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Evaluation of Training Capacity in Voluntary Counseling and Testing (VCT): Jamaica and the Eastern Caribbean

Background

In 2006, I-TECH conducted an evaluation of Jhpiego's voluntary counseling and testing (VCT) training activities in the Caribbean region from 2001 through December 2005. Funding was provided to Jhpiego by USAID/USAID Jamaica /Caribbean Regional Program (CHART) and the Centers for Disease Control's Global AIDS Program (CDC GAP) under a number of grants, cooperative agreements, and subcontracts; over US$1.6 million was committed through September 2006.

Methods

The evaluation methods included key informant interviews of Jphiego staff and stakeholders in the countries of Barbados, Jamaica, St. Lucia, and Trinidad and Tobago, in addition to analyses of Training Information Management System (TIMS) data. Also, Jphiego shared the results of its then recently completed Caribbean Regional HIV Counseling and Testing Survey.

Findings

Analyses of data showed that four major themes characterized the environments in which the VCT training program occurred:

  • There are time constraints for providers in public health clinics.
  • Stigma is associated with HIV and AIDS.
  • There is a tension between regional standardization vs. responding to local needs.
  • There is an emergence of outreach for VCT services.

Results are summarized below in the four areas that were the focus of the evaluation.

  • Program implementation. In the four years beginning in December 2001, Jphiego, CHART, and their partners in the ministries of health trained more than 2,700 health care professionals in 12 countries with a common VCT curriculum. Jphiego’s Caribbean Regional HIV Counseling and Testing Survey reported that 67% of trainees were currently providing VCT services. There were 305 sites that provided both HIV counseling and testing services in eight countries.
  • Training model and effectiveness. The Jhpiego VCT training program is based on a "training ladder" in which selected VCT trainees are trained to become "VCT trainers"; selected VCT trainers are trained to become "advanced trainers"; and selected advanced trainers are trained to become "master trainers." A total of 181 people completed the clinical training skills course, of which 67% (121 people) became certified as trainers by co-teaching a VCT skills course. Among certified trainers, 66% (80 people) taught more than one course. Sixteen people completed the advanced training skills course, and 14 people were certified as advanced trainers. Six of the advanced trainers subsequently received training in curriculum development and were certified as master trainers by developing the group education curriculum.
  • Supervision and monitoring systems for VCT training and implementation. To monitor and evaluate the VCT skills course, four activities were integrated into the course. In addition, Jphiego created TIMS; developed the Performance/Quality Improvement (PQI) program—a standards-based management system—in partnership with the MOH in Jamaica; and, as previously noted, conducted the Caribbean Regional HIV Counseling and Testing Survey. In 2003, 20 people were trained initially to collect baseline PQI data at VCT sites throughout Jamaica. Every facility met substantially more criteria at the second and third assessments than at the baseline assessment.
  • Sustainability. By all accounts, the transition to MOH support of VCT training in Jamaica proceeded smoothly, and the MOH in Jamaica currently has funds for VCT training from the World Bank. The transition to MOH support of VCT training in the other countries is still in process. The degree to which VCT specifically and HIV and AIDS generally are prioritized within each MOH may largely determine the future viability of maintaining a VCT workforce and infrastructure in these countries. Jhpiego and CHART were unclear about the future of VCT training in the region, as well as their respective roles in the effort. Several interviewees described the important role that Jhpiego, as a "neutral" stakeholder, played in bringing training and technical assistance to the region.

Recommendations

  • Outreach for VCT services: Foster the development of outreach strategies for VCT services, and establish a clear link between VCT outreach strategies and testing services.
  • VCT testing statistics: HIV testing data were collected in a variety of categories that were not comparable across countries and not available from every country. Routine reporting on VCT testing statistics should be negotiated as part of the workplan, with appropriate representatives of the MOHs and/or national AIDS programs.
  • Existing network of trainers: Additional advanced trainers will be needed to sustain VCT training programs in some countries. Annual meetings provide an opportunity to advanced and master trainers to showcase their accomplishments and to share lessons learned.
  • PQI: There is strong interest in developing a PQI process in all countries; such processes could build on Jamaica's, Barbados's, and St. Lucia's efforts.
  • Integration of Jphiego and CHART activities: Jhpiego and CHART should develop a collaborative vision for integrating the VCT training program into CHART. The program should allow for a different process of integration in each country.

Results of this I-TECH evaluation have been published in the online journal Human Resources for Health. See: Hiner CA, Mandel BG, Weaver MR, Bruce D, McLaughlin R, Anderson J. Effectiveness of a training-of-trainers model in a HIV counseling and testing program in the Caribbean Region. Human Resources for Health. 2009;7:11.

A link to the full text of the article is available on the I-TECH website here.

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