An evaluation of utilisation of voluntary conselling and testing services by uniformed personnel in the Zambia National service in Lusaka district

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Sosala, Edith Kasia
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The purpose of the study was to ascertain the reasons why uniformed personnel in the Zambia National Service did not utilise the VCT services which were located in the ZNS Camps. This would be of value to the management in the ZNS to be aware of the barriers existing that prevent VCT utilisation and how these barriers could be overcome in order to enhance the service, thereby promoting good health and productivity among personnel. OBJECTIVES The general objective of the study was to find out the barriers and perceptions of VCT which contributed to lack of utilisation of VCT services among ZNS personnel Specific objectives were to determine extent of utilization of VCT services; to evaluate factors associated with utilisation or lack of utilisation of VCT services; to evaluate the knowledge and perceptions of VCT services; to find out the percentage of VCT clients accessing ART services and to make recommendations on the VCT programmes in the Zambia National Service in the light of the research findings. RESPONDENTS The study included male and female Commissioned and Non-Commissioned Officers of the rank from Private to Lieutenant Colonel aged between 18 and 49 years, who had not previously utilised the Camp VCT services. A total of 596 personnel participated in the study. METHODS Data was collected both quantitatively and qualitatively. Quantitative data was collected by administering a standardised pre-tested questionnaire to each participant. In addition, four focus group discussions were conducted; one in each Camp. A total of 24 personnel participated in the discussions. A checklist was also used in which information was collected from staff managing the VCT clinic and from the clinic VCT records. The study was a cross-sectional survey. A convenient sample was chosen from the four Camps. However, due to the low ratio of female to male personnel in ZNS, all female personnel were purposely included in the study. FINDINGS The findings show that the overall knowledge of HIV and AIDS was very high (97%), and that over 97% of the respondents were aware that VCT services were available at the Camp clinics. Although records indicated that HIV and AIDS programmes such as HIV and AIDS Sensitization, Home Based Care, PMTCT, Peer Education and VCT were being implemented in the Camps, only 74% of the respondents said that they would like to know their HIV status but only 53.7% knew their status. The respondents who knew their status had done their HIV test either at the government or NGO facilities. The respondents listed the barriers preventing VCT utilisation in ZNS Camps as fear of stigma (59.4%), fear of intimidation by Senior Officers (14.8%), fear of dismissal from employment (4.9),lack of confidentiality of VCT results by health providers (58%). Respondents felt that VCT services were attached with a lot of stigma and discrimination (70%). Focus Group Discussions strongly criticised the centralised structure for ART which lacked confidentiality of HIV and AIDS information of personnel. The VCT clinic Audit revealed that only 77 personnel had utilized VCT services and only 60 personnel were on ART during the period under review despite the 28.2% HIV prevalence rate in the ZNS. Some of the major respondents' suggestions for improvement in the management of HIV and AIDS programmes in ZNS included retraining of health providers in issues of confidentiality, decentralising laboratory and ART services to Camps, sensitisation of Camp leadership on HIV and AIDS and continued campaigns in education on HIV and AIDS in order to reduce the problem of stigma. CONCLUSIONS A number of organisational procedures need to be followed in ZNS to ensure safeguards for the collection, transfer, storage, use, dissemination and disposal of personnel identified data and other HIV related information. Policies and procedures developed must cover both paper-based and electronic systems. Whenever possible, release of HIV-related data must be kept to a minimum. A written data policy should exist in ZNS and should be reviewed at regular intervals. This needs to define the purpose and uses of HIV data, outline which data elements can be released and for which purpose. Security breaches and loss of confidentiality on the part of health providers should be thoroughly investigated and appropriate sanctions imposed on culprits in order to win back the integrity of the Health profession.
Conselling-clinical guidance