HIV/TB counselling - who is doing the job?

The global response to HIV/AIDS is neglecting crucial but underfunded resources necessary to keeping millions on lifelong, daily care, especially in Sub-Saharan Africa that has the double challenge of addressing high HIV and TB burdens with the lowest number of health care workers, the international humanitarian organization Médecins Sans Frontières/Doctors Without Borders (MSF) said ahead of the IAS conference on HIV pathogenesis, treatment and prevention.

In a newly released report based on case-studies from eight sub-Saharan African countries, "HIV/TB counselling: who is doing the job?" MSF documents how the lack of both financial and political support for HIV and TB counsellors remains a major stumbling block to reaching UNAIDS' target of having 90% of people living with HIV knowing their status, 90% of them initiated in care and 90% achieving an undetectable viral load within five years.

MSF found highly variable job profiles, deployment, and training of lay counsellors. Five out of the eight countries were 100% reliant on donor funding for lay counsellors programmes and five had not yet begun the process of adding these essential workers to the health care workers rolls. Without recognition and support for lay counsellors, there are little chance of ramping up testing, linking people to care, and helping people stay adherent on ART.

"Testing people for HIV and initiating them on antiretroviral treatment is like starting them on a lifelong marathon race against the virus. But it is only a start: people living with HIV need support to run this endless race, but support is only patchily provided", says Dr Helen Bygrave, MSF’s HIV advisor.

Zambia was the only country with a recognized counselling cadre among its civil servants partially funded by the government. In Lesotho the worsening of the HIV national program in 2012 was attributed partly to the failure to retain or support counsellors. In Mozambique, where one in three persons abandon antiretroviral treatment within a year of initiation, the small number of counsellors working are entirely dependent on international donors funding and policies. In South Africa, a MSF study found that while children have double rates of treatment failure as compared to adults they are able to attain high rates of resuppression (77%) when helped by trained counsellors.

"People living with a chronic disease, be it diabetes, hypertension or HIV, know that adherence to lifelong treatment is a skill that needs to be learned. What people on ART need most are not only medics but also counsellors who know their daily realities and can support them to surmount obstacles to adhere to their treatment and remaining in effective care, especially in resource-poor countries. Counsellors need to be properly trained, supervised and paid. They are an investment for the future", says Saar Baert, MSF's patient support coordinator.