ABSTRACT

Issues: Voluntary counselling and testing (VCT) is a critical issue impacting HIV disease management from a national and global perspective. In Jamaica (population 2.6 million), 2% of women in antenatal clinics are HIV-positive and mother-to-child-transmission (MTCT) accounted for 7% of all reported cases in 2002. Notwithstanding this, VCT was ad hoc and not standardized. In 2003, a structured VCT programme was developed islandwide with over 300 VCT service providers and 16 qualified trainers.

Description: We describe the challenges and successes of VCT provided by five trained research nurses in the Perinatal HIV/AIDS Programme in Kingston which services 19 000 pregnant women per year in three major maternity centres and their 42 feeder antenatal clinics.

Lessons learned: The VCT model used was group education, opt-out individual testing, individual posttest counselling for seropositives and informing seronegatives of their negative status. Major challenges encountered included lack of quality control of the counselling process and lost opportunities for un-booked women who presented in labour. However, successes enjoyed included client assessment of risk behaviours with appropriate lifestyle changes, increased uptake of HIV testing and adherence to care for themselves and their infants, as well as reduction in stigma.

Recommendations: VCT has proven to be an important intervention that enabled improvement in the awareness, prevention and control of HIV in Jamaican pregnant women. Nurses who are appropriately trained in VCT can play a pivotal role in successful provision of VCT services.