative

At SAfAIDS monthly discussion forum (May, 2001), Dr Patrick Osewe of 
USAID presented and discussed the New Start HIV Counselling and Test-
ing Initiative. In 1998, Population Services International, NACP and 
USAID launched an initiative to provide voluntary counselling and 
testing (VCT) in Zimbabwe. To date, the New Start clinics have pro-
vided HIV counselling and testing to 18,973 individuals. 

New Start Vct Services 
*Voluntary and anonymous testing 
*Clients pay $Z50 *Free promotion weeks  
*Client centred counselling 
*Same day results 
*Do not issue written results to clients 
*Emphasis on quality


Zimbabwe has among the highest HIV prevalence in southern Africa. 
Many Zimbabweans are aware of HIV and AIDS in both urban and rural 
areas. A significant number of Zimbabweans feel that they are already 
infected, yet they have never been tested. Current statistics show 
that the reverse is true. Around 70 % of Zimbabweans are HIV nega-

Before VCT was introduced in Zimbabwe, an HIV test was costly and re-
quired a physician's referral. As a result, few people were tested. 
Due to the inaccessibility of HIV testing, individuals soon recog-
nised that they could use blood donation as a way of getting tested. 
The National Blood Service would accept them as a regular donor if 
they were negative on two consecutive occasions. However, it could be 
a lengthy and stressful process for someone waiting for results. In-
dividuals needed an easier process with greater access to HIV test-
ing-hence the New Start initiative

VCT Delivery Models Several models exist for the delivery of VCT ser-
vices. For example, VCT services can be implemented as a service pro-
vided in public sector clinics or in partnership with non-
governmental organisations (NGOs). Another option would be to estab-
lish a clinic that deals only with HIV counselling and testing. Un-
certain which option was best for Zimbabwe, the New Start initiative 
implemented several different VCT delivery models. 

1. Public Sector Clinic Opportunities 
*Clinics are in high density areas 
*High volume of clients 
*Some staff have counselling experience 
*Less stigma 
*Mobilisation of community resources 
*Low price for services 
*High potential for replication

*Staff perceive services as additional burden 
*Low motivation of staff - low salary 
*Limited staff 
*Long waiting periods 
*Inconvenient clinic hours 
*Lack of space for expansion

2.NGO Provider 
*Quality standards easily enforced 
*Long tradition of working with communities 
*Employ staff according to demand and resources 
*Flexible hours 

*Weak management support system 
*Diversion from core activities 
*Potential for stigma 
*Donor dependent

3.Public Sector/NGO Partnership 
*Increased absorptive capacity 
*Reduce waiting time 
*Clinics continue to focus on core activities 
*Additional resources 
*Community mobilisation/target population

*Lack of space 
*Unwillingness to accept outside providers 
*Management of relationship

4. Private sector model Opportunities 
*Commitment to quality 
*Perceived to be private and confidential 
*Respond to client needs 
*Complementary to other services

*Expensive and inaccessible 
*Limited absorptive capacity 
*Resist quality control-operate under limited supervision

The New Start programme was integrated with the services of public 
sector clinics or in partnership with NGOs throughout the country. 
The newest clinic was developed as a direct walk-in site that only 
provides VCT services. Through an evaluation of the various delivery 
models, it was found that clients preferred the programmes in public 
sector clinics. Clients felt that the purpose of their visit would 
remain anonymous by visiting a clinic where there was a high volume 
of clients and numerous health services were provided. However, the 
clinic staff found VCT was a further duty and service that put addi-
tional burden on an already overworked staff. The evaluation found 
that the quality of the programme was more efficient in clinics where 
staff were devoted only to providing VCT services. 

Quality Assurance of the New Star Programme

*Weekly group supervision meetings are conducted 
*Counselling session reflection 
*Periodic visits by site facilitators 
*Direct observation 
*Mystery clients (anonymous observation of service) 
*In-service training 
*Stress management workshops 
*Exchange visits 
*10% of specimens for Quality Assurance at laboratory

The New Start programme continues to face several challenges, with 
both the staff and the clients. The programme strives to maintain 
country and regional standards as well as to develop criteria for 
hiring counsellors. There is a high risk of staff burnout from the 
increasing number of clients attending the clinics. The programme is 
examining various options such as training lay counsellors and/or 
peer educators.  Additionally, the New Start Initiative is continu-
ally exploring various strategies to encourage follow-up counselling, 
the mobilisation of communities and partner notification.

Characteristics of New Start Clients 
*56% male: 44% female 
*50% have never married while 36% are married. 5% are widowed 
*78% are HIV negative while 22% are HIV positive 
*More female clients are positive than male clients 
*More married clinics are positive that never married or widowed 
*The majority of HIV+ clients are between the age of 25-29 
*Between the ages of 20-24, there are approximately 5 times more 
  women who test positive as compared to men in a similar age group.  
*66% of clients come to be tested because they are curious

The Next Steps The New Start Initiative is examining methods to de-

*A mobile VCT programme to high density and rural areas 
*Linkage with support groups 
*Linkage with other services 
*Youth Friendly VCT sites 
*Communication Campaign 
*Linkage with pilot treatment initiatives For more information, 
please contact:  

Southern Africa AIDS Information Dissemination Service
17 Beveridge Road
Box A509, Avondale
Tel: +263-4-336193/4, 307898
Fax: +263-4-336195

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