Assessment of Integrated Counselling and Testing Centers (ICTC) in Chhattisgarh, India

Executive Summary The HIV epidemic in the state of Chhattisgarh, India is concentrated among high risk groups, though, there is an evidence of the infection spreading to the general population. According to the HIV Sentinel Surveillance 2012-13, NACO report, HIV prevalence among ANC clinic attendees in the state is 0.51, prevalence among FSW is 2.73, prevalence among MSM is 14.98, and prevalence among IDUs is 0.42. HIV prevalence among MSM in the state is highest in the country (India -4.43). The state has total 129 ICTC center located mainly in district and community health centers. A study was carried out to assess the performance of these ICTCs so as to provide information to health care providers, administrators and policy makers for better service delivery. A Cross sectional facility based survey was carried out between June 2015 and August 2015. Random sampling techniques were used for the selection of districts from 5 divisions. All ICTCs with counsellor posted were eligible for sample selection. The study tools were developed based on the guidelines of ICTC and the tools developed by UNAIDS to evaluate ICTC centers. Data analysis was made using excel sheet. Out of 129 ICTC only 73 ICTC centers had both Counsellor and LT, although there were 101 counsellors and 84 laboratory technicians posted at different ICTC centers. 45 ICTC centers had no Laboratory Technician. 10 Lab technicians had no counsellor though there were 18 more counsellors than laboratory technicians. 17 ICTC centers had neither Counsellor nor LT. Only 57% of the ICTC centers had adequate space for counseling. There was lack of flip chart and leaflets at some centers. 83% centers had Condom and condom demonstration models. Only 31% of counsellors had correct knowledge on HIV testing and 33% had correct counseling skill. The knowledge on risk assessment and HIV/AIDs ranges between 49% to 65%. About 60% of the counsellors scored excellent grading, 13% of them scored good grading and remaining 17% and 7% of them scored average and poor grading. Hence the performance of about 24% counsellors is below satisfactory. About 83% counsellors maintain the quality of counseling and about 17% of the counsellors perform below average in maintaining the quality of counseling. Over all the performance of the ICTCs are reasonable; however the assessment identified some key gaps which need to be addressed to improve the functioning of ICTCs. To address the key gaps following recommendations are suggested: Rationalization of the human resources to operationalize key services of ICTC; Immediate recruitment of staff to replace vacant positions or delisting of ICTC without HR; Regularization of quality training to ICTC staff Strengthening monitoring and supervision of ICTC centers and its services.