According to UNAIDS, Nigeria has the second highest number of new infections reported each year. An estimated 3.6 per cent of the population aged 15-49 years are living with HIV. Even though the situation is dire, the uptake of HIV counselling and testing (HCT) remains low, especially in rural areas. This is mainly because the rural population has limited knowledge about HIV and AIDS and HCT facilities, are far and few.
Some of the towns in Cross River State such as Calabar South have a high prevalence rate of 7.1 per cent, which is above the national prevalence rate of 3.6 per cent. To increase the demand for HCT and other health services at community level, the Nigerian Red Cross Society in collaboration with the National Agency for the Control of AIDS (NACA) planned and implemented a community-based HCT in three local government areas of Cross River State - Calabar South, Boki and Yala.
Advocacy with community leaders and key decision makers in the target communities was carried out to introduce the project and ensure buy-in from the community. To show their support and consent, town criers announced the presence of the Red Cross in the communities and asked that all community members support the initiative.
To ensure that the volunteers were equipped with adequate knowledge and skills, trainers from Local Agency for the Control of AIDS (LACA) and HCT centres were recruited to train the community-based volunteers and supervisors. During a three day orientation session, 400 community-based volunteers, most of whom are community health workers and staff of LACA, received training. The orientation was carried out simultaneously in all the three local government areas under close supervision of the NACA technical team.
Following the training, the community-based volunteers were deployed to carry out a five day house-to-house visit and counsel people on HIV prevention, treatment and the need for everyone to get tested and know their status. Volunteers used community gatherings, church visits and other social avenues to create awareness on HIV and AIDS and other diseases like malaria.
During this period, volunteers assembled at the health facility on daily basis to register and collect kits and client intake forms. At the end of the day, they returned the forms and kits (both used and unused) to their supervisors. The supervisors in turn handed over these to the health personnel for proper documentation of results and safe disposal.
Out of the 39,248 persons counselled, tested and given results, 330 persons tested HIV positive - 265 in Calabar South; 35 in Yala and 30 in Boki. "Those who tested HIV positive were immediately referred to the health facilities for confirmation and treatment. Their data was also collected and sent to the health facilities for follow up", says Samuel Matoka, IFRC's Health Delegate in Nigeria.
Ten health facilities were identified for referral: four in Yala and Boki and two in Calabar South. "These facilities are managed by health personnel who are trained on HCT and prevention of mother-to-child transmission and other health services. The test kits and monitoring tools are kept at the health facilities, under the supervision of the personnel who were also facilitators of the training", adds Samuel.
While the overall experience of HCT in Cross River State was good, the team faced several challenges. The coordination mechanism between the National Red Cross office and State offices was weak and there were gaps in communication between stakeholders. More time should have been allotted for advocacy, community mobilization and stakeholders involvement.
"Even though those who had tested HIV positive were immediately referred to health facilities, there was no mechanism in place to follow up whether they actually reached out to the health facilities or not", says Samuel. He goes on to add that, "Volunteers should be able to provide long-term support to the communities by following up with people who have tested positive and continue raising awareness about HIV and AIDS".