Availability of Personnel, Counselling and Testing Materials Ene

AVAILABILITY OF PERSONNEL, COUNSELLING AND TESTING MATERIALS AS

FACTORS AFFECTING VOLUNTARY COUNSELING AND TESTING SERVICES
(VCT) IN BRAITHWAITE MEMORIAL SPECIALIST HOSPITAL, PORT HARCOURT

BY

ENE PETER, JANET

Department Of Human Kinetics and Health Education, Faculty of Education, University Of Port
Harcourt, Port Harcourt, Rivers State, Nigeria.
Abstract:
Voluntary Counseling and Testing (VCT) is an essential component of comprehensive AIDS
prevention and treatment programmes. The study investigated how availability of personnel and
counseling and testing materials affects VCT at the Braithwaite Memorial Specialist Hospital
(BMSH) Port Harcourt. The sample size consisted of 100 health personnel and non health
personnel drawn from the VCT centre BMSH Port Harcourt Rivers State using simple random
sampling technique to compute the sample size. Cross-sectional descriptive survey design was
adopted for the study. Two research questions were answered. Questionnaire was used for data
collection. The result showed that all the variables investigated do not affect VCT services in
BMSH Port Harcourt. It was therefore recommended among others that there should be increased
training of all categories of health personnel; doctors, nurses, counselors, laboratory staff, etc to
facilitate skilled and expert service delivery in HIV and AIDS, and VCT services; so as to provide
adequate manpower to effective care for client and to reduce time spent by clients in the centre.
The study therefore concluded that all the afore mentioned socio - economic factors, are important
variables in rendering VCT services in Braithwaite Memorial Specialist Hospital, Port Harcourt
that have been properly addressed and put into careful consideration in designing strategies
aimed at ensuring effective and result-oriented VCT services in Braithwaite Memorial Specialist
Hospital, Port Harcourt.

Introduction
According to Wigley (2004) Voluntary Counseling and Testing (VCT) is an essential component
of comprehensive Acquired Immune (Immuno) Deficiency Syndrome (AIDS) prevention and
treatment programmes. VCT enables people to learn their HIV status in the most informed and
supportive way possible. Counseling is done before the test to educate them about HIV infection,
and afterward to help them respond appropriately to the results. Wigley (2004) states further that
VCT thus serves as an entry point to services that promote health and risk reduction. Those who
test negative receive prevention counseling and those who test positive receive referrals to
prevention, care, support and treatment programs. VCT also encourages and provides support for
disclosing one's HIV status to sexual partners. Wigley (2004) also notes that in 1993, Family
Health International (FHI) supported
two on-going VCT sites in Nigeria through its USAID-Funded Impact Project. These two centres
in Lagos and Kano were the first stand alone VCT facilities in Nigeria. The Lagos center is

New Era Research Journal of Human, Educational and Sustainable Development, Vol. 5. No. 3 & 4, May/August, 2012
operated by the Salvation Army, a global philanthropic organization that has worked with the
Nigerian government on AIDS programs since 1992, with plans to expand to 22 sites in 2004.
However VCT centers have opened up in teaching hospitals, specialist hospitals and other
specially designated sites all over the country today. Studies on HIV voluntary counseling and
testing in developing countries to prove the efficacy and cost effectiveness of providing voluntary
counseling and testing for HIV-1 in developing countries were reported in the new issue (July 8,
2000) of the British Medical Journal - The Lancet. The efficacy study, headed by Thomas J.
Coates, director of the AIDS Research Institute at the University of California, San Francisco,
enrolled 3,120 individuals and 586 couples in Nairobi, Kenya, Darees Salam, Tanzania, and Port-
of-Spain Trinidad.
However, AIDS is a highly infectious disease of the human immune system caused by Human
Immuno Virus (HIV), (Sepkowitz, 2001). According to the centre for Disease Control and
Prevention (CDC), (2006), this condition progressively reduces the effectiveness of the immune
system and leaves the individual susceptible to opportunistic infections and tumours. AIDS' first
recognized case by the CDC Cohen, (2000) notes, occurred in the USA (San Francisco) in 1981
and also in the early 1980's among a number of gay men in New York (Avert, 2010). The CDC,
(2006) states that HIV is transmitted through direct contact of mucous membrane or blood stream
with bodily fluid containing HIV, such as blood, semen, vaginal fluid, preseminal fluid and breast
fluid. This transmission can involve anal, vaginal or oral sex, blood transfusion, contaminated
hypodermic needles, exchange between mother and baby during pregnancy, childbirth, breast
feeding or other exposure to one of the bodily fluids. Also, under the auspices of Advocates for
Youth's YOUTHLIFE Initiative, the Youth Action Rangers of Nigeria (YARN) conducted
"mystery client" research of VCT centres in Lagos, Nigeria - assessing youth friendliness and
reported at the International Conference on AIDS (15th July 2004: Bangkok, Thailand). The results
and lessons learned from the research as the YARN researchers discovered include the following;
most Lagos-based VCT center were not youth-friendly. Most notably, staff attitudes were
moralistic, and were not as open and friendly as they could have been to youth. Issues of
transportation to the centers, hours of operation, assurances of confidentiality, were also some of
the inhibitors to youth-friendly services. In turn, the youth researchers conducted informal
interviews and focus group of their peer to ascertain what would help make these centers more
youthfriendly. The findings of the research conducted by Youth Action Rangers of Nigeria
(YARN) in addition to the observation of the Center for the Right of Health, that available testing
(VCT) services may be coercive, costly or lack strict confidentiality and increasing fear of stigma
prompted the researcher to embark on this study to investigate how availability of personnel and
counseling and testing materials affects VCT at the Braithwaite Memorial Specialist Hospital Port
Harcourt.

Statement of the Problem

VCT is when a person chooses to undergo HIV and AIDS counseling so that they can make an
informed decision about whether to be tested for HIV. VCT is an HIV intervention/prevention
strategy to reducing the burden of HIV and AIDS. It is also being recognized as an entry point to
care and support as well as being an essential tool for behaviour change for people who test both
Availability of Personnel, Counselling and Testing Materials Ene
HIV positive and HIV negative, hence contributing toward reduction of stigma. VCT provides
important information about a person's sero-status and encourages reduction of risk behaviour
while at the same time assisting with linkages to medical care. However, studies and reports show
that some VCT centers are riddled with problem which include amongst others, youth
unfriendliness, coercive, high, cost or lack strict confidentiality and increasing fear of stigma. The
problem of this research therefore, is to investigate how availability of personnel and counseling
and testing materials affects VCT at the Braithwaite Memorial Specialist Hospital Port Harcourt.

Purpose of the Study

The aim of this study is to find out how availability of personnel and counseling and testing
materials affects VCT at the Braithwaite Memorial Specialist Hospital Port Harcourt.

Specific Objective of the Study

Specifically, this study intends to find out whether.
1. Is availability of personnel a factor affecting voluntary counseling and testing services in
Braithwaite Memorial Specialist Hospital, Port Harcourt?
2. Is availability of counseling and testing materials a factor affecting VCT services in
Braithwaite Memorial Specialist Hospital, Port Harcourt?

Significance of the Study

The study has various significant aspects:
The result will establish how availability of personnel and counseling and testing materials
affects VCT at the Braithwaite Memorial Specialist Hospital Port Harcourt.
This will provide information that will help to improve quality of services rendered in the
centre.
Also the findings will serve as a good reference material for students and other researcher
who would want to investigate other relevant areas of voluntary counseling and testing.

Delimitation (Scope) of the Study

The study was delimited to how availability of personnel and counseling and testing materials
affects VCT at the Braithwaite Memorial Specialist Hospital Port Harcourt. It is limited to the
voluntary counseling and testing unit in Braithwaite Memorial Specialist Hospital, Port
Harcourt. It was delimited to the various categories of health personnel involved in voluntary
counseling and testing services in Braithwaite Memorial Specialist Hospital, Port Harcourt.
That is, doctors, nurses, counselors, laboratory staff and other paramedical personnel and
clients. It was delimited to the use of questionnaire and descriptive research design.
Descriptive statistics of frequency distribution tables, graphs and percentages for demographic
data and to answer research questions.

New Era Research Journal of Human, Educational and Sustainable Development, Vol. 5. No. 3 & 4, May/August, 2012
 Definition of Terms (Operational)

Voluntary: This is when an individual willing opts to go for the counseling and testing.
Counseling: This is when professionals provide information about HIV/AIDS and testing
and help people to accept to be tested or not. Also, the counselor assist in what to do after the
result of the test is ready.

Testing: This is laboratory examination of blood specimen of people to show if Human Immuno
Virus is present or absent in it.

Concept of Voluntary Counseling and Testing (VCT)

Voluntary counseling and testing (VCT) is an essential component of comprehensive AIDS
prevention and treatment programs. VCT enables people to learn their HIV status in the most
informed and supportive way possible: with counseling both before the test to educate them about
HIV infection, and afterward to help them respond appropriately to the results. VCT thus serves
as an entry point to services that promote health and risk reduction, with those who test negative
receiving prevention counseling and those who test positive receiving referrals to prevention, care,
support and treatment programs. VCT also encourages and provides support for disclosing one's
HIV status to sexual partners. VCT stands for voluntary counseling and testing (Wigley, FHI,
2004). VCT is when a person chooses to undergo HIV/AIDS counseling so that they can make an
informed decision about whether to be tested for HIV. Hornby, (2006) defines voluntary as "done
willingly, not because you are forced" In same vein, counsel is defined as "advice, especially given
by older people or experts; a piece of advice. Also, "to listen to and give support or professional
advice to somebody who needs help" (Hornby, 2006). Whereas testing is defined as (2) "a medical
examination to discover what is wrong with you or to check the condition of your health" (Hornby,
2006). Counseling is a private conversation with a specially trained person aimed at helping
individuals to help themselves. Counseling encourages an individual to explore possible solutions
to their problems, and to consider the impact that certain decision may have on their lives.
HIV/AIDS counseling provided at VCT sites is free and confidential. This means that the
Counselor cannot tell anyone about the result without their permission. The individual must
receive face-to-face counseling before the test. This is known as pretest counseling-, and is aimed
at ensuring individuals make a well-informed decision about whether to have the HIV test or not,
and encourages exploration of the possible impact that having the test may have on their lives.
Once the test has been done, post-test counseling is done. This is the counseling during which
result is give to the individual. People who have good pre and post-test counseling are able to cope
better with their results, and are more likely to look after their health, and protect others from
infection. The counseling that an individual may have once they already know their result is
known as on-going counseling. On-going counseling helps people to live positively with HIV and
provides them with support and guidance with regard to any problem that they may face. Having
the HIV antibody test is an individual's own personal decision. It is not forced on people to have
it done (Angaza Project Tazania, 2001).
Availability of Personnel, Counselling and Testing Materials Ene

Goals of Voluntary Counseling and Testing (VCT)

• VCT aims at reducing spread of HIV; mitigating its impact; reducing fear & anxiety
associated with HIV testing; improving the length & quality of lives of those who test
positive by linking them to treatment, care & support services; and reducing HIV stigma.
Get information and counseling on how to live positively with the virus. This means
learning to accept the fact that the individual is HIV-infected, seeking emotional support,
eating a healthy diet, learning how to control the amount of stress in their lives, making
sure he or she does not become re-infected, and planning for the future.
• Learn to recognize the signs of opportunistic infections so individuals can get treated
promptly.
• Find out what resources are available within the community to help people manage their
HIV status.
• Find out about prophylactic drugs. These drugs do not cure HIV/AIDS, but can prevent the
individual from getting some opportunistic infections that are common with people living
with HIV/AIDS, for example, tuberculosis and some kinds of pneumonia.
• Access Nevirapine. This is a drug available at a number of hospitals andclinics that lessens
the chance of a pregnant mother passing the virus onto her baby.
• Get emotional support by seeking counseling and joining support groups.
• Make sure that they do not infect anyone else or get re-infected themselves. Learn how
to manage the stress in their lives.

VCT can motivate those who are not infected with HIV to stay HIV antibody negative, and to
accept those who are infected (Angaza Project Tazania, 2001). Angaza Project Tazania,
(2001) notes the following about voluntary counseling in HIV and AIDS.

Pre-Test Counseling:
This is the kind of counseling done before an individual decides whether they want to have the
HIV antibody test. Some of the issues the counselor will discuss with the individual are:
• Why the individual decided to come for counseling.
• What counseling is and the role of the counselor.
• The individual's personal history.
• Whether the individual has any health problems.
• What the individual's risk of being HIV infected is.
• What the individual knows about HIV/AIDS.
• Information about HIV/AIDS, including the test procedure and what people who are HIV
infected can do to make sure that they stay as healthy as possible for as long as possible.

New Era Research Journal of Human, Educational and Sustainable Development, Vol. 5. No. 3 & 4, May/August, 2012
• What alternative there are for solving their problems.
• Which issues the individual wants to tackle first.
• What impact the individual thinks a positive, indeterminate or negative result would have
on the individual's life and how he/she think he she would react to receiving them.

• The advantages and disadvantages for having the test done.

• What kind of support system the individual has including who he/she would be able to tell
if tested HIV antibody positive.
• How the individual had coped with problems in the past.

Post Test Counseling:

This is the kind of counseling done after the test. During this session the counselor will:
• Give the test result.
• Let the individual express his/her feeling about being HIV antibody positive, negative or
indeterminate. Help to revisit the issues being raised during the pre test counseling session;
including any plans the individual might have made.
• Discuss any immediate problems and help to decide on a plan of action.
• Answer any questions asked by the individual and provide all useful information.
• Discuss positive living.

HIV Counseling
HIV counseling seeks to reduce HIV acquisition and transmission through the following:
• Information. Clients should receive information regarding HIV transmission and
prevention and the meaning of HIV test results. Provision of information is different from
informed consent.
• HIV prevention counseling. Clients should receive help to identify the specific behaviors
putting them at risk for acquiring or transmitting HIV and commit to steps to reduce this
risk. Prevention counseling can involve >1 sessions.

Information
All clients who are recommended or who request HIV testing should receive the following
information, even if the test is declined:
• Information regarding the HIV test and its benefits and consequences.
• Risks for transmission and how HIV can be prevented.
• The importance of obtaining test results and explicit procedures for doing so.
• The meaning of the test results in explicit, understandable language.
• Where to obtain further information or, if applicable, HIV prevention counseling.
• Where to obtain other sen/ices.
Availability of Personnel, Counselling and Testing Materials Ene
In certain settings where HIV testing is offered, other useful information includes a) descriptions
or demonstrations of how to use condoms correctly; b) information regarding risk-free and safer
sex options; c) information regarding other sexually transmitted and blood borne diseases; d)
descriptions regarding the effectiveness of using clean needles, syringes, cotton, water, and other
drug paraphernalia; e) information regarding drug treatment; and f) information regarding the
possible effect of HIV vaccines on test results for persons participating in HIV vaccine trials. For
efficiency,

Availability of Personnel, Counselling and Testing Materials

information can be provided in a pamphlet, brochure, or video rather than a face-to-face encounter
with a counselor. This approach allows the provider to focus face-to-face interactions on
prevention counseling approaches proven effective with persons at increased risk for HIV
infection. Information should be provided in a manner appropriate to the client's culture, language,
sex, sexual orientation, age, and developmental level. Certain informational videos and large-
group presentations that provide explicit information regarding correct use of condoms have
proven effective in reducing new STIs and could be effective in reducing HIV.

HIV Prevention Counseling

HIV prevention counseling should focus on the client's own unique circumstances and risk and
should help the client set and reach an explicit behavior-change goal to reduce the chance of
acquiring or transmitting HIV. HIV prevention counseling is usually, but not always, conducted
in the context of HIV testing. The client-centered HIV prevention counseling model involves two
brief sessions, whereas other effective models are longer or involve more sessions. Regardless of
the model used, in HIV prevention counseling, the counselor or provider focuses on assessing the
client's personal risk or circumstances and helping the client set and reaches a specific, realistic,
risk-reduction goal. These guidelines avoid using the terms "pretest" and "posttest" counseling to
underscore that prevention counseling is a risk-reduction process that might involve only one or
>1 session. Several models for HIV prevention counseling in conjunction with HIV testing have
been developed, evaluated in controlled studies, and documented to be efficacious in changing
behavior or reducing sexually transmitted infections, including individual face-to-face counseling,
large- and small-group counseling with a facilitator, and video-based counseling.

Research Design
The design of the study was cross-sectional descriptive survey. Cross sectional descriptive survey
design was used in this study to investigate the socio-economic factors affecting voluntary
counseling and testing (VCT) services at the Braithwaite Memorial Specialist Hospital, Port
Harcourt.

Area of the Study

New Era Research Journal of Human, Educational and Sustainable Development, Vol. 5. No. 3 & 4, May/August, 2012
Braithwaite Memorial Specialist Hospital is a Rivers State government owned Specialist Hospital
located in Old GRA, Port Harcourt. It is the only health facility in the state with the status of a
specialist hospital. The VCT centre in this hospital is located in the General Out Patient
Department (GOPD).

Population of the study

The population for the study consisted of all the health personnel in the HIV/AIDS clinic and
laboratory services, and clients at the Braithwaite Memorial Specialist Hospital, Port Harcourt.

Sample and Sampling Technique

Simple random sampling technique (using random numbers) was used to select a sample size of
about 50 respondents from the members of staff of the clinic and clients.

Instrument for Data Collection

A self-developed, structured and validated questionnaire constituted the major instrument for
gathering data in this study. The questionnaire was in a modified Likert format of agree and
disagree. The questionnaire was made up of two sections, A and B. Section A addressed the
demographic data which includes sex, age, educational qualification of health personnels and non
health personnels, while section B addressed the variables under study.

Validity of Instrument
In order to ensure the face and content validity of the questionnaire, a draft of the questionnaire
was given to the researcher's supervisor and two other lecturers of the School of Public Health
Nursing, Port Harcourt.

Field Testing of the Instrument

The researcher carried out field testing of the instrument by administering the questionnaire to 10
respondents at the Family Medicine Department of Braithwaite Memorial Specialist Hospital.

Reliability of Instrument
Reliability for internal consistency of the instrument was done using Split Half method. For this
purpose, the 10 questionnaires served to the General Outpatient (GOPD) Department of
Braithwaite Memorial Specialist Hospital were also used. These were retrieved after being
filled for calculation. The 10 questionnaires retrieved were split into two equal halves of odd
and even numbers. These were coded and first correlated using Pearson Product Moment
Correlation Coefficient. Then, the reliability on full test was done using Spearman Brown
formula; rf = 2* reliability on half test/ 1+ reliability on half test, rf = 2* r Vi / 1+ r V2.
The reliability of the entire instrument was 0.69. The Reliability Coefficient value so obtained was
high enough to guarantee the use of the instrument for this study.
Availability of Personnel, Counselling and Testing Materials Ene
Procedure for Data Collection
The researcher got a letter of identification from the Principal School of Public Health Nursing,
Port Harcourt to the area of study. The researcher administered copies of the socio-economic
factors affecting voluntary counseling and testing (VCT) services directly to the respondents
through personal contacts.

Procedure for Data Analysis

Data for this study was analyzed using Statistical Package for Social Sciences (SPSS) version
14. They were analyzed according to the research questions. Also, data collated on agree and
disagree dichotomous format was analyzed using descriptive statistics of frequency distribution
table, and graphs percentages for demographic data and to answer the research questions.

Findings:

Research question 6: Is unavailability of personnel a factor affecting VCT services in BMSH,

Port Harcourt?
Table 1: Percentage responses on unavailability of personnel as a factor affecting VCT
services in BMSH, Port Harcourt.
S/No Items AGREE (%) DISAGREE (%) TOTAL
19 Members of staff are not always 30(38.46) 48(61.54) 78
available to render voluntary
counseling and testing (VCT)
services when needed in this centre.

20 This has resulted in low patronage of 78(100.00) 78

voluntary counseling and testing
(VCT) services in this centre.
21 Counseling staff and materials are in 30(38.46) 48(61.54) 78
short supply most of the time in this
centre.

N=78, (%): percentages (fraction in parentheses)

Table 1 indicates that unavailability of personnel is not a factor affecting VCT services in
BMSH, Port Harcourt. 61.54% disagreed that personnel are not always available. 78 (100.00%)
of respondents were of the opinion that unavailability of personnel has not resulted in low
patronage of services in the centre.

Research question 2: Is unavailability of counseling and testing material a factor affecting VCT
services in BMSH, Port Harcourt?

New Era Research Journal of Human, Educational and Sustainable Development, Vol. 5. No. 3 & 4, May/August, 2012
Table 2: Percentage responses on unavailability of counseling and testing material as a
factor affecting VCT services in BMSH, Port Harcourt.
S/No. Items Agree Disagree Total
22 Testing materials (such as reagent, 24(30.77) 54(69.23) 78
syringes and needles, etc) are not always
available in this centre.
23 Unavailability of materials has adversely 20(25.64) 58(74.36) 78
affected voluntary counseling and testing
(VCT) services in this centre.

24 This has resulted in unsatisfactory 24(30.77) 54(69.23) 78

patronage of voluntary counseling and
testing (VCT) services in this centre.

N=78, (%): percentages (fraction in parentheses)

Table 2 indicates that unavailability of counseling and testing material is not a factor affecting
VCT services in BMSH, Port Harcourt, 69,23% of the respondents specifically disagreed that
test reagents, syringes and needles etc, are unavailable in the centre; and also disagreed that
unavailability of counseling and testing material has resulted in unsatisfactory patronage of
voluntary counseling and testing (VCT) services in this centre.

Discussion of Findings
Table 1 indicates that unavailability of personnel is not a factor affecting VCT services in BMSH,
Port Harcourt. 61.54% disagreed that personnel were not always available. Therefore, 78
(100.00%) of respondents were of the opinion that unavailability of personnel has not resulted in
low patronage of services in the centre. The finding of this research (based on the BMSH
experience) is that members of staff are always available but inadequate. This may be due to
shortage of trained VCT personnel. Table 2 indicates that unavailability of counseling and testing
material is not a factor affecting VCT services in BMSH, Port Harcourt. 69.23% of the
respondents specifically disagreed that test reagents, syringes and needles etc, are unavailable in
the centre and also disagreed that unavailability of counseling and testing material has resulted in
unsatisfactory patronage of voluntary counseling and testing (VCT) services in this centre. This
result is due to increased government involvement over the years in Nigeria in VCT services
across the country in order to curb the prevalence and death rate resulting from HIV and AIDS
epidemic in Nigeria.

Conclusion
The findings revealed that all the factors examined have no effect on VCT services in BMSH, Port
Harcourt. Based upon the finding of this research, the following conclusions are drawn:
Availability of Personnel, Counselling and Testing Materials Ene
Availability of personnel is not a factor affecting voluntary counseling and testing services
in Braithwaite Memorial Specialist Hospital, Port Harcourt.
Availability of counseling and testing materials is not a factor affecting VCT services in
Braithwaite Memorial Specialist Hospital, Port Harcourt.

Recommendation
Based upon the findings of this research, it is therefore recommended that:
There should be increased training of all categories of health personnel; doctors, nurses,
counselors, laboratory staff etc to facilitate skilled and expert service delivery in HIV and
AIDS, and VCT services. So as to provide adequate manpower to effective care for client
and to reduce time spent by clients in the centre.
VCT service centres should be provided in all the local government areas of the state to
decongest the BMSH VCT service centre in order to reduce time spent by clients in the
centre.
Workshops and seminars should be organised for all categories of health personnel on a
continues basis so that they will be adequately equipped to render VCT services when the
need arises, anywhere and anytime in order to ensure wider coverage of the members of the
public.
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