HTS Policy: Efficacy, Challenges in Managing HIV/AIDS in South Africa

This report provides a comprehensive evaluation of the HIV Testing Services (HTS) policy in South Africa, focusing on its effectiveness in managing the HIV/AIDS epidemic. It delves into the background of HIV prevalence in South Africa, highlighting the aims and objectives of the HTS policy, which include early identification of HIV-positive individuals and linking them to appropriate care and treatment. The report also discusses the principles outlining the policy, such as consent, counselling, confidentiality, correct results, and connection to care, as well as the ethical challenges and the standards and norms of the policy. Furthermore, it explores various approaches, including community and facility-based settings, and the methodology involving pre-test, HIV testing, and post-test services, providing a thorough analysis of the HTS policy's role in HIV/AIDS mitigation in South Africa.

Running head: HTS POLICY IN MANAGING HIV/AIDS
HTS POLICY IN MANAGING HIV/AIDS
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Background:
South Africa has witnessed the chief and greatest high-profile HIV prevalent in the whole
world, with an expected 7.2 million individuals existing with HIV in the year of 2017. South
Africa accounts for the third of all different HIV infections in southern portion of Africa. It
was found that, in the year of 2017, there existed 270,000 cases of new HIV infections and
out of which 110,000 South Africans deceased because of AIDS-related sicknesses. South
Africa developed a major antiretroviral treatment (ART) programme among all the countries
and the efforts have been essentially sponsored from its particular national assets. In 2015,
the country itself was financing more than $1.34 billion yearly to course its HIV programmes
Zuma et al., 2016).
The National Strategic Plan on HIV, STIs and TB, 2012-2016 (NSP) comprise the decrease
of the novel HIV infections around 50 per cent consuming combination inhibition methods
and introduction of around 80 per cent of qualified patients on ART, with 70 per cent of
retainon treatment (Daly, Spicer & Willan, 2016).
Introduction:
The HIV epidemic had a distressing result on the population of South Africa. The
virus is found to be transferred via body fluid contact and it progresses to AIDS which effects
the immune system of the infected person. This disease is effects the person, chief to their
lives. The current condition of the disease is making it a greater danger for South Africa’s
economic growth. An estimation of 5.7 million people or around 12% of South Africa is
affected by the infection.The effect of the epidemic can be observed most severely by the
theatrical change in South Africa’s death rates(Johnson et al., 2015).
HIV counselling and testing (HCT) is nowadays denoted as HIV testing services (HTS) to
hold the full array of facilities that must be delivered in collaboration with HIV testing. The

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services include pre and post-test counselling, association with prevention, treatment and care
providing related to HIV (Onoya et al., 2016).The Government of South Africa has boarded
on efforts to strengthen HTS and reinforce its excellence at all healthcare facilities and non-
healthcare locations.Focusing on 2014 data, itis observed that around 92.3% of the South
African population has a knowledge about HTS and about 66.2 % had used it in the previous
years.The National Strategic Plan on HIV aims to induce reduction in generation of new
infections by 50% using combination of different measures (Rosenberg et al., 2016).
Thesis Statement: Taking insights on the above discussed urgency and alarming state of
HIV disease burden in the country of South Africa, this paper aims to extensively evaluate
the policy components of HTS concerning its efficacy, challenges, evaluation and
monitoring for the purpose of HIV/AIDS mitigation in the nation.
Aims and objective of the policy:
The aim of the HTS policy is to identify people who are existing with the HIV
infection timely using necessities of worth testing for everyone which includes children, adult
and elderly population. It focuses on collaborating the people with the prevention measures,
proper treatment and support system that is required. The HTS policy contributes in reduction
of the new infection of HIV and helps the people to live a quality life. In order to achieve its
goal, the HTS policy ensures to identify HIV positive people at a very early stage and
connect them to proper care services and treatment andlink the HIV negative people to
prevention facilities (Meehan et al., 2018).
The objective of HTS policy are as follows:
 To ensure guidance for HTS request and acceptance of helpful behaviour.
 To provide delivery of proper, high feature service without any discrimination.

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 To make the healthcare system stronger and better to deliver targeted and useful
HTS.in communities to increase the access, utilization and major coverage of the
policy.
 To guide proper monitoring and assessment of the policy (Venteret al., 2017).
Principle outlining the policy:
It delivers regulation on providing HTS;high worth serviceswithout discrimination to all the
citizensof South Africafocusing on the 5Cs (Consent, Counselling, Confidentiality, Correct
results and Connection to care) as commended by WHO (World Health
Organization,2015).And according to the principle every individual must have the right to get
access of the HTS without any discrimination on the bases of race, ethnicity, gender and
socioeconomic status (Flynn et al., 2017). People should consent to the policy and if the
patient is not in a state, then the members of the family can provide permission on behalf of
the person.The information, knowledge, education and communication regarding HIV should
be accurate and clear and should be provided to every people of the country. The
confidentiality of every individual who is being provided with HTS should be maintained and
it can only be broken in case of consent and for the wellbeing of the person. The test reports
of the HIV positive patient should be double checked and no false or incorrect data should be
provided. The policy also relies on the principle where it states that every individual who is
getting counselling and treatment for HIV must have the correct link to proper healthcare
facilities (Mavedzenge et al., 2016). The HTS also considers health promotion and quality
treatments for children, as a necessity, to the best of interests and concerns which is in
compliance to the United Nations Children’s Emergency Fund’s (UNICEF) guiding principle
of fulfilling a generation free from HIV/AIDS for the world’s children (United Nations
Children’s Emergency Fund, 2019). Establishing an end to the menace of HIV/AIDS in the
country of South Africa, is lastly, the foundational guiding principle for the HTS policy,

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which shows compliance to the United Nation’s Sustainable Development Goal of
eradicating this disease by the year 2030 (United Nations, 2019).
Ethical challenges:
The HTS providers should certify that every HIV testing services respect the human
rights of the individual suffering or not,regardless of their age, ethnicity, race, gender,
disability, colour socioeconomic, nationality and governmental status. The ethical
considerations in HTS are as follows:
 Human rights and rights to access: it states that equality should be provided to
everyone belonging to any kind of community, the HTs should be available for
everyone in every public health facility. The healthcare facilities should know and
perform their duties and responsibilities in a proper and legal manner(Matoga et al.,
2018).
 Rights and dignity and non-discrimination: every individual have the right to get
resected and protect its dignity and according to the consideration any information
regarding the patient and the HIV condition can be shared or violated without his/her
concern. The information can be shared unless the court has provided orders in South
Africa. And the patient has full right to reject the testing procedure anytime if he is
not willing(Kufa et al., 2017).
 Informed consent: it is important to provide proper information about the health
condition and HTS to the patient and his family. And in South Africa, anyone who is
above the age of 12 and is mature enough to understand the situation and
circumstances can give consent.
 The children’s act: according to this act, children can only be diagnosed for the
infection in two conditions; first if the it’s for their best and proper lawful consent is

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provided and the other one is if doctors, parents or any one from the healthcare system
has contracted infection in the body fluid. If the child is above 12 years of age, he/she
has the right for consent and no one can expose a child’s HIV condition without
consent (Vu et al., 2018).
Standard and norms of the policy:
The norms and standards of HTS in South Africa is distributed in two parts:
1. Operational requirements for the facility based HTS service: according to the
standard, every individual whoever is attending the healthcare facility should be
recommended for HTS, weather they show any symptoms or not. The standard
includes proper guiding documentation and standard operation procedure(SOPs) of
HTS and details about the location where it will be provided. The healthcare facilities
should be trained for the use of SOPs. The care providers should have proper
knowledge and information about HIV and the centre where the children are treated
or test should be friendly and should focus not to violet the children’s law. The
infrastructure should have every important equipment that are required including,
clean water, storage space and hygiene(Alemnji et al., 2016).
2. Operational requirement for community-based HTS services: According to the
standard, which is in compliance with the WHO recommendations, the safety and
security of the facility is also important and should be kept in mind. The faculty in the
HTS services should be trained not only to help other but keep themselves safe. They
should be informed to use proper protective means man maintain proper hygiene. The
equipment that are used in the centre should also be stored in safe and clean area to
avoid contamination and increase the risk of the infection to spread (World Health
Organisation, 2018).

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Approaches:
The HIV testing services (HTS) policy has various approaches and settings, which
include community and facility based setting. These approaches are required for attaining
consent and providing the pre-test information. Community based approaches comprises of
various methods such as home-based analysis, workplace testing, mobile outreach
movements, events, educational setting and mobile outreach operations. The calculated mix
of facility based setting and community based setting accelerates early analysis of HIV-
positive individuals(Napierala et al., 2013). Client-initiated counselling and testing (CICT)
and Provider-initiated counselling and testing (PICT) are the models constructed to
incorporate in both the setting. PICT discusses the testing and counselling, which is offered
routinely to the health facility. Based on this setting and approaches, the HIV-positive
individual can be actively linked to different services for improving the health condition,
which includes treatment, support, care and prevention methods. The people with HIV-
negative result should not be ignored, instead should be educated with threat reduction
guidance (WTO, 2018). The mix of both PICT and CICT will lead to an enhanced yield,
equity, efficiency and cost-effectiveness, which will timely support and complete the link of
these approaches for effective care.
 PICT- The healthcare supplier offers provider-initiated HIV counselling and testing to
the individual who require medical assistance. This is offered to every individual
joining the clinical services in private and public sector. PICT model can be either
provider-referred or provider-delivered. To guarantee the incorporation of HTS in
general practice, analysis on patient flow must be adapted.
 VCT- Voluntary counselling and testing is done within the healthcare competence for
clients with specific choice of treatment.

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 HTS approaches in community- The community-based approaches are used by
qualified healthcare workers for the people requiring access to the healthcare facility.
The examples of community-based approaches are (WTO, 2018):
1. Stand-alone HTS
2. Home-alone HTS
3. Mobile outreach HTS
4. HTS required in workplace
5. HTS required in schools and institutions.
Methodology:
The methodology is differentiated into three different zones namely Pre-test services,
HIV testing procedure and Post-test services. The in-detail analysis is explained below
respectively:
 Pre-Test Services: The pre-test events must be conducted before leading any test for
any individual setting or for any target populations. The steps involved in this kind of
service are as follows (Bell et al., 2018):
1. Demand establishment- The places where the HIV testing rate is below average
requires continuous promotion of HTS program. In this section, the key role will
be to reach the population of Africa for campaign and promotions.
2. Confidentiality- The HIV test result should be confidential regarding any status
and information of the patient.
3. Pre-test information- The pre-test information should be presented to the patient in
an appropriate way rather than waiting for the post-test counselling.

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4. Increased tuberculosis case outcomes- In accordance with HIV, tuberculosis is the
most common illness in-patient. The early detection with respective to TB is
mandatory for the patient suffering with HIV to prevent death rate.
5. Sexually communicated contaminations and non-communicable illnesses- STI and
NCDs are the major reason for increase in the burden of diseases in Africa. All the
patients suffering with these diseases must be registered for the screening test and
the result must be documented.
6. Pre-test evidence session- The pre-test information conference must be attended
by all group of people with or without HIV test.

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Source: HIV/TB screening for TB finding in HTS
 HIV testing Process: HIV-testing process includes the following steps (Hoddinott et
al., 2018):
1. HIV-testing procedure- IN South Africa, the HIV testing is conducted using two
different technology namely rapid HIV assessment for kids elder than 18 months
including adults and polymerase chain reaction (PCR) for kids younger than 18
months. A national HIV testing algorithm is constructed for rapid screening test for
HIV.
Source: HIV-testing algorithm

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2. Documenting and handling HIV result- The key result should be documented in each
model and setting of HTS, which will permit the health care worker to analyse and
monitor the patient.
3. Written confirmation of the result- The nurses and management should issue the
written confirmation of the patient result irrespective of the status of the patient health
condition, which includes date, test result, signature of the authority, patient’s name
and stamp of the authority.
 Post-Test Services: Regardless of the patient heath outcome, post-test services should
be offered depending on the complexity of the result. The steps involved in these
services are as follows(Balachandran et al., 2018):
1. Post-Test services for HIV-negative people- In this service, the patient should be
guided with different risk-reduction therapy and commendations to include preventive
behaviours in their life style such as using condom before any sexual intercourse.
2. Services for discrepant result people- The patient with such issue must undertake HIV
rapid test as the previous test result was not confirmed. A proper follow-up should be
provided for such patients for effective result.
3. Post-Test services for HIV- positive people- The patients with HIV-positive result
should obtain a proper health counselling information regarding their result status.
The professional counsellor, health workers and social workers, can provide the
counselling to the HIV-positive patient.
Monitoring and Evaluation:
For appropriate management and implementation of HTS program, the proper and
effective monitoring and evaluation is necessary. Monitoring and Evaluation is done to

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ensure that the resources in the program is utilised well, efficient and mannered way of
conducting activities and if proper access of services taking place. Regular monitoring of the
program is required for effective service quality to the patient with supreme health benefit.
The process of monitoring requires different HTS program tools including templates,
registers, client survey, support from health facility and consistent reporting system. Once the
monitoring is completed, assessment of the HTS report including the result is done to check if
the program is efficient in attaining the objective (Naidoo et al., 2019). Innovative data
investigation and indicators are used in final evaluation of the result. Quality assurance (QA)
indicators are used for recording the precise result of every individual HIV test to allow easy
specialist care for the HIV-positive patient. The complete process of HTS report involve
Quality assurance (QA) and Quality improvement (QI). Hence, quality management system
(QMS) is set up for the complete assessment of HTS (Kennedy et al., 2017).
Conclusion:
Focusing on the above thesis, it can be concluded that, the aim of HTS is to provide a
proper national outline in order to direct the population of South Africa and other countries
about the usefulness of HTS to infants, teenager, adults in every sector of the country. The
major purpose of the HTS policy is to provide better quality and regularity of the delivery of
the facilities that is required for testing and treatment process.Health facility established HIV
testing is an importantprovision to meet HIV worldwide goal. And in order to root these
guidelines in the living of the people of the country who are attached and are using the HTS
policy, the healthcare staffs, planners, government agencies, hospitals and other stakeholders
must show proper commitment and adherence to the laws and intention that are underlying
the policy. And to help the population to recover the, mortality rate and decrease the effect of
HIV, the policy should be committed collectively and to attain better quality service and
improved standardisation of HTS policyacross the country. Implementation of this policy can