It was clear from the start of TCE (Total Control of the Epidemic) in year 2000 that to move the question of the people taking control of HIV, knowing ones HIV status is the starting point for the individual to take action on stopping the spread of HIV to other people if tested positive and as well to remain HIV negative if tested negative.
It has over the years been one of the priorities of the TCE and HOPE program to ensure that as many people as possible get tested. Constantly during the years we have raised the goals for mobilizing people for testing. Testing is also the entry point for HIV positive pregnant women to control the passing of HIV to the unborn child.
We have been advocating for the most radical way of testing, which is Home Based Testing, because it is the most effective way of reaching out to many people.
Today TCE is doing home based testing in Zambia and Mozambique and recently also in Malawi.
In Zambia, Malawi and Mozambique the Field officers have been trained in Counseling and prick testing following government regulations and here TCE Field Officers are going door to door to do Home Based testing for people who opt for testing.
Because of Home Based Testing many more people especially in rural areas are now getting access to HIV testing and are getting to know their HIV status and we can see the demand for treatment and other health services are growing. This has meant that we had to engage the Government and donors in assuring that people who test HIV positive get treatment and all the other services they deserve. This is a good development.
An example from Zambia
Development Aid from people to people Zambia (DAPP) introduced the Total control of the Epidemic (TCE) program in 2006. The project is funded by the Centres for Disease Control and Prevention (CDC Zambia). The project is based in Mazabuka District in the Southern province of Zambia covering the whole District with a population of 280.000.
The project has employed locals as Field Officers to provide house to house counselling and testing services to people in all the households. The project has partnered with the government to increase the uptake for counselling and testing services in the district. TCE Zambia has provided this service for the past four years in the district. Since we started doing house to house testing Field Officers have done 126.696 tests in the district of Mazabuka. 44.549 are people tested more than once which means that 82.147 are people having been tested first time. The people are tested as individuals as well as couples and all get the results there and then as the testing is performed with rapid test kits. It is a very high rate of people tested for a district where close to 60% of the sexually active population now knows their HIV status.
In the beginning more women were tested, but due to the analysis of our results done every week during the weekly Field Officers meeting the picture have changed completely as we decided to put more emphasis to also reach out to the me, and now more men are coming for the services and they are also volunteering to mobilize others to know their HIV status. The government has been providing technical assistance to make sure quality work is being done and they have also been providing most of the test kits and other supplies required.
After testing a lot of people in hard to reach areas through the home based testing, questions were raised on what will then be done after testing. This contributed to the introduction of us carrying out Mobile ART services and strengthening the referral system to care, treatment and support services. People are well counselled on behaviour and they have started to change behaviours which put them at risk of contracting the virus. The advantage of the Field Officers providing both counselling and testing is that it is the same person who does carry out the entire process in people's homes where they are more free and confident.
Many people are now accessing ARVs, because of the Mobile ART team and they are able to support their families through the income generating activities they start.