Table 4 Summary of Similarities and differences in facility-based and mobile/outreach sites
Facility-based site | Mobile/outreach sites | |
|---|---|---|
General | ||
Study working definitions | Facility-based testing sites: fixed or static facilities within the public or mission health sector (e.g. hospitals, health centres or dispensaries) where individuals walk in for HIV testing or other health care services | Outreach HIV testing sites include but are not limited to mobile testing clinics using cars or tents, home visits, workplaces, schools, campaigns or special event testing services like World AIDS Day Most mobile/outreach testing sites are operating under Non-Governmental Organizations |
Funders | Government facilities | Non-Governmental organizations/sponsors |
Client/individual level | ||
Reason for testing at a particular site | Coming voluntarily for HIV test, or Coming for medical care and HIV test suggested by staff (PITC), or Referred from lower level facilities, or Admitted to the ward and then advised to take a test | People come for HIV testing because they were passing by and saw the tents of track and decide to test, or Heard the public announcement for free services in their area, or Coming voluntarily for HIV test because HIV testing services were brought closer to where they live |
Number of clients tested during the study period | 5234 with 21.5% diagnosed HIV positive | 6539 with 7.9% diagnosed HIV positive |
Health care provider level | ||
Human resource or types of staff available | Nurses: 1–2 in VCT Nurses 2–5 at CTC Doctors 1–2 doctors at CTC Other staff- lab technician, pharmacy, and recorders 1–4 | Nurse counsellors 3–6 Home-based carers 1–2 Doctors only at the research mobile Mobile sites normally have more counsellors, home-based carers (HBCs), and peer health educators; they only have doctors in special events |
Client follow up | PITC actively implemented but no active post-test follow-up of clients Some minimal follow-up for clients who are initiated on ART by treatment experts (in facilities where they exist) to ensure that they do not stop treatment | KIHUMBE, SHDEPHA, and St John Hus sites follow up their HIV positive clients through the Home-based care workers who are paid by the organization HBCs sometimes assist clients with the linkage to care process and conduct home visits for support and follow up HBC provides the numbers of the clients who are lost to follow-up to the site manager who compiles and writes an annual report for loss to follow-up and sends reports to the regional office |
System level | ||
HIV testing and HIV care activities | The sites offer HIV testing and HIV care services Clients come from home following services at the health facility Clients may come to the site for another sickness, and the health care provider may advise the person to test for HIV | The sites offer HIV testing and refer the clients to facility-based CTCs for HIV care services Conducts mobile/outreach HIV testing, moves from one place to another following people in the community or their homes Some of the mobile sites (e.g. KIHUMBE) also conduct HIV test in some of their offices in fixed buildings During special events and campaigns, music and dancing groups entertaining people are standard |
HIV testing place/venue | Fixed buildings like hospitals, health centres or dispensaries (at the HIV testing and CTC section) In one facility, there was a television set at the CTC clinic clients were watching while waiting for services | Mobile cars/vans, Fixed buildings/clinics Open areas/grounds Tents |
Functioning tools/equipment and guidelines | Register books Reports Referral form/letter Patient files Laboratory services available Guidelines- HIV testing guidelines were not available at the site, but most staff reported being trained on the current guidelines | Register books Reports Referral forms Clients tracing forms for HBCs No laboratory services except for the research mobile HIV testing guidelines were not available at the site, but most staff reported being trained on the current guidelines |
Record keeping | Register books and monthly reports in some sites were incomplete | All register books and monthly reports were well kept and complete |
Information available | Health education on HIV and HIV treatment adherence sessions Posters related to HIV diseases fixed in waiting areas | Advertisements of services by local radio stations Car announcement/public announcements Campaigns Flyers with HIV information distributed to community members Community mobilization and invitation for free HIV testing |
Testing algorithms | Use of Determine ™ as primary test if reactive Uni-gold is used for confirmation, However, Elisa test can be done if necessity arises | Use of Determine ™ as a primary test if reactive Uni-gold is used for confirmation If necessary, they refer clients for Elisa at the nearby hospital or ask the participants to come again after 2 weeks for re-testing |
Referral procedure for HIV positive clients Same referral forms are used at the facility-based and mobile sites | Provide referral form to the CTC within the facility | Provide the referral letter/form and advise the client to link at the facility of their choice |
Contextual level | ||
Availability of HIV testing and HIV care services | HIV testing services availability is better compared to availability of HIV care service In most of the sites (including dispensaries) HIV testing is done, although the distance was still a challenge especially in Chunya and Mbeya rural districts | HIV testing services are brought closer to clients’ homes, however, the challenge was to get care and treatment services In some cases, clients needed money for transport to reach a site where they can receive care |