Professional Documents
Culture Documents
4TH EDITION
PEPFAR
OCTOBER 2016
Ministry of Health
Uganda
4th Edition
October 2016
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National Implementation guidelines for HTS in Uganda, October 2016
Uganda Ministry of Health 2016
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National Implementation guidelines for HTS in Uganda, October 2016
Contents
Abbreviations............................................................................................vii
Foreword....................................................................................................x
Acknowledgements.................................................................................xiii
1.0. Introduction.............................................................................1
1.1. Overview............................................................................1
1.2. Situational Analysis of HIV and AIDS in Uganda................2
1.3. History of HTS in Uganda.........................................................4
1.4. Rationale for Policy Review......................................................5
1.5. Policy Framework......................................................................7
1.6. Target Audience.........................................................................8
1.7. Process of Policy Review..........................................................8
1.8. Guiding Principles and Values.................................................9
1.9. Lay-out.........................................................................................12
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National Implementation guidelines for HTS in Uganda, October 2016
4.4. Confidentiality............................................................................39
4.5. Correct Results............................................................................43
4..6. Linkage to care............................................................................43
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National Implementation guidelines for HTS in Uganda, October 2016
7.8. Monitoring Linkage...................................................................123
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National Implementation guidelines for HTS in Uganda, October 2016
8.7.5. Evaluation of test kits and other laboratory reagents...........157
8.7.6. Quality assurance/control measures for monitoring and
evaluation.................................................................................157
8.8. Research.....................................................................................158
8.8.1. HIV testing in surveillance settings........................................159
14.0. References..................................................................................170
14.1. Annex 1. Policy Guidance for development of HTS
implementation guidelines......................................................172
14.2. Annex 2: Glossary of terms......................................................174
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National Implementation guidelines for HTS in Uganda, October 2016
Abbreviations
ACP AIDS Control Programme
ADPs AIDS Development Partners
AIDS Acquired immune deficiency syndrome
ANC Antenatal Clinic
ART Antiretroviral therapy
ARV Antiretroviral drug
BCC Behavioural Change Communication
CDC Centre of Disease Control and
Prevention
CHAI Clinton Health Access Initiative
CITC Client Initiated Testing and
Counselling
CPD Continuous Professional
Development
CPHL Central Public Health Laboratory
CQI Continuous Quality Improvement
DBS Dry Blood Spot Sample
DHO District health office/officer
DNA Deoxyribonucleic Acid
EID Early Infant Diagnosis
ELISA Enzyme-linked immune-sorbent assay
EQA External Quality Assurance
FP Family planning
GBV Gender-Based Violence
HBHCT Home Based HIV Counselling and
Testing
HEI HIV Exposed Infants
HIV Human Immunodeficiency virus
HMIS Health Management Information
System
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National Implementation guidelines for HTS in Uganda, October 2016
HSSIP Health Sector Strategic & Investment
Plan
HTS HIV Testing Services
HCT HIV counselling and testing
ICF Intensified Case Finding
IDPs Internally displaced persons
IEC Information Education and
Communication
ILO International Labour Organisation
IPC Interpersonal Communication
IQC Internal Quality Control
JMS Joint Medical Stores
KPs Key Populations
M&E Monitoring and Evaluation
MoEST Ministry of Education, Sports and
Technology
MoH Ministry of Health
MSM Men who have Sex with Men
NGO Non-governmental organization
NHRL National Health Reference Laboratory
NHSP National HIV and AIDS Strategic
Plan, 2016-2020
NMS National Medical Stores
NQIT National Quality Improvement
Teams
OVC Orphans and Vulnerable Children
PCR Polymerase Chain Reaction
PEP Post Exposure Prophylaxis
PITC Provider Initiated Testing and
Counselling
PLHIV People Living with HIV
PMTCT Prevention of Mother to Child
Transmission of HIV
PPP Public-Private Partnership
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National Implementation guidelines for HTS in Uganda, October 2016
PTC Post-Test Clubs
PWDs Persons with Disabilities
QA Quality Assurance
QC Quality Control
QIT Quality Improvement Teams
RCT Routine HIV Counselling and Testing
RHT Rapid HIV Antibody Test
SGBV Sexual Gender- Based violence
SOPs Standard Operating Procedures
SRH Sexual Reproductive Health
STD Sexually Transmitted Disease
STI Sexually Transmitted Infection
SW Sex Worker
TB Tuberculosis
TWG Technical Working Group
UCA Uganda Counselling Association
UDHS Uganda Demographic Health Survey
UHPC Uganda HIV Prevention and Control
Act, 2014
UNAIDS The Joint United Nations
Programme on HIV and AIDS
UNHCR United Nations High Commission
for Refugees
USAID United States Agency for
International Development
UVRI Uganda Virus Research Institute
VCT Voluntary HIV Counselling and
Testing
VSMC Voluntary Safe Male Circumcision
WHO World Health Organization
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National Implementation guidelines for HTS in Uganda, October 2016
Foreword
The Government of Uganda (GoU) has made the fight
against HIV and AIDS one of its top priorities. The strategies
aimed at responding to the HIV and AIDS epidemic, are
an integral part of the Health Sector Development Plan
2016-2020, National HIV and AIDS Strategic Plan (NHSP
2015/16-2019/20) and the National Health Policy (NHP
II). HIV Testing Services are offered within a legal and
human rights framework ensuring quality counselling,
confidentiality, informed consent, giving of correct results
and connecting those tested to further care and prevention.
MoH acknowledges the need to continuously adopt new
approaches in response to the changing epidemic. This
enables the country to appropriately focus the response
to target priority areas and population groups; hence the
need for periodic HTS policy reviews to incorporate new
evidence-informed approaches.
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National Implementation guidelines for HTS in Uganda, October 2016
providing HCT services increased to 3,565 in 2014;
including all public and private hospitals and HC IVs.
There has been a progressive increase in the number of
individuals tested since 2011 from 5,524,327 individuals
to 9,564,992 in 2014 with nearly two thirds of these being
women, and about 10% being children under the age of
15 years. About 1,727,465 were pregnant women during
Antenatal Care (ANC) visits. Over the last three years
the percentage of women and men aged 15 -49 years who
received an HIV test in the past 12 months and know their
results has ranged from 42% to 51.4%1,2. While this may be
explained by the increase in the population, it still shows
that there are many missed opportunities for HCT HTS
The drive to end the HIV epidemic and meet the new
nationally adopted global 90-90-90 targets towards
elimination of HIV by 2030 as enshrined in the National
HIV/AIDS Strategic Plan 2016-2020, underpins the review
of the HTS policy and guidelines.
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National Implementation guidelines for HTS in Uganda, October 2016
of HTS into general health care and, strengthening
coordination, monitoring and evaluation. The HTS policy
and Implementation guidelines are aligned to the 2015
World Health Organization Consolidated HTS guidelines
and the Uganda HIV Prevention and Control Act, 2014.
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National Implementation guidelines for HTS in Uganda, October 2016
Acknowledgements
This document was developed through
through the
the contributions
contributions
and expertise of a number of people and Institutions.
Organisation Name
Organisation Name
Ministry of Health (MOH)
Dr. Allan Muruta
Ministry of Health (MOH) Dr. Patrick Tusiime
Dr. Joshua Musinguzi
Dr. Allan Muruta
Dr. Wilford Kirungi
Dr. Joshua Musinguzi
Dr. TumwesigyeBenson
Dr. Tumwesigye Benson
Geoffrey Taasi
Taasi Geoffrey
Dr. Kadama Herbert
Dr. Kadama Herbert
Dr Norah Namuwenge
Tinkasiimire Talugende
Nyegenye
Tinkasiimire Wilson
Talugende
Dr Linda
Nyegenye WilsonNabitaka
Dr.Katureebe
Dr Linda Cordelia
kisakye Nabitaka
Juilet Cheptoris
Dr. Katureebe Cordelia Mboijana
Dr. Doreen Ondo
Juliet Cheptoris
Micheal
Dr.Doreen Muyonga
Olowo Ondo
Dr. Barbara Asire
Micheal Muyonga
Dr. Shaban Mugerwa
Dr Peter Kyambadde
Florence Nampala
Dr. Barbara Asire
Uganda AIDS Commission Dr. Peter Mudiope
Dr.ShabanMugerwa
Dr. Carol Nakkazi
Florence Nampala Busingye
Judith Kyokushaba
Uganda AIDS Commission Dr.Peter Mudiope
Dr. Carol Nakkazi
xiii | Page
National Implementation guidelines for HTS in Uganda, October 2016
Organisation NameName
Centres
Centres for
for Disease
Disease Control StevenDr.
Control and Wiersma
Esther Nazziwa
and Prevention
Prevention (CDC) (CDC), Dr Stella Alamo
Apolot Talisuna
Madina
Uganda
Dr. Esther
Aleti Nazziwa
Philliam
ApolotSamMadina
Wasike
Aleti Rose Apondi
Aleezaibo Philliam
Dr. Stella Alamo
Sam Wasike
Neetu Abad
Rose Apondi
World Health
Centres Organisation
for Disease Control Behel Rita Nalwadda
Stephanie
(WHO)
and Prevention (CDC), Dr. Kaggwa Mugaga
Atlanta William Lali
World
ClintonHealth
HealthOrganisation Rita Nalwadda
Access Initiative Dr. Betty Mirembe
(WHO)
(CHAI) Catherine Amulen
Clinton Health Access Dr. Betty Mirembe
Brenda Kunya
Kabasomi
Initiative (CHAI) Catherine
VickyAmulen
Abenakyo
Baylor Uganda Brenda Kabasomi Mbeine
Dr. Denise Birungi
STAR-EC Vicky Silver
Abenakyo
Mashate
Baylor Uganda Dr. Denise Birungi
Dorothy Namuganga
STAR-EC
Makerere University School of Silver Mashate
Prof. Rhoda Wanyenze
Public Health (Mak. SPH) Dorothy Namuganga
Dr.Edgar Kansiime
Makerere University
Infectious Diseases Institute (IDI) Florence Namimbi
School of Public Health Prof. Rhoda Wanyenze
ANECCA Rose Nasaba
(Mak. SPH) Dr.Edgar Kansiime
Pretium Solutions LTD Musoke Nassir
Infectious Diseases
USAID/CHC
Institute Venansio
Florence Namimbi Ahabwe
Uganda Virus Research Rose Nasaba
ANECCA Rose Akide
InstituteSolutions LTD
Pretium Musoke Nassir
Makerere University, School
USAID/CHC Agatha
Venansio AhabweKafuko
of Humanities
Uganda Virus Research In-
stitute
NAFOPHANU Rose Akide
Nanyanzi Prossy
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National Implementation guidelines for HTS in Uganda, October 2016
Organisation
Organisation NameName
Name
Makerere
Makerere University,
MildmayUniversity,
Uganda Grace
Agatha Kabunga
Kafuko
Agatha Kafuko
School of Humanities
School Humanities
Ministry of Justice and Kyampaire Dorothy
NAFOPHANU
NAFOPHANU Nanyanzi
Nanyanzi Prossy
ProssyLuzige
Luzige
Constitutional Affairs Lillian Andama
Mildmay Uganda
Mildmay UgandaPersons Grace Namuddu
GraceKawooyaVicentKabunga
Namuddu Kabunga
Other Resource
Kyampaire
KyampaireDorothy
Dorothy
Ministry
Ministry ofofJustice andand
Justice Janet Kabatebe Bahizi
Constitutional Affairs
Constitutional Affairs LillianNabalonzi Jane Kisitu
LillianAndama
Andama
Consultants Teddy
Rosemary Chimulwa
RosemaryKidyomunda
Kidyomunda
UNFPA Dr. Enid Mbabazi
UNFPA Judith Amongin
JudithDr. Denis Nansera
Amongin
KawooyaVicent
United States Agency
TheInternational
for HTS policy and implementation
Dan Wamanya
Janet Kabatebeguidelines
Bahizi review
process was made
Development possible with financial support from
(USAID)
Other
the Resource
ELMA Persons
Philanthropies Nabalonzi
and Bill Jane
and Kisitu
Melinda Gates
Central Public Health
Foundation throughthe Wilson
Teddy Nyegenye
Nabwire Chimulwa
Clinton Health Access Initiative
Laboratories (CPHL)
(CHAI), Medical
National and theStores
UnitedDr.Nations Population Fund
Enid Sunday
Mbabazi
Izidoro
(UNFPA) to whomthe MoH is very grateful.
(NMS)
Consultants Dr. Denis Nansera
Kawooya Vicent
The HTSgratitude
Special policy and implementation
is extended to the guidelines
Members of review
the
process
Other was
Resource
National made possible
PersonsServices
HIV Testing with financial
JanetCommittee support
Kabatebe Bahizi
(NHTSC) forfrom
the ELMA Philanthropies and Bill and Melinda
providing backstopping support to the review process. Gates
Foundation throughthe Clinton Nabalonzi
Health Jane KisituInitiative
Access
(CHAI), and the United
The Consultants comprising Teddy
Nations Nabwire
Ms.Population
Teddy Chimulwa
N. Fund (UNFPA)
Chimulwa,Dr.
to whomthe
Denis MoH is very
Nanseraand Dr. grateful.
Enid Mbabaziare
Consultants Dr. Enid Mbabazicommended
for leading
Special the policy
gratitude review process
is extended to theand compiling
Members of the
the
Policy and implementation Dr. Denis
guidelines. Nansera
National HIV Testing Services Committee (NHTSC) for
providing
The backstopping support to the review process.
It isHTS
mypolicy andhope
sincere implementation
that this HTS guidelines
Policyreview
and
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The made possible with
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Chimulwa,Dr.
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for the provision and Bill
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of accessible,and Melinda
commended
equitable, Gates
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Foundation
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human-rights through
the policy theand
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sensitive Clinton
process Health
high and Access
compiling
impact HTS Initiative
inthe Policy
order to
and implementation guidelines.
xv | Page
National Implementation guidelines for HTS in Uganda, October 2016
(CHAI), and the United Nations Population Fund (UNFPA)
It is my sincere hope that this HTS Policy and implementation
tofast-track
whomthethe MoHNational
is veryHIV and AIDS Strategic Plan target
grateful.
guidelines will provide the necessary guidance for the
of identifying 90 percent of HIV infected Ugandans and
provision
Special of accessible, equitable, quality, of
human-rights
linkinggratitude
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byNational
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HIV Testing Services Committee (NHTSC) for providing fast-track the
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90 percent of HIV infected Ugandans and linking them to
Sincerely
The
HIV Consultants comprising
care and support servicesMs.
by Teddy
2020 N. Chimulwa,Dr.
Denis Nanseraand Dr. Enid Mbabaziare commended for
leading the policy review process and compiling the Policy
and implementation guidelines.
Sincerely
ItDr
is my sincere
Joshua hope that this HTS Policy and implementation
Musinguzi
guidelines will provideSTD/ACP
Programme Manager, the necessary guidance for the
provision of accessible, equitable, quality, human-rights
sensitive and high impact HTS in order to fast-track the
………………………………..
National HIV and AIDS Strategic Plan target of identifying
90 percent of HIV infected Ugandans and linking them to
Dr Joshua Musinguzi
HIV care and support services by 2020
Programme Manager, STD/ACP
Sincerely
………………………………..
Dr Joshua Musinguzi
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National Implementation guidelines for HTS in Uganda, October 2016
1.0. Introduction
1.1. Overview
The revised HTS policy and Implementation guidelines
replace the 2010 Uganda HIV Counselling and Testing
(HCT) Policy and National Implementation guidelines for
HCT, 2010. It is informed by new evidence generated from
implementation of HTS at international, regional and
national levels as well as lessons and good practices from
the East African region. Uganda has adopted the WHO
terminology “HIV Testing Services (HTS)” to replace ‘HIV
Counselling and Testing (HCT)’in order to incorporate all
services aimed at ensuring delivery of high quality HTS.
These include: counselling, coordination with laboratory
services for quality assurance and correct results and
linkage to care and Prevention services.
Definition of HTS
HIV testing services (HTS) in Uganda will include the full
range of services that shall be provided together with HIV
testing. This includes pre-test information, HIV testing,
post-test counselling, linkage to appropriate HIV prevention,
treatment and care services and other clinical and support
services; and coordination with laboratory services to support
quality assurance and the delivery of correct results. The
human rights approach shall encompass use of the essential 5Cs;
Consent, Confidentiality, Counselling, Correct test results and
Connection (linkage to prevention, care and treatment). This
includes HTS services provided to various population groups
including key Populations at-risk and Vulnerable populations,
prevention of mother-to-child transmission of HIV (PMTCT)
and ARV treatment to all those who need it.
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National Implementation guidelines for HTS in Uganda, October 2016
The 2016 HTS policy and implementation guidelines
integrate both the policy statements and implementation
guidelines.
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National Implementation guidelines for HTS in Uganda, October 2016
140,000 in 2013 and to 95,000 in 2014. Similarly the new
infections among children reduced from 31,000 in 2010
to 15,000 in 2013 and to 5200 in 2014. Other remarkable
improvements have been witnessed in the reduction of
annual AIDS related deaths from 67,000 to 63,000 in 2010
to 2013 respectively and to 31,000 in 20145.
Urban areas continue to have a higher HIV prevalence
rate (8.7%) than rural areas (7.0%)6and a rising epidemic
in adolescents and young people with girls and women
disproportionately affected7. The MOT 2015 synthesis
also notes that women carry much of the burden of the
epidemic in Uganda- with higher prevalence rates in many
categories when compared to their male counterparts.
According to the 2015 MOT synthesis, on average, of the
total new infections, about 22% occurred among stable
married couples who constitute about 42% of the total
population, 25% among those with one partner (non-
marital) who constitute about 15% of the total population,
32% among casual heterosexual partners who constitute
about 23% of the total population and 20% among sex
workers, clients of sex workers and partners of these
clients who constitute about 5% of the total population.
Therefore the populations most susceptible to risk of new
HIV infections are the Key Populations, contributing 21%
of the total new infections although they are just 5% of the
total population.
There are several risk factors and key drivers that are
5 UAC 2015, The Uganda HIV and AIDS Country Progress Report 2014
6 MoH, 2011. Uganda AIDS Indicator Survey, 2010
7 Uganda Bureau of Statistics (UBOS) and ICF International Inc. 2012.Uganda
Demographic and Health Survey 2011.Kampala, Uganda: UBOS and Calverton, Maryland:
ICF International Inc.
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National Implementation guidelines for HTS in Uganda, October 2016
fuelling the epidemic and play a crucial role in the spread
of HIV. The key factors include multiple concurrent sexual
partners, lack of condom use, transactional sex, cross
generational sex, early sex, sexually transmitted diseases,
discordance and non-disclosure, and lack of circumcision.
The drivers of the epidemic on the other hand are:
negative socio-cultural norms and values, wealth, income
inequality and poverty, gender inequality, human rights,
stigma and discrimination and inequity8.
8 Uganda AIDS Commission (UAC) 2015. KYE,KYR Modes of Transmission Synthesis 2014
9 Uganda Bureau of Statistics (UBOS) 2012. Uganda Demographic and Health Survey 2011
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National Implementation guidelines for HTS in Uganda, October 2016
1.4. Rationale for Policy Review
By end of 2014, access to HTS in Uganda had improved,
with 3,565 HTS outlets spread across the country, and at
least 51.4% of the population aged 15-49 knowing their
HIV sero-status. While the number of people testing for
HIV surpassed annual targets (8million people tested
annually), the rate of HIV re-testers was high (40%)10. HTS
coverage in infants, under 5 years, children, adolescents,
Orphaned and Vulnerable Children (OVC), couples,
People With Disabilities (PWDs), and Key populations
{Sex Workers (SWs), Men who have Sex with Men
(MSM), truck drivers, the fisher folk, uniformed services
personnel, prisoners}, and among the emerging high risk
groups (alcoholics and drug addicts, boda-boda cyclists,
music artists, health workers, plantation workers) remains
low11.
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National Implementation guidelines for HTS in Uganda, October 2016
Routine HTS program data shows a stagnating average
HIV prevalence of 3.5% among the general population
and above 10% among key populations12. Clearly HIV
testing is becoming more inefficient and expensive as we
approach the first 90 while the resources are declining. An
assessment of the effectiveness of facility and home-based
HTS approaches in 2013 shows that $6.4 and $5 are spent
to test oneindividualfor HIV in a facility-based and home-
based model respectively The same assessment shows that
it takes $86.5 and $54.7 to identify an HIV positive person
through the two models respectively13.
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National Implementation guidelines for HTS in Uganda, October 2016
• Address emerging Global, Regional and National
issues such as goal 3 (Good Health and wellbeing-
healthy lives and promote wellbeing for all at all ages) of
the Sustainable Development goals and UNAIDS
fast track 90 -90- 90 treatment targets by 2020
• Regularize HTS related legal issues arising out of
the East African and National HIV prevention and
Management Acts
• Streamline testing for adolescents and children
• Align the HTS policy with the new WHO consolidated
technical guidelines for HTS (2015) and address HTS
priorities of the new National HIV strategic plan and
the National AIDS Action Plan (2016-2020)
• Appropriately and more efficiently target the HIV+
with unknown HIV status
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National Implementation guidelines for HTS in Uganda, October 2016
strategic and policy instruments as outlined in Appendix 1
of this document.
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National Implementation guidelines for HTS in Uganda, October 2016
The TWG had specific terms of reference (TORs) which
ensured close coordination with the Consulting team. A
desk review of high- impact evidence and good practices
in HTS programming, appraisal of the 2010 HTS policy
through a rapid assessment, and consultations with
research and academic institutions in Uganda were carried
out to generate recommendations to inform the 2016 policy.
Policy writing workshops were conducted where the TWG
and technical stakeholders reviewed the various chapters
of this document. Input was sought through Consultative
meetings withthe Ugandan parliament Committee
for Health; other line Ministries and departments;
Uganda Counselling Association (UCA); Civil Society
Organizations (CSOs), HTS Implementing Partners;
and Special Interest and vulnerable groups (adolescents
and youth, People With Disabilities (PWDs), uniformed
officers and other KPs) and Development partners.
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National Implementation guidelines for HTS in Uganda, October 2016
principles. The circumstances and conditions under
which people undergo HIV testing must be anchored in
an approach which protects their rights. The HTS policy
therefore upholds the basic human rights of individuals
and families as enshrined in the various legislations and
implementation principles.
Right to dignity:
• Privacy and Confidentiality: All information
concerning a client, including information relating
to his or her health status, treatment or stay in a
health establishment is confidential. No one shall be
subjected to arbitrary or unlawful interference with
his or her privacy. Clients’ information shall only be
released if the client consents, ordered by the court
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National Implementation guidelines for HTS in Uganda, October 2016
of law and or if necessary for the advancement of the
client’s care and treatment.
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National Implementation guidelines for HTS in Uganda, October 2016
1.9. Lay-out
The overarching aspiration of these guidelines is to ensure
identification of HIV infected persons currently not
reached with HTS and appropriately link them to care,
treatment and Prevention services. This shall be achieved
through implementing the HTS continuum of linkage to
care and prevention as prescribed by WHO (figure 1)
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National Implementation guidelines for HTS in Uganda, October 2016
2.0. Purpose and Objectives of the HTS
Policy and guidelines
2.1 Purpose
The purpose of the revised HTS policy and guidelines
is to provide a framework to regulate the planning,
implementation, monitoring and evaluation of high
quality HIV Testing Services by standardizing guidance
to HTS providers to achieve universal HTS coverage in
Uganda to ensure identification of HIV infected persons.
2.2 Objectives
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National Implementation guidelines for HTS in Uganda, October 2016
3.0. Priority Populations
Populations with increased risks of HIV infection and
transmission; yet have limited access to HTS shall be
prioritized. Broadly, the policy provides guidance for
reaching Infants and children, adolescents and Youths,
pregnant women, couples and partners, men, key and
other vulnerable populations. This will ensure effective
identification of HIV positive individuals and their linkage
into care.
Policy Statements:
a) HIV Testing Services shall be designed to address
the unique needs of persons categorized as priority
populations
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National Implementation guidelines for HTS in Uganda, October 2016
infection. These include; couples and sexual partners
especially discordant couples, infants and young
children, sexually abused persons, adolescents and
Youth especially girls, young women, emancipated
minors, orphans and Vulnerable Children (OVC),
out of school children, persons with mental illness,
persons with disabilities (PWDs), health workers,
internally displaced persons, refugees, prison
inmates and migrant workers.
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National Implementation guidelines for HTS in Uganda, October 2016
3.1 Couples and sexual partners
In Uganda 60% of new infections occur among married
people and discordant couples may account for up to 50%
of these infections. HTS coverage for couples in Uganda
is low and many people do not know their partner’s HIV
status. Couples and partner HTS have a number of benefits
including adoption of prevention strategies (condom
use, immediate ART initiation, PrEP); safer conception;
improved uptake of and adherence to ART and ART for
PMTCT and increases men’s uptake for HTS14.
HTS for Couples and Sexual partners will be enhanced
through targeting couples and sexual partners with HTS
information and setting up testing points in areas such as:
• Antenatal care settings
• Post natal and Family planning clinics
• HIV care and treatment clinics
• Home-based HTS for index partners
• Religious premarital preparations
• Couple testing campaigns
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National Implementation guidelines for HTS in Uganda, October 2016
HTS providers must assess for potential gender-based
violence(GBV)during individual partner counseling
sessions. If this is identified early, HTS providers should
support people’s decisions not to test with their partners
until they are ready. HTS Providers should refer clients to
programs that address gender based violence.In addition
couples will be informed about and be supported to join
support groups, including discordant couple groups,
where applicable.
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National Implementation guidelines for HTS in Uganda, October 2016
DNA/PCR.Other entry points for identifying HIV Exposed
Infants (HEIs) include; the Out Patient Department (OPD),
In Patient Department (IPD), Immunization/Young Child
Clinic (YCC), and PostNatal Care (PNC). Identification of
HIV Exposed Infants (HEIs) will be done through checking
PMTCT codes on the maternal passport and child health
cards to identify infants eligible for EID. In the absence of
PMTCT codes on the maternal passport and child health
cards; an HIV antibody rapid test of the mother should be
done to ascertain the HIV exposure status of the infant.
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National Implementation guidelines for HTS in Uganda, October 2016
3.2.3. Adolescents (10-19 years)
Globally 2.1million people of the 34 million estimated
to be living with HIV are Adolescents16. In 2013, 115,330
Adolescents in Uganda accessed HIV Testing services,
with a positivity rate of 2.5%17. However, adolescence is
a period characterized with vulnerabilities which increase
risk to HIV infection amongst this age group. Yet only 17%
of Ugandan Health Facilities offered Adolescent friendly
services18. In Uganda adolescent girls are generally at
higher risk of acquiring HIV than their male counter parts.
Adolescents from key population groups are at especially
higher risk for HIV infection.
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National Implementation guidelines for HTS in Uganda, October 2016
HTS services by older relatives, neighbors or family friends.
HTS providers should support adolescents to disclose their
HIV status to significant others for psychosocial support.
The providers must assess and ensure that disclosure does
not result in stigma and discrimination of the adolescents.
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National Implementation guidelines for HTS in Uganda, October 2016
3.3. Youths
HIV prevalence increased from 1.5% in 2005 to 2.4% in
2011 in the 15-19 age-groups and from 4.7% to 5.4% in the
20-24 age groups with young women bearing the largest
burden. Sixty percent (60%) of women and 42% of men
aged 15-24 years had had sex by the age of 18 years. Only
42% and 46% respectively used a condom on their last
sex encounter in 2011; a reducing trend from 54% in 2005.
There was also an increasing trend in premarital sex from
22.5% in 2005 to 31% in 2011. Key risk factors accountable
for this are: low risk perception, need to experiment with
sex and therefore engaging in high risk sexual behavior19.
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National Implementation guidelines for HTS in Uganda, October 2016
Providers of HTS should ensure successful linkage to
appropriate HIV prevention, treatment, care and support
services through a functional linkage system.
20 UNAIDS. (2009). Disability and HIV Policy Brief, UNAIDS/WHO and OHCHR.
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National Implementation guidelines for HTS in Uganda, October 2016
organisations so as to increase access and coverage of HTS
amongst PWDs.
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3.6. HTS for Key populations (KPs)
There is still a big unmet need for HTS among key
populations due to limited access to health services in
Uganda, yet HIV incidence and prevalence is high amongst
this population22. The Uganda HIV and AIDS Strategic
Plan 2015/16-2019/20 highlights Key Populations to
include: Sex workers, Fisher-folk, Men who have ex with
Men (MSM), long distance truck drivers, boda-boda/taxi
drivers and uniformed personnel. In Uganda sex work and
homosexuality are criminalized and therefore people from
these sub-populations may not seek health care services.
Stigma, discrimination, lack of confidentiality, coercion,
fear of repercussions, and lack of appropriate health
services, resources and supplies prevent such populations
from testing. For the same reasons, key populations may
find it difficult to easily accept linkage to care.
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Key strategies for reaching KPs should include;
• A peer-led approach where Key Population peers
are involved in provision of services
• Services should be offered at the convenience of Key
Populations through flexible opening hours, walk-
ins or same-day appointments
• Services should be offered in a place that ensures
privacy, confidentiality and safety
• Use of snowball and peers to reach their contacts
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Therefore, all pregnant women and their partners should
be offered HTS through a PITC model.
3.8. Men
There are fewer men than women who have taken an
HIV test in Uganda23 and men usually have taken an HIV
test when they are already symptomatic with AIDS. As
a consequence, men are more likely to start ART at later
stages of HIV infection and experience higher morbidity
and mortality after starting ART. This low uptake
compromises the impact of proven HIV prevention
interventions, including SMC and treatment for prevention
among men24. The reasons for the low uptake of HTS
among men may include fear, stigma, the perception that
health facilities are “female” spaces and both the direct
costs and the opportunity costs of accessing services.
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spend most of their time at the work place and hence are
unable to seek conventional HTS in health facilities. HTS
providers should adhere to the 5Cs while providing HTS
at the work place.
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vulnerable populations should always be voluntary
and additional effort must be taken to ensure informed
consent25.
25 UNHCR. (2009). Policy Statement on HIV Testing and Counselling in Health Facilities for
Refugees, Internally Displaced Persons and other Persons of Concern to UNHCR. UNHCR/WHO/
UNDP.
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Policy Objective:
To ensure that HTS are provided in a respectful, non-
discriminatory and ethical manner reflecting professional
integrity of the provider and respecting the human rights
of the person being tested.
Policy Statements:
a) All persons shall have the right to access quality HTS
irrespective of race, gender, ethnicity, disability, socio-
economic and political status.
b) All persons should consent to HTS. In situations where
consent cannot be obtained from the client, the next of
kin, guardian/parent or other authorised persons shall
provide consent on behalf of the client.
c) Clear and accurate information, education and
communication shall be provided to all persons
seeking HTS through pre and post-test counselling to
enable one make appropriate decisions related to HIV
testing.
d) Confidentiality shall be maintained in the process of
providing HTS services. Confidentiality may only be
broken with the CONSENT of and in the best interest
of the individual.
e) Disclosure of a client’s HIV status shall follow the
standard guidelines
f) HTS providers MUST ensure that the test results
provided to the client are correct
g) All persons accessing HIV counselling and testing
shall have the right to be linked to appropriate health
services
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4.1. Human Rights
Access to HTS
HTS should be designed to address the unique needs of
all persons including priority populations. HIV testing
services should be designed to minimize barriers which
make them inaccessible to some population groups.
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HTS providers should ensure no stigma and discrimination
during delivery of HIV testing services. Service providers
should ensure privacy and protection of clients from
discrimination due to perceived or confirmed HIV status.
Persons who test HIV positive shall not be discriminated
against directly or indirectly on the basis of their HIV
positive test results. For instance, HIV testing shall not
be required at the time of recruitment, as a condition for
continued employment or for insurance purposes unless
authorized by a legal body or justified as part of ethical or
professional standards
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4.2. Consent for HTS
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o Persons who have committed sexual offences
o Individuals to be initiated on Post Exposure
Prophylaxis
o Donors of blood, body tissue and organs
However, service providers MUST ensure that the
individuals under this category understand the purpose
of their testing.
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symptomatic and when the child’s history relates to HIV
exposure.
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Special Guidance
Situation
Mental • Since mental health patients have
health cognitive disability, consent should be
patients obtained from the next of kin, guardian
or authorized person.
• Patients/clients with temporary mental
impairment e.g. under influence of drugs
or alcohol are unable to give informed
consent. Therefore the service provider
should not offer the test. HIV testing is
not an emergency. However where the
service provider deems it necessary,
he/she should make a decision to test
for HIV at their discretion for the benefit
of the patient.
Persons with • The health facility should provide
hearing/ for sign language services through
speech appropriate training of staff or
disability collaboration and referral for sign
language services.
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Special Guidance
Situation
Post-exposure • In case of occupational and non-
prophylaxis occupational exposure, the source
person shall be tested without requiring
consent
• For the exposed person, HIV testing
for post exposure prophylaxis shall be
done using the HTS protocol
Blood and HIV testing should be done as part of the
other tissue donation process. Donors however shall be
donors given an opportunity to know their results.
4.3. Counselling
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o Client-centered information tailored to the
behavior, circumstances and special needs of
the person to be tested
o Personalized risk assessment
o Possible results and how to handle the situation to
reduce transmission; and
o Benefits of HIV testing
o The services available in case of an HIV-positive
diagnosis, including where ART is provided
o A brief description of prevention options and
encouragement of partner testing for sexually active
individuals
o The fact that the test result and any information
shared by the client is confidential
o The fact that the client has the right to refuse to be
tested and that declining to test will not affect the
client’s access to HIV-related services or general
medical care
o Potential risks of testing to the client in settings
where there are legal implications for those who
test positive and/or for those whose sexual or other
behavior is stigmatized
o Such other relevant information as the counselor
may deem necessary
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o Continuing necessity of taking protective measures
to avoid contracting HIV
o People with significant ongoing risk may need
more active support and linkage to HIV prevention
services.
o Emphasis on the importance of knowing the status
of the sexual partner(s) and information about the
availability of partner and couples testing services;
• Referral and linkage to relevant HIV prevention
services, including voluntary male circumcision
o SMC for HIV-negative men, PEP, PrEP for people at
substantial ongoing HIV risk;
o The need for retesting based on the client’s level of
recent exposure and/or ongoing risk of exposure
(see next section);
o Opportunity for the client to ask questions and
request counseling
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o Such other information as the counselor may deem
necessary.
4.4 Confidentiality
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All information discussed with the client during the
process of providing HIV Testing Services should not be
disclosed to anyone else without the CONSENT of the
client.
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Disclosure of a Client’s test results to other persons.
The results of an HIV test may be disclosed to;
• Parent or guardian of a minor
• Parent or guardian of a person of unsound mind
• A legal administrator or guardian with written consent
of the person tested
• A qualified /certified medical practitioner and
counsellor of the individual, where the HIV status is
clinically relevant
• A person authorized by the HIV prevention and
Control Act or any other law; or any other person as
may be authorized by a court e.g. in the context of
defilement or rape
• Any person exposed to blood or body fluids of a person
tested.
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years, the health worker should provide on-going support
to the process until the child is ready to be disclosed to.
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4.5 Correct Results
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HIV Testing Services shall not be complete unless
individuals are appropriately linked to HIV Prevention,
care, treatment and support services. HTS providers
should ensure that all persons diagnosed with HIV are
effectively linked and referred to appropriate prevention,
treatment, care and support services.
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5.0 Social Behaviour Change
Communication (SBCC) for HTS
Social Behaviour Change Communication (SBCC) is a
process where communication is used to influence people’s
knowledge, attitudes, skills and practices (behaviour).
SBCC is conducted at individual, interpersonal,
community and national levels. SBCC involves providing
information to empower individuals and communities to
make desirable health decisions and practices. SBCC is
integral in the successful implementation of HTS. SBCC
supports identification of determinants of HTS uptake;
influences risk perception; and adoption of risk reduction
behaviours. The SBCC process includes: situational
analysis, design, implementation, monitoring, Evaluation
and learning
Policy statements
1. SBCC interventions shall be integrated into the HTS
programs for implementation and sustainability at
all levels
2. SBCC interventions shall be evidence-based so as
to target the right population and place
3. SBCC interventions shall empower the community
with knowledge and skills to take appropriate
action to seek and utilize HTS.
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5.1 SBCC Integration in HTS Cascade
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HTS Relevant Messages to Responsible
Cascade be emphasized Human
Resource
During The Flow/ process of Health
Health HTS. (Every site/point worker
Education offering HTS should have
a flow-chart indicating
the flow of HTS. Within
the facility as well as
community (during
the testing days) clear
signs/posters/printed
information that direct
clients to areas designated
for counselling and testing
should be visibly displayed.
Directions to designated
areas can also be provided
verbally during education
session).
During Benefits of testing, Counsellor/
Pre-test individual risk Lay provider
Counselling assessment, meaning
and and implications of
Information test results, available
giving support systems based
on test results and
preparing one to make
an informed decision to
test
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HTS Relevant Messages to Responsible
Cascade be emphasized Human
Resource
During How the testing will Tester
testing be done, how long it
will take and what will
happen after the results
are out.
During Test results and their Counsellor /
Post-test implications, risk Lay Provider
Counselling reduction options,
importance of
disclosure, available
services for the HIV
positive, coping
strategies, referral and
appropriate behaviour
change
Linkage into Importance of linkage, Counsellor
Prevention, available referral points / Lay
Care, and services and client Provider/
Treatment choice Linkage
and support Facilitator
services
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5.2 Communication and Mobilisation for
HTS
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Relevant stakeholders within the SBCC arena should
review SBCC materials and tools to ensure that they cater
for local contexts and target audiences.HTS Implementers
should submit SBCC materials and tools to the national
technical working group for review and approval by the
health promotion and Education Division of MOH before
implementation.
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5.3 Demand creation
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HTS, SBCC partners should innovate, learn document and
share results for replication.
Policy Objective:
• To standardize delivery of high quality and
population specific HTS at facility and community
settings.
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Policy Statements:
a) A mix of facility and community-based approaches
shall be used to provide HTS
b) Facility based HIV testing services shall be provided
at various service points within the facility as part of
routine service delivery.
c) HIV testing services in community settings shall be
offered following a targeted approach especially for
priority populations who are less likely to attend
facility based HTS.
d) HTS services shall be incorporated in all health
related plans and programs and therefore be an
integral component of all routine health care services
e) Voluntary HIV Counselling and Testing shall be
provided on a client’s request.
f) Provider Initiated HIV Counselling and Testing shall
be provided by a health worker as part of routine
preventive services, clinical management and care.
g) Mandatory and Diagnostic HIV testing shall be
considered under special circumstances.
h) HTS service providers shall adhere to the nationally
approved HTS protocol for adults and children as
per the various approaches and models.
i) All HTS delivery approaches and models shall
adhere to the principles of Consent, Confidentiality,
Counselling, Correct Test Results and Connection
j) The National recommended HTS algorithm shall be
used to guide the performance of HIV tests using
either rapid or DNA PCR tests in both public and
private sites.
k) MOH shall ensure periodic evaluations of HIV test
kits and test algorithms
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l) Repeat testing shall be conducted in specified
circumstances to rule out laboratory or transcription
error and either to rule in or rule out sero-conversion.
m) HIV re-testing shall be done based on client’s level of
recent exposure and or ongoing risk of exposure.
n) All individuals newly and previously diagnosed
with HIV shall be re-tested before ART initiation.
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and existing facilities and testing points/sites where HTS
is carried out will be assessed to ensure they conform to
acceptable standards and thereby be certified (See section
11.7for details). The two main approaches to HTS delivery
shall remains voluntary counselling and testing (VCT)
sometimes called Client initiated counselling and testing
(CICT) and provider initiated Counselling and testing
(PITC). In Uganda, the HTS cascade shall follow the steps
depicted in the figure 2below;
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Figure 2: The HTS Process/Journey
Facility
HTS Entry Point
Community
VCT/CICT
HTS Approach
PITC
Pre-test
Counselling/
Information
giving
Post test
Counselling
Prevention
Linkage & Services
Referral
Care, Treatment
& support
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6.1.1 HTS at health facilities
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health facilities regardless of the reasons for the clinic visit.
The health worker should provide adequate information
to the patients about the benefits of testing to enable them
make an informed decision to test.
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the patient or attendant should be given an opportunity
to know his/her status to promote adherence; prevent
further transmission and enhance psychosocial support
for the patient.
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HTS at community level should be offered in various ways
as listed below:
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Door-to-door testing may be implemented ONLY in
high HIV prevalence settings or communities for key
populations such as the fisher folk, hotspots for Sex work
or through the snow-ball approach to Sex workers and
Men who have sex with Men.
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HTS at the work place should majorly aim to reach more
men.
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promptly linked to a facility for further HIV testing, where
the validated national testing algorithm is performed. See
figure 3 below;
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Integration of HTS into other health programs is critical
for sustainability, minimizing missed opportunities for
HTS, reducing HIV-related stigma and discrimination,
improving utilization of services and enhancing
convenience for clients. It also enhances program
effectiveness and efficiency.
HTS should continue to be integrated into the health
services delivery systems in a manner that facilitates
access and increases impact. Effective HTS programming
practices can improve the quality and efficiency of HTS in
some settings and these include:
• Integration of HTS into other health services
• Decentralization of HTS to primary health-care
facilities and outside the traditional health care system
(for example, workplaces, places of worship)
• Task sharing of HTS responsibilities to increase the
role of trained lay providers
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HTS services should be an integral component of all
routine health care services. For sustainability, HTS
interventions shall be incorporated in all health related
plans and programs.
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Figure 4: HIV/TB testing and Screening Algorithm in
HTS
Initiate Consider
Provide
TB TB Link to Post-test
treatment preventive TB counselling
and ART therapy & Treatment
ART
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Key approaches for TB/HTS integration should include
the following:
• Active promotion of HTS among TB clients through
the distribution of information materials and health
education talks by HTS counsellors at the OPD and
in the waiting rooms of the TB clinic.
• Health workers should routinely offer HTS to all TB
patients, their family members and other contacts as
standard of care during individual consultations.
• On site HTS should be introduced at TB clinics and
routine screening of all clients with presumptive and
diagnosed TB should be done. Partners of known
HIV-positive TB patients should be offered voluntary
HTS with support for mutual disclosure.
• Clinical assessments for TB among HTS clients who
test HIV positive should be conducted.
• Suspected TB patients should be referred to the TB
clinic for additional assessments.
• Health workers and community service providers
should be trained onthe integrated approach.
• Clients with presumptive and diagnosed TB should
be encouraged to refer their partners for HTS.
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Therefore all women attending ANC should be routinely
screened for both syphilis and HIV.
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HIV-positive and HIV-negative clients; HTS information
should also be offered at all FP settings.
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PITC should be offered as part of the MNCH care package
to all pregnant and breastfeeding women.
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other locations. Providing HIV testing in places closer to
people’s homes reduces transportation costs and waiting
time experienced in health facilities hence increase uptake
of HTS. Decentralization of services, however, may not
always be appropriate or acceptable to potential users.
In some settings centralized HIV testing services may
provide greater anonymity than neighborhood HTS
especially for key populations or others who fear stigma
and discrimination. In some low prevalence settings,
decentralizing HTS may be inefficient and costly.
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priority groups. It is not simply a means to save resources
but rather one valuable tool to improve access to, coverage
and quality of services.
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and SOPs, and be involved in regular external quality
assessment (EQA).
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Good Practices in HTS Programming
This policy and guidelines adopts good practices identified
and documented globally, regionally and nationally to ensure
effective HTS programming and delivery. These include
initiatives and innovations that prove relevant, efficient, cost-
effective, and sustainable and add value to the realization
of the goals and objectives of this policy. Identified good
practices include;
Integration of HTS with other health services especially
MNCH, STI, TB and general medical care
Expansion/scale-up of HTS to public and private health
facilities under the Public-Private Partnership (PPP)
and outside the health facility (for example, workplaces,
educational establishments like schools, places of worship)
Task shifting and task sharing to trained and supervised
lay providers, counselors, social and development
workers, and teachers
Targeting individuals and couples in most need of HTS
classified as priority populations
Target setting for the HTS program
Using data to improve HTS programming.
Use of peer-led HTS innovations for HTS delivery in
adolescent/youth, PWDs and Key Populations
Capacity strengthening for HTS providers through Pre-
service training and in-service training, mentorships and
Coaching, and peer and group supportive supervision
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Key Populations
Access to HTS for key populations should be prioritized.
Key populations continue to be disproportionately affected
by HIV in all settings. In 2013 there were an estimated
2 million new HIV infections worldwide. Of these, an
estimated 40% occurred among key populations. Within
key populations, adolescents (10–19 years old) and young
people (15–24 years old) are at greater risk for acquiring
HIV. The estimated HIV testing coverage among key
populations in Uganda remains low and data on HIV
testing coverage collected for key populations is based
on small samples from a limited number of settings. In all
settings people from key populations are less likely than
the general population to link to HIV services in a timely
manner because their behaviour is criminalized and they
experience stigma and discrimination.
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Mobile clinics: HTS is offered in mobile Vans at hotspots
for Key populations especially Sex Workers and men who
have sex with men (MSMs)
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6.4 The HIV Testing Services Protocol
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which the test results are given. Clients are then linked
to care, treatment and prevention services as appropriate
depending on the test result. Follow-up support is then
provided which may be available at the HTS site in the
form of post-test clubs or on-going counselling. Clients
should be referred elsewhere for further care and support
where these services are not available.(Figure 5 below).
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Figure 5: The HTS Protocol
Client registration
Consent obtained
Provide counselling
and encourage testing
Obtain sample and carryout the test
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Client registration
Clients should register with their names to enable
appropriate referral and linkage to services. All HTS sites
must ensure confidentiality of client information. Where
HTS is provided in health facilities, HTS clients may
register like other patients at the outpatient department to
avoid being stigmatized.
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During pre-test counselling of a couple, the counsellor
should ensure that the couple understands the importance
of receiving results together. Similarly, people in
polygamous marriages/relationships should be given
options to bring their partners for HTS. Pre-test counselling
should include;
• Benefits of knowing one’s HIV status
• Benefits of couple HIV counselling and testing
• An explanation of the HIV testing process
• The meaning of an HIV-positive and an HIV-
negative diagnosis
• The need for consent for an HIV test
• A summarised version of HIV risk assessment and
risk reduction
• A brief description of prevention options and
encouragement of partner testing
• Importance of disclosure including mutual
disclosure
• The need for referral and linkage to prevention,
treatment, care and support
• The services available in the case of an HIV-positive
diagnosis, including where ART is provided
• The potential for incorrect results if a person already
on ART is tested
• The fact that the test result and any information
shared by the client is confidential
• The fact that the client has the right to opt out of the
testing and that declining testing will not affect the
client’s access to HIV-related services or general
medical care
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• The potential risks of testing to the client in settings
where there are legal implications for those whose
sexual or other behavior is stigmatized
• An opportunity to ask the provider questions.
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session should make it clear that both testing and post-test
counseling can be provided individually, if either partner
prefers it that way, and then the couple is supported to
disclose to each other.
Post-test counselling
Post-test counselling will be offered as a discussion
between a provider and a client(s) with the aim of
informing the client of their HIV results and assisting
them to cope with the results. The results of the HIV test
will determine the counselling messages to be given to
the client. Confidentiality and privacy should be observed
during result giving. Under no circumstances should
results be given in a group and the results should be given
to clients in written form.
For PITC, if the client is too ill or unconscious; the
provider should to wait until it is appropriate to give the
results or consider giving them to the next of kin who is
appropriately identified.
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pre-test counselling and testing separately, the service
provider should reinforce the benefits of and support the
disclosure of test results to the spouse or sexual partner.
The minimum package for post-test counselling should
include;
• Assessing the client’s readiness to receive test result
• Giving the test results clearly, without ambiguity
• Assessing the client’s understanding of the test
result and its implications
• Making on-going plans for risk reduction, partner
notification and testing
• Making arrangement for follow-up support
• Making plans for involving significant others and
disclosure
• Referral and linkage to prevention, treatment, care
and support
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readjustment caused by the shock of knowing their HIV
positive status.
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• Assess the risk of suicide, depression and other mental
health consequences of a diagnosis of HIV infection.
• Provide additional referrals for prevention, counseling,
support and other services as appropriate (for
example, TB diagnosis and treatment, prophylaxis for
opportunistic infections, STI screening and treatment,
contraception, ANC, risk reduction plans, and sexuality
counseling.
• Encourage and provide time for the client to ask
additional questions.
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results may be difficult for the provider to explain and
for the couple to accept. There may be need to engage
an experienced counselor and clinician and be attached
to discordant couples’ support groups. HTS providers
should, as much as possible adhere to the protocol for
discordance counseling.
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in which infection happened and the developmental
age of the individual
• Information on adolescents’ rights and responsibilities,
especially their right to confidentiality and health care
• An opportunity to ask questions and discuss issues
related to sexuality and the challenges they may
encounter in relationships, marriage and childbearing
• Individualized planning on how, when and to whom
to disclose HIV status and engage families and peers in
providing support
• Referral for small-group counseling and structured
peer support groups, which may particularly benefit
adolescents with HIV
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• An opportunity for the client to ask questions and
request for further counseling
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6.5 Counselling in HTS
Counselling is a core principle in the provision of HTS.
Counselling is central in ensuring that HTS adheres to the
human rights; is provided with utmost privacy and respect
to ensure confidentiality; testing processes are monitored
for quality to ensure correct test results are given and
referral and linkage is done to ensure clients are linked to
further care as per their HIV test results. This sub-section
describes how counselling should be provided across the
HTS continuum.
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As far as possible, the child should be involved in the
decision, along with the parent or guardian. For children
who cannot clearly understand the results, the parent or
guardian should be fully involved and should sign the
consent.
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Counselling Children for disclosure
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Disclosure of HIV Status amongst Couples & sexual
partner(s)
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6.6.1 Diagnostics for HIV
All HIV testing should be performed in accordance
with the assay manufacturer’s instructions. In addition,
SOPs and job aids should be developed that help testing
providers to minimize testing and reporting errors and
improving the quality of the testing results.
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Venous whole blood: Whole blood freshly collected by
vein-puncture. The specimen should be subjected to
testing immediately.
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Dried blood spot (DBS): Venous or capillary whole
blood is applied to a filter paper by hanging drop or
microcapillary. Whole blood is later eluted from the filter
paper and used for the test procedure.
The collected blood sample on the DBS can be store at 4 °C
for up to 3 months, at –20 °C for longer.
The use of specific assays with DBS should be validated
by the manufacturer. When the manufacturer has not
validated their assay for DBS, the use of DBS is considered
“off-label”, or unauthorized for returning medical results.
Handling specimens
Universal precautions should be observed during specimen
handling. Standard operating procedures should be
followed to ensure that accurate test results are obtained.
Guidelines for sample referral and transportation should
be followed.
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A. Screening test: Alere Determine HIV 1/2
B. Confirmatory test: Stat-Pak
C. Tie-Breaker: SD Bio line
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The Nationally approved Algorithm for HIV testing in Uganda is as follows:
A. Screening test: Alere Determine HIV 1/2
B. Confirmatory test: Stat-Pak
C. Tie-Breaker: SD Bio line
Figure Figure
6 below shows Uganda’s
6: Serial HIVserial testing
Testing Algorithm. for testing
Algorithm
persons above 18 months of age in Uganda, 2016
Figure 6: Serial HIV Testing Algorithm for testing persons above 18 months of age in
Uganda, 2016
Screening Test
Screening Test
DETERMINE
Non-Reactive
Non-Reactive Reactive
Reactive
Non-Reactive Reactive
Non-Reactive Reactive
Tie-Breaker Test Report HIV
SD BIOLINE Positive
Report HIV
Non-Reactive Report as Reactive
Negative Inconclusive
Re- test at 14 days
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Algorithm for testing infants below 18 months of age
Serological tests: Serological tests (Antibody tests) do not
determine HIV status in this age group. This is because the
test may detect antibodies that might have been passed
from the mother through the placenta to the infant.
Therefore a positive serological test may only tell you that
the child has been exposed to HIV, rather than that the
child is HIV-infected. These babies should be enrolled at
the Mother – baby care point (MBCP) and should undergo
the Virological HIV testing process for HIV exposed
infants.
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Virological testing using nucleic acid testing (NAT)
technologies should be conducted using dried blood spot
(DBS) specimens.
A POSITIVE virological test result for a child aged 6
weeks – under 18 months will confirm that the child is HIV
infected. The following procedures should be followed to
diagnose HIV in infants:
• The 1st DNA – PCR test should be done at 6 weeks of
age to diagnose HIV infection among infants infected
during pregnancy and delivery.
• A 2nd DNA – PCR test should be done 6 weeks after
cessation of breastfeeding to diagnose HIV infection
among infants who may not have been infected
during pregnancy and delivery but got infected
during breastfeeding.
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Figure 7: HIV Testing Algorithm for children <18months
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Figure 7: HIV Testing Algorithm for children <18months
There is need to pro-actively look for infants whose mothers
never attended PMTCT services through the routine offer
of PITC in child health services, immunization clinics,
under-5 clinics, malnutrition services, well-child services
and services for hospitalized and all sick children, TB
clinics, and services for orphans and vulnerable children
and testing the family members of index clients to identify
HIV-exposed infants.
6.7.1 Re-testing
Most persons do not require a re-testing to validate an
HIV negative result. However, it is important to identify
individuals who truly require retesting. Retesting should
be done on a second specimen from the same individual
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using the same testing algorithm after a specified period
or in case of observed exposure.
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Table 2: Populations eligible for re-testing
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Retesting before initiating ART
In 2016, Uganda adopted the ‘test and treat’ strategy for all
HIV positive individuals.
Re-testing for individuals starting ART is thus critical in
ensuring that HTS reduces the risk of misdiagnosis of
HIV status and ensure that individuals are not needlessly
placed on life-long ART with potential side-effects, waste
of resources, and made to suffer psychological impact of
misdiagnosis.
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to increase access to and uptake of HIV testing services,
particularly among individuals who may not otherwise
test. In Uganda, however, the degree of acceptability
for HIVST is not yet known since such studies are still
ongoing. Evidence from these will inform scale-up and the
HTS program in general.
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7.0 Linkage to Prevention, Care,
Treatment and Support Services
The second 90’ in the UNAIDS fast-track targets of 90-
90-90 by the year 2020 is “linkage of 90% of HIV positive
individuals to treatment’. Without effective strategies that
ensure linkage and enrolment in care, the effect of HTS
in reducing HIV transmission, morbidity and mortality
cannot be fully realized.It is therefore the mandate of
the HTS program to ensure identification and linkage
of HIV positive individuals to care, treatment, support
and prevention services. The success of linkage shall be
measured by enrolment into care and not by intermediary
process indicators such as the number of referral cards
issued. This section therefore provides guidance to HTS
providers to ensure successful linkage of all HIV positive
individuals identified. It emphasizes the critical role of
Linkage Facilitators as well as strategies to track intra-
facility, inter-facility and community to facility linkages.
Policy Statements
a) Inter and intra facility networking and collaborations
should be promoted for effective linkages of clients.
b) All HTS service points should have a regularly updated
referral directory of community and institutional
prevention, care and support services.
c) HTS providers should link all HIV positive individuals
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to prevention, treatment, care and support.
d) HTS providers should refer HIV Negative persons to
appropriate HIV prevention services
e) All HTS providers should designate personnel to work
as Linkage Facilitators
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Steps involved in linking an HIV positive client to care
• Provide client with adequate information about HIV
and AIDS care and treatment services available.
Provide the client with a number of facilities to choose
from as his/her preferred choice.
• Discuss the Pros and cons for each option for the client
to make an informed decision. Remember the journey
to good treatment adherence starts with proper and
appropriate linkage to care
• After the client has chosen the facility, complete the
HCT Client result slip and the triplicate referral form
indicating the facility the client has been referred to.
• Remember to record the clients’ contact information on
the triplicate referral form for easy tracking and follow
up.
• Record in the HCT register column 20 where the client
has been referred.
• Tell the client the exact location of the care clinic in the
facility of referral as well as the clinic days.
• If the client prefers to receive care from your facility,
hand over the client to the Linkage Facilitator who
should escort and hand over the client to the service
provider in the care clinic. Clients should be handed
over to care and prevention points together with the
linkage and referral documentation forms
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Figure 8: Intra-Facility Linkage- How does an HIV+
client travel through the facility?
ENTRY POINT
Registration
Group Education
Pre-test Counseling
HCT Register/ HCT
Card
Testing Point/
Laboratory
HCT Log
Post - test
Counseling
Client Results Slip
Is there care at
Home this Facility?
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Table 3: Description of Flow Chart
1. Client arrives 2. The Client is 3. The test
at the facility counselled is performed
with unknown by the service and results
status. provider at sent back to the
the entry Counselling
point. The point
service
provider
performs the
HIV test or
sends client
to the testing
point (Lab).
Activities for the Activities for Activities for the
HCW: the HCW: HCW:
─ Provide ─ Fill out HTS ─ Perform HIV
pre-test client card test correctly
information ─ Record in daily
giving through consumption
health talk log for test kits
─ As part of ─ Record result
history taking, on HTS card
establish
Client’s HIV
status
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4. The Service 5.The HIV 6. Further
provider positive client Counselling,
provides post- is escorted to appointment
testcounselling the HIV clinic giving and
for the positive with the referral treatment is
client and forms in the given at the
provides referral facility and ART clinic
and linkage enrolled in care
information on the same day
Activities for the Activities for Activities for the
HCW: the HCW: HCW:
─ Provide results ─ Linkage ─ Completing
accurately Facilitator pre-ART
─ Provide should escort register
information client to ART ─ Opening client
oncare clinic file
available at ─ Hand ─ Pre-ART
the facility client to Counselling
and elsewhere responsible ─ Baseline
inthe staff investigations
catchment area ─ Ensure client ─ Appointment
─ Complete the is enrolled setting
client card and on the
include referral same day
notes of linkage/
─ Complete referral
the triplicate
referral form
7. Use the linkage data to review and monitor the
indicator performance periodically
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7.2 Tracking Inter-Facility Linkage after
Referral
Follow up should begin one week after referral has been
done. A client should have reached and been enrolled in
care within 30 days of referral. The purpose of tracking
(follow up) is therefore to establish which clients have
been linked and which ones have not. Follow up using
phones or home visits should be done for those not linked.
Follow up should check for the following;
• If the client reached the facility/clinic
• If the client received the services
• If the services provided served the purpose for
which the referral was made
Timeline Action
Day of Client diagnosed HIV positive and
Linkage referred to preferred facility
Linkage Facilitator documents clients
contacts
Linkage facilitator obtains clients consent
for home visiting Linkage facilitator
introduces client to Community Health
worker
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Week 1 Linkage Facilitator calls Client or Facility
X contact where the client was referred.
If client reached, document complete
linkage.
Week 2 If the client didn’t reach the facility by
week 1, the Community Health Worker
(VHT) visits Client’s home to remind
him/her about the referral
Week 3 Linkage Facilitator calls Client or Facility
X contact. This helps to confirm if the
VHT visit to client’s home made any
impact. If client reached, document
complete linkage.
If client didn’t reach, Linkage Facilitator
visits client’s home to discuss reasons
for the clients failure to reach the referral
point
Week 4 Linkage Facilitator calls Client or Facility
X to confirm if client reached. If yes,
document linkage as complete. If no,
document as Lost
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4. Physical home visits by both Community health
workers (VHT) and Facility based health workers
(Linkage Facilitator).
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Quality Improvement (CQI) should be done.
Appropriate information about services to which the
client is referred for and linked to should be provided;
mechanisms for documentation, feedback and monitoring
should be established.
SMC
Home- ART
based care PMTCT
Blood
donation
Family Planning
Nutrition HTS
Psycho-social
support
STI management
OI
Paediatric Management
care OVC
TB/HIV
services
care
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7.4 Good practices to increase linkage to HIV
care
Uganda has adopted the ‘test and treat’ strategy for all
individuals testing HIV positive. Hence, same day linkage
to HIV care and treatment should be prioritized. It is noted
that some people may not be linked to care and treatment
immediately due to social, psychological and clinical
reasons. Often, people need time to accept the diagnosis
and seek support from partners and families before being
linked to care. ;
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• Support and involvement of trained lay providers
who are peers and act as Linkage Facilitators, expert
patients/clients and community outreach workers
to provide support and find people who are lost to
follow-up.
• Intensified post-test counseling by both facility and
community health workers
• Provision of brief strengths-based case management
which emphasizes people’s self-determination and
strengths, is client-led and focuses on future outcomes,
helps clients set and accomplish goals, establishes good
working relationships among the client, and the health
worker and other sources of support in the community,
and provides services outside of office settings
• Using communication technologies, such as mobile
phones and text messaging, which may help with
disclosure, adherence and retention particularly for
adolescents and young people
• Promoting partner testing may increase rates of HIV
testing and linkage to care, as may approaches in
PMTCT settings that encourage male involvement
• Intimate partner notification by the provider, with
permission, is feasible in some settings; it identifies
more HIV-positive people and promotes their early
linkage to care
• Decentralized and community-based distribution of
ART
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7.5 Linkage for HIV Positive individuals
With the test and treat strategy, all individuals who test
HIV positive should immediately be initiated on treatment.
Where this is not possible, linkage should be effected
within 7 days after diagnosis for intra-facility linkage. For
linkage across facilities (inter-facility), a client should be
followed up within 30 days of HIV diagnosis for linkage
to be successful.
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in settings of high HIV incidence, key populations and
negative partners in sero-discordant couples.
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• Linking HIV positive individuals to care and
treatment both within and across facilities
• Peer to peer education and counselling
• Follow up of clients referred to other facilities
• Client follow up in the community
• Drug adherence counselling and monitoring
• Reporting
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providers and the services provided
• Keeping a record of clients to follow up and potential
clients in catchment area
• Keeping a record of other linkage facilitators in the
catchment area
• Actively following up clients in the community
• Gathering client’s concerns and preferences and
giving feedback to providers
• Preparing monthly reports
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8.0 HTS Health Systems
requirements
In order to increase access, meet the 5 Cs, and ensure
quality, HTS should be offered within a functional health
system. The following elements will especially be critical
in achieving this; committed leadership and governance,
qualified Human Resources for Health, clear financing
mechanisms, infrastructure, a functional procurement and
supply chain management system and a clear Monitoring
and Evaluation plan.
Policy Statements:
a. Governance and coordination of HTS under the multi-
sectoral approach remains the responsibility of the
Uganda AIDS Commission (UAC)
b. Overall technical leadership for HTS shall be the
mandate of MOH with delegated functions along the
decentralized health system.
c. HTS shall be offered under infrastructure which
ensures privacy and confidentiality during counselling;
physical accessibility for all; safety of the provider,
client and community and appropriate storage of HTS
supplies and commodities.
d. MoH shall maintain a functional procurement and
supply chain management system to ensure a
sustained delivery of HIV testing services through
forecasting, quantification, monitoring stocks, and
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timely ordering of adequate and quality HTS supplies
and commodities at all levels
e. It shall be the mandate of the MoH to mobilize resources
to finance HTS and ensure universal access to quality
HTS through provision of affordable services by both
public and private health facilities.
f. HTS shall be offered by trained and certified providers
including Lay Providers, counsellors, laboratory
personnel, medical workers, data managers and
logistics managers.
g. Training of HTS providers shall be conducted by
accredited HTS Training Institutions using MOH
approved curricula
h. Monitoring and evaluation of HTS will be conducted
in line with the National Monitoring and Evaluation
Framework for HIV/AIDS in the health sector.
i. The MoH shall ensure availability of a functional HIMS
for HTS and all HTS implementers shall adhere to
standardised mechanisms for data collection, storage,
analysis, and reporting
j. Quality Assurance shall be an in-built component of
the HTS cascade. All facilities will offer HTS as per
the set standards, implement quality improvement
activities and carry out quality control activities to
ensure quality HTS
k. MOH shall guide HTS research to evaluate feasibility,
acceptability, quality and effectiveness of interventions
for evidence-based programming
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8.1 Leadership and Governance of HTS
Governance and coordination of HTS under the multi-
sectoral approach remains the responsibility of the
Uganda AIDS Commission (UAC)
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of HIV Testing Services. The ACP will fulfil this mandate
through a National HIV Testing Services Committee
(NHTSC) comprising of representation from key HTS
organisations and development partners who will advise
on the technical aspects of the HTS program.
8.1.2 Accountability
Accountability should focus on tracking how financial
resources and other inputs for provision of HTS translate
into service provision, uptake and impact on identifying
individuals living with HIV as per the triple 90 strategy.
The accountability mechanisms should engage key
stakeholders who finance HTS the beneficiaries and HTS
providers.
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be engaged to witness arrival of stocks as they are
delivered.
• Annual financial audits for HTS resources should be
conducted.
• Financial reports for HTS resources should be compiled
quarterly. Funds spent on salaries and motivation
of HTS providers should be included in financial
expenditures.
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to track utilization of HIV test kits and compilation of
monthly reports.
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8.2.2 Counselling space
HTS should be provided in designated, clean, well
ventilated areas with sufficient lighting and adequate
space for both the service provider and client. The
designated areas should be private to allow for confidential
discussions and sitting space for both the counsellor and
the client. At outreach sites, counselling may be conducted
in an open space such as under the tree but confidentiality
should be observed.
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management and distribution of HTS commodities within
the facility to avoid stock-out of test-kits at different testing
points.
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8.3.1 Stock monitoring and management of test
supplies
MoH shall ensure HTS commodity availability at all HTS
sites by utilizing the approved national warehousing
and commodity management systems. MoH approved
tools for stock management of laboratory reagents and
HIMS records shall be used by HTS programs to track
stock levels and consumption patterns of HTS supplies
and commodities. The use of both electronic and paper
based tools such as the stock cards should be enhanced.
Information generated shall be used for improvement of
HTS services delivery and ensuring that facilities always
have adequate stock of HTS supplies and commodities
within the required expiry dates.
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HTS supplies and commodities should be availed through
the approved National warehouses which shall distribute
to facilities through the district mechanisms.
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commodities. All HTS supplies and commodities should be
purchased centrally through approved MoH Warehouses
as stipulated in the supply chain rationalization of the time.
Each warehouse should ensure that the commodities are
stored and distributed to all facilities in accordance with
good manufacturing practice.
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8.4 Financing for HTS
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The site manager should determine whose fees should be
waived based on recommendation from the counsellor.
Free days may also be considered as a way of attracting
clients for whom a fee would represent a barrier to using
HTS.
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8.5 Human Resources for HTS
•HTS shall be offered by trained and certified providers
including Lay Providers, counselors, laboratory
personnel, medical workers, data managers and logistics
managers
•Training of HTS providers shall be conducted by
accredited HTS Training Institutions using MOH
approved curricula
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trained should provide these services under supervision
of a qualified and competent HTS provider.
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8.5.3 HTS Provider qualifications
HTS providers should have a minimum educational
background of at least ‘Ordinary level or its equivalent.
This applies equally to those with or without a medical
background.
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• Be oriented in the use of standardized HIV counselor
training courses approved by MOH.
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HTS providers shall be supervised on a quarterly basis
and the outcomes of supervision documented for follow
through.
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• Lay providers who have undergone a tailor-made three
weeks comprehensive HTS training using approved
curricula and certified by MoH.
• All the above should be regularly mentored and
supervised.
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Lay provider • Mobilize HTS clients and conduct
health talks.
• Conduct pre and posttest counseling
sessions.
• Perform rapid tests( under the
supervision)
• Support linkage of clients diagnosed
with HIV to care, treatment, prevention
and support services.
• Distribute condoms and IEC materials
to clients.
• Mobilize and sensitize, educate and
refer communities for HTS.
Facility • Oversee planning, staff deployment,
In-charge/ monitoring and evaluation of HTS
manager services.
• Ensure adequacy of supplies and
commodities for HTS.
• Ensure availability& use of the HTS
policy, SOPs and HMIS tools.
• Participate in supportive supervision.
• Work with the HTS focal person to
ensure quality HTS delivery.
• Communicate and monitor the HTS
performance targets
• Ensure availability of conducive space
for providing HTS
• Facilitate timely reporting for HTS and
commodities to the relevant offices.
• Provide regular feedback to staff on
HTS.
• File records of all HTS trained and
supervised/mentored staff.
HTS Focal See roles under section 12.0
person
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Laboratory in- • Ensure internal quality controls and
charge external quality assurance (QA) for HIV
testing, and perform QA audits and
Proficiency Testing corrective actions.
• Supervise HIV rapid testing at all
testing points and ensure accurate
documentation of HIV test results in the
log book
• Ensure availability and correct use of
HIV testing SOPs(testing algorithms
adult and infant, EID dispatch
books, HIV testing log book, waste
management and safety precautions)
• Conduct mentorship of HTS providers
on quality testing
• Ensure accountability for HTS
commodities (test kits, DBS
commodities, PT panels) management
• Liaise with the HTS focal person
to ensure timely reporting for
commodities consumption, and
accurate projection
• Ensure proper storage and management
of testing commodities in accordance
with the SOPs.
• Perform HIV ELISA tests
• Re-test all HIV positive samples before
clients are initiated on ART
• File all records for EQA-PT, QA audits,
internal quality controls, and HTS lab-
related training
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HTS • Ensure that HTS providers receive
supervisors/ regular debrief sessions to mitigate burn
Mentors and out in order to maintain quality HTS
trainers provision.
• Identify performance gaps and provide
mentorship and/or supervision to HTS
providers through one to one or group
sessions in the service delivery points.
• Build capacities for self and peer
supportive supervision among HTS
providers.
• Perform observed sit in sessions to
ensure adherence to HTS SOPs.
• Provide timely feedback to the HTS
providers on their performance
• Support continuous quality
improvement, and trainings
• Coach and health workers
• Provide technical support supervision
• Train HTS providers
• Participate in research related activities
Logistics • Accurately forecast the requirements for
management HTS supplies
officer • Collecting and using accurate supply
chain information,
• Storage, management and distribution
of HTS commodities.
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education pre-test information giving, task-sharing, work
scheduling and improved work habits should reduce on
felt workload.
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Information about HIV testing should be collected using
the Daily Activity register for recording HIV Test Kits
(HMIS 055A4)
8.6.3 Reporting
At Facility level: On a monthly basis, each health facility
should compile an HTS report which is part of the monthly
health facility report. The data should be summarized on
the monthly health unit report form (HMIS 105) and a
copy sent to the DHO and another copy retained at the
health facility. The monthly report is generated from the
HCT register.
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Figure 9: HTS data flow chart
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8.7 Quality Assurance and control for HTS
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8.7.2 Certification of HTS Providers and Site
accreditation
MOH in collaboration with other certifying and licensing
bodies shall establish and implement a certification and
accreditation system for HTS training institutions, HIV
testing sites/points (both public and private facilities) and
HTS providers. Sites that meet the accreditation criteria
shall be allowed to provide HIV testing training and
services. Sites which do not meet the minimum standards
required shall be supported to attain accreditation status
before they are allowed to provide HTS.
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• Availability of a functional Linkage system for both
HIV care and prevention services
• Current (External Quality Assurance) EQA
assessment (for existing sites)
The initial assessment should be used to plan for setting
up or improving provision of HTS.
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8.7.3 Quality assurance for Laboratory reagents and
test kits
Proactive post market surveillance must be conducted (to
identify any problems before use) through in country lot/
batch verification testing, before and after distribution of
test kits to testing sites according to set National guidelines.
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All testing sites shall be assessed bi annually using SPI-
RT checklist and certification awarded to those that meet
the desired criteria. Sites that do not meet certification
criteria shall be supported to bridge gaps identified during
assessment.
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Figure 10: Steps for post Market surveillance of WHO
prequalified Diagnostic kits
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8.7.5 Evaluation of test kits and other laboratory
reagents
MoH should conduct periodic evaluations and quality
assurance of HIV testing kits and reagents. Protocols for
quality standards for reagents should be developed, printed
and distributed regularly to all the facilities performing
HIV testing as per the manufacturer’s specifications for
the HIV test kits or reagents in use.
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• All sites offering HTS shall have well displayed SOPs
showing HTS indicators to be collected, indicator
definitions and sources of data.
• All sites offering HTS shall have well displayed SOPs
showing data flow from the point of collection to the
national level and stakeholders
• All sites offering HTS shall have secure storage of HTS
records. Access to patient records by unauthorized
persons shall not be encouraged so as to ensure
confidentiality of client information.
8.8 Research
MOH shall guide HTS research to evaluate feasibility,
acceptability, quality and effectiveness of interventions
for evidence-based programming
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All HTS research shall conform to the relevant legislation
and ethical standards of practice set by appropriate
research ethical committees and bodies of government at
various levels
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HIV diagnosis. This is particularly critical when test results
and an HIV status are reported back to an individual
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9.1 Collection and reporting systems for
periodic assessments
The MOH should conduct periodic assessments of HTS
in form of surveys or operations research or programme
evaluation. The protocol including structured and
standardized data collection tools for collecting and
analysing the information for this assessment shall be
developed by MoH.
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1. In accordance with the counselling guidelines for the
different populations and ages
2. As per the national HIV testing algorithms
3. Following the HIV testing SOPs
4. And accurately filing the HTS client card
5. And accurately filing the Daily HIV Testing Activity
register
6. And accurately filing the HTS register
7. Passing the QC tests
8. Passing the proficiency test
The MoH aims at achieving 90% in each of the above
indicators
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11.0 Policy Performance Indicators
The following Key HTS indicators shall be monitored to
ensure that the desired outcomes of the policy are realised;
At input level;
1. 90% of HTS providers trained and certified to offer
HTS
2. 90% of HTS points/sites certified annually to offer
HTS
3. Lay Providers trained and certified to offer HTS
At Process,
At Output/outcome indicators
1. 90% of HIV positive individuals identified
2. 90 % of HIV positive individuals identified linked
into care
3. Increased knowledge of HIV and AIDS
4. Increased adoption of safer sex behaviours
(reduction in multiple sexual partners, age at first
sex- using the UPHIA as baseline)
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12.0 Policy Implementation Framework
This section highlights the proposed framework for
ensuring implementation of the policy guidelines to
improve HIV testing services.
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• Coordination of ADPs funding to support HTS
priority areas
• Coordination of HTS partners
• Planning, policy formulation and setting standards
• Capacity building
• Advocacy and resource mobilisation
• Equitable distribution of HTS services across the
country
• Supplies and logistics management
• Quality assurance, monitoring and evaluation
• Research
At District level;
The District Health Officer (DHO) through the district
HTS Focal Person shall coordinate and ensure effective
implementation, supervision and monitoring of HTS
within the district.
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• Managing HTS supplies and logistics
• Data management and reporting about HTS in the
district
• Quality Assurance of HTS
• Ensure adequate supply of HTS supplies and
commodities
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• Reinforce adherence to and use of the HTS policy
and implementation guidelines during provision
of HTS
• Build capacity of HTS providers through training,
mentorship, and assessment for certification
• Implement, monitor and report HIV testing services
• Ensure HTS sites participate in EQA for HIV testing
through working with UVRI. IP should make sure
HIV testers and not just sites participate in EQA,
and feedback from UVRI to sites is prompt.
• Ensure sites are using all nationally approved data
collection tools and conduct quarterly DQA
• Ensure sites receive adequate support supervision
for both HIV testing and HIV counseling.
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Figure 11: National HTS Coordination structure
UAC NCTC
Lab &
MOH Top Logistics
Management
SBCC
National
STD/ACP Level
Cap.
Building
HTS Unit
Policy &
Research
QA & M&E
District Health
Office District
Level
District DLFP
HTS FP
HUB
Coordinator
HF I/C HTS
Delivery
Point
HF HTS FP
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13.0 Policy Review Plan
The National HTS Policy shall be reviewed every 5 years.
This is in alignment with the National HIV and AIDS
Strategic Planning process.
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14.0 References
1. MOH 2014, Minsterial Directive on Access to
Health Services without Discrimination
2. UAC 2015, 2014 Uganda HIV and AIDS Progress
Report
3. MOH 2012, Client Charter 2012/13-2014/15
4. MOH 2011, Monitoring and Evaluation Plan
for Heath Sector Strategic and Investment Plan
2010/11-2014/15
5. UAC 2015, The National HIV and AIDS
Monitoring and Evaluation Plan 2015/2016-
2019/2020
6. MOH 2011, Uganda HIV Counseling and Testing
Policy, 3rd Edition
7. UAC 2015, National HIV and AIDS Strategic Plan
2015/2016- 2019/2020
8. UAC 2015, National HIV and AIDS Priority
Action Plan 2015/2016-2017/2018
9. MOH 2010, National ABC Policy guidelines for
HIV/AIDS
10. MOH 2010, Safe Male Circumcision Policy
11. MOH 2011, Uganda Antiretroviral Therapy Policy
12. MOH 2011, Uganda National Malaria control
Policy
13. MOH 1999, National Health Policy
14. MOH 2011, The Integrated National Guidelines
on ART, PMTCT and Infant and Young Child
Feeding, 1st Edition
15. MOH 2013, Uganda National Infection Prevention
and Control Guidelines
16. UAC 2015, Lessons learned from the Uganda HIV
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and AIDS Country Response Progress Reporting ,
2015
17. MOH 2014, Addendum to the National
Antiretroviral Therapy Guidelines
18. MOH 2010, Health Sector Strategic and Investment
Plan 2010/11-2014/15
19. UAC 2015, Know your Epidemic, Know your
Response: Modes of HIV Transmission Study
20. MOH. (2006). Uganda HIV/AIDS Sero-
behavioural Survey, 2004-2005. MOH and ORC
Macro.
21. WHO 2015, Consolidated Guidelines on
HIV Testing: 5 Cs- Consent, Confidentiality,
Counseling, Correct Results and Connection
22. MOH 2016, Rapid Assessment Report of the
2010 HIV Counseling and Testing Policy and
Implementation Guidelines
23. UNHCR. (2009). Policy Statement on HIV Testing
and Counselling in Health Facilities for Refugees,
Internally Displaced Persons and other Persons of
Concern to UNHCR. UNHCR/WHO/UNDP.
24. WHO. (2010). Handbook for Improving HIV
Testing and Counselling Services. Field Test
Version. WHO.
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14.1 Annex 1. Policy Guidance for
development of HTS implementation
guidelines
These HTS implementation guidelines should operate
within the scope of the national, regional and international
polices; in alignment with national plans and harmony
with other MOH implementing guidelines.
International guidelines
• WHO Consolidated Guidelines for HIV Testing,
2015
• UNAIDS, 90*90*90 Fast Track Targets
• 65th UNGASS declaration to end the AIDS epidemic
as a public health threat by 2030
• The Sustainable Development Goals
Regional Guidelines
• The East African HIV Prevention and
Management Act 2012
National guidelines
• The Constitution of the Republic of Uganda
(3rdrevision, 15thFebruary 2006)
• The Penal Code, ACP 120.
• The Uganda HIV Prevention and Control Act(2014)
• The National Development Plan II(2016-2020)
• The National HIV and AIDS Strategic
Plan(2015/2016-2019/2020);
• The National HIV and AIDS Monitoring and
Evaluation Plan(2015/2016-2019/2020)
• The National HIV and AIDS Indicator
Handbook(2015/2016-2019/2020)
• The National HIV and AIDS Priority Action
Plan(2015/2016-201718)
• The National Health Policy(2010)
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• Uganda Adolescent Sexual Health and Development
Policy(2011)
• Ministerial Directive on Access to Health Services
without Discrimination (2014)
• The Uganda Patient’s Charter (2009)
• The National Integrated Antiretroviral Treatment
and Care Guidelines for Adults and Children 2009
• Addendum to the National Treatment Guidelines,
2014
• The National Policy Guidelines On Post Exposure
Prophylaxis For HIV, Hepatitis B And Hepatitis C,
2007
• The National Policy on Injection Safety and
Healthcare Waste Management
• Uganda Clinical Guidelines, 2003
• PMTCT Guidelines, September 2006
• National Infection Prevention and Control
Guidelines, 2004
• The Home based care policy guidelines
• The Uganda National Laboratory Policy, 2009
• Safe Male circumcision Policy, March 2010
• TB/HIV Collaboration policy
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14.2 Annex 2: Glossary of terms
Acute HIV Infection: Acute HIV infection is a highly
infectious phase of disease that lasts approximately
two months and is characterised by nonspecific
clinical symptoms. Acute HIV infection contributes
disproportionately to HIV transmission because it is
associated with a high viral load. HIV infection may not
be detected on antibody-based HIV tests only. Persons
who are in the phase of acute HIV infection often have flu-
like symptoms and may be core infectious than persons
with chronic HIV infection.
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Care-giver: Any person other than a parent or guardian
who care for a child, including a foster parent; a person who
cares for a child with the implied or express permission
consent of a parent or guardian or a person who cares for
someone who is ill.
Decentralization
Refers to the process of delegating or transferring
significant authority and resources from the central
ministry of health to other institutions or to field offices of
the ministry at other levels of the health system (regional,
district, health sub-district, primary health-care post and
the community)
Diagnostic sensitivity: This is defined as the percentage/
probability that an HIV test should correctly identify all
individuals who are infected with HIV as per used assay.
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all individuals that are not infected with HIV (true HIV-
negative).
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AIDS. It should therefore have a strong referral system
with other health services, and efforts should be made to
offer other related services such as AIDS care and support,
family planning and STD care in an integrated manner.
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Index Testing or index case HIV testing: A focused
approach to HIV testing in which the household and
family members (including children) of people diagnosed
with HIV are offered HIV testing services.
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recorded in the client’s file and signed by the client and
the health care worker.
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the National HIV Prevention strategy are: Sex Workers,
Fisher Folk, Long distance Truck drivers, men who have
sex with men (MSM), people in prisons and other closed
settings, boda-boda men and the Uniformed Personnel.
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workplaces, school establishments with a mechanism for
ongoing support services for HTS clients.
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quality HIV Testing services according to defined national
and international standards.
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transmission of HIV with the goal of getting the client to
assess their behaviour and reduce their risk of infection.
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tasks between cadres of health-care providers with longer
training and other cadres with shorter training, such as
trained lay health services providers.
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The policy and guidelines were developed with support from
the following partners:-
PEPFAR