Task-shifting HIV counselling and testing services in Zambia: the role of lay counsellors

Quantitative and qualitative data were collected by means of semistructured interviews from all active lay counsellors in each of the facilities and a facility manager or counselling supervisor overseeing counseling and testing services and clients. At each of the 10 selected facilities, all counselling and testing record books for the month of May 2007 were examined and any recordkeeping errors were tallied by cadre. Qualitative data were collected through focus group discussions with health care workers at each facility.Lay counsellors provide counselling and testing services of quality and relieve the workload of overstretched health care workers. Facility managers recognize and appreciate the services provided by lay counsellors. Lay counsellors provide up to 70% of counselling and testing services at health facilities. The data review revealed lower error rates for lay counsellors, compared to health care workers, in completing the counselling and testing registers.Community volunteers, with approved training and ongoing supervision, can play a major role at health facilities to provide counselling and testing services of quality, and relieve the burden on already overstretched health care workers.Zambia is among the countries hardest-hit by the HIV/AIDS epidemic in Africa. It is estimated that 1.2 million of the total Zambian population of 10 million was infected with HIV by 2005 [1,2]. Although declining HIV trends have been observed in young people since 1998, HIV/AIDS in Zambia is still a major threat to the lives of adults of reproductive age and their children [3]. Increasing access to HIV counselling and testing – the entry point to follow-on care, support and treatment services – could alter this trend.Shortages of health care workers (HCWs) have been a bottleneck in the provision of HIV/AIDS services in resource-limited settings. The World Health Organization/Ministry of Health establishment recommends a staff population ratio of 1:5000, 1:700, and 1:8