Voluntary counseling and testing centers with minimum conditions to provide quality services
The number and percent of facilities that provide voluntary counseling and testing (VCT) services meeting minimum conditions necessary to provide quality counseling and HIV testing services
Evaluators take a random sample of facilities and assess the quality of counseling and testing services (including NGOs, private clinics and doctors‘ surgeries). They evaluate structural elements necessary to provide quality counseling and testing services, including trained staff, adequate privacy for counseling, systems for maintaining confidentiality, a directory of services for referral, and adequate conditions for ensuring quality control of specimen tests.
Evaluators may choose to weight the score obtained by each site in the random sample by the annual client load of that site. The indicator is the number of clients served in the last year by sites with adequate conditions to provide quality VCT services, divided by the total number of clients served in the last year by all sites sampled.
This indicator is calculated as:
(# of clients served in the last year by sites with adequate conditions to provide quality VCT services/ Total # of clients served in the last year by all sites sampled) x 100
Assessment by external evaluator of adequacy of key elements for conducting VCT
UNAIDS protocol for the evaluation of voluntary counseling and HIV testing services
In many countries, voluntary counseling and testing has landed in the hands of under-funded and ill-equipped non-government and community organizations or has become a corollary of private sector health service providers. Many of these entities lack even the most basic structural facilities necessary to provide quality counseling, such as a room where counseling can occur privately, or a regular electricity supply to ensure the adequate storage of specimens until testing.
This indicator measures a condition that is necessary but not sufficient to guarantee quality counseling services. The percentage of clients served in a facility that meets conditions for quality counseling is also likely to reflect other factors, such as access, available testing services, or the history of positive experiences at the center by other community members. Inevitably, a number of contextual variables influence the results of an indicator assessing quality. The goal of the indicator is to provide a framework for assessing some accepted goals and guidelines.
A potential difficulty in constructing this indicator is that sites with inadequate record keeping may be unaware of their overall client load; it will therefore be impossible to weight the indicator by client load. One could construct the indicator as a simple percentage (i.e., the percentage of facilities surveyed which meet minimum conditions for adequate service). However, because poor conditions at a small facility with a low caseload is relatively less important than poor facilities at a large and busy center, one should apply weighting where possible. (In truth, a strong correlation may exist between conditions and caseload: caseloads may be low because conditions are poor.)
As with other aggregate indicators, the evaluator may need to obtain information on different elements separately for program planning purposes. Disaggregating this indicator by type of service provider (NGO, hospital, private clinic) may also be useful.