AIDSQuest: The HIV/AIDS Survey Library
HIV Research Domains: Topic N Voluntary Counseling and Testing

Overview
Voluntary counseling and testing (VCT) provides an important opportunity for individuals to learn their HIV status, as well as be counseled on HIV prevention or be given treatment options if HIV-positive. While in the developing world access to and demand for these services remain low, there are currently numerous attempts to expand upon available services and treatments. Confidentiality, quality of counseling, and access to clinical services are some of the key issues to evaluate as part of VCT.

Individual knowledge and attitude surveys are often utilized to evaluate experiences of those who have been counseled. Exit interviews with clients can determine the impact of the session on the client, as well as their satisfaction with the services. Interviews with counselors and other providers regarding their attitudes and practices are another useful option.

There have also been measurement tools developed for third-party evaluations of actual counseling sessions, where the observer fills out a checklist on how well the counselor performed. Observations can attempt to evaluate whether the counselor covered all of the important issues, as well as if they were able to establish a good rapport with the client. Direct observations as well as examining records may also help determine if the clients were appropriately referred to other services such as family planning counseling, or treatment for sexually transmitted infections. It is important to take into account that the presence of the observer during the counseling session may impact the performance of the counselor and/or the comfort level of the client.

Surveys regarding VCT services can also evaluate VCT sites themselves, such as logistical or supply considerations and coverage. Questions may include: Is there adequate space for privacy? How many trained counselors work full-time at this center? Has there ever been a shortage of testing kits? When have clients been denied HIV tests? These types of questions have been included under the policy topic in the subsection on health care services.

Questions can also be asked regarding possible post-test disclosure of status to others. For example: Who would you discuss your test results with? Partner notification issues are particularly important. These questions can be very sensitive, and should be approached carefully.

As with other types of questions, it is important to keep comparability in mind when designing a survey. This is especially true if you are going to ask similar questions within the same survey, collect more than one round of data (e.g., pre-and post-tests), or if you will want to compare your results to other studies. It is best to compare questions that are asked in exactly the same way.

Examples of questions relating to voluntary counseling and testing have been drawn from the surveys listed below.

1. Services, attitudes, and disclosure

• Horizons—Ndola Demonstration Project Counseling Observation Checklist
• Horizons—Testing Clinic- and Community-based Strategies for Reducing Mother-to-Child Transmission of HIV
• Horizons—HIV-associated Violence: Implications for HIV Counseling and Testing Programs
• AIDSCAP/WHO/CAPS—Voluntary Counseling and Testing Efficacy Study (Baseline Instrument)
• UNAIDS—Tools for Evaluating HIV Voluntary Counseling and Testing
• Population Council—Situation Analysis Rapid Assessment Surveys
• Horizons—Kenya Health Workers Survey