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Evaluating the national HIV counseling and testing (CT) program of St. Lucia: a study to determine coverage, utilization, successes, and gaps in service delivery

  • Author(s): Asrat, Anjabebu S.
  • Advisor(s): Nuru-Jeter, Amani
  • et al.
Abstract

This dissertation presents findings from an evaluation of the national HIV counseling and testing program of St. Lucia. The research methods used include: semi-structured interviews, written document analysis, record reviews, and participant observations. Findings from the study will support decision making to assist in the improvement and expansion of CT service provision in the country.

The findings from this research provide evidence that there are many gaps in the national program. The major gaps include: 1) the lack of a full time coordinator to manage the CT program, 2) inadequate CT data collection, analysis, and use for decision making, 3) the absence of accurate denominator data (total tests conducted) from all sites providing CT services, 4) incomplete antenatal testing data, 5) absence of a training needs assessment or training plan, 6) shortages of personnel at all levels, 7) inadequate referral networks and linkages to support services for People Living With HIV/AIDS (PLWHA), 8) insufficient prioritization of the labs in all areas of planning, budgeting, personnel, renovations/refurbishments, training, and storage needs, 9) lack of adherence to national, regional, and international guidelines in rapid test use, 10) lack of evaluation of testing promotions and campaigns to determine reach, 11) inadequate space and infrastructure for CT service provision, and 12) insufficient inclusion of the private sector into all areas of the national program including dissemination of protocols, data collection forms, reporting structures, and training.

Detailed and specific recommends are made to address each of the identified gaps. In summary, these recommendations are that: 1) a full time coordinator is recruited for the national level for oversight and coordination, 2) new data collection instruments and processes for recording and reporting CT are developed, 3) all facilities conducting testing are required and supported to report to the national level, 4) systems are put in place to capture pregnant women and ensure that they are tested, receive their results, and that these are reported accordingly, 5) training needs and a training plan are developed and used to identify and train relevant staff, 6) additional personnel are hired to meet all needs including lab personnel, 7) referral networks are strengthened to ensure a continuum of care for patients in need, 8) labs are included during planning processes, 9) national guidelines are disseminated, 10) promotional efforts are evaluated, 11) infrastructure for CT service provision are improved, and 12) the private sector is included into all areas of the national program.

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