Malawi Comprehensive HIV Testing and Counselling Training 2013

Great strides have been made in Malawi since 2000 when rapid testing was introduced, resulting in a rapid expansion in provision and utilization of HIV testing and counselling services at community and facility levels. The Ministry of Health has provided leadership resulting in soaring numbers of persons tested, and the target during HTC week in 2012 was to test 250,000 persons, a goal unthinkable merely 12 years ago. At the end of March 2013, 422,866 patients were alive and on ART. Additionally, 825 static (607 within and 218 outside of health facilities) and 534 outreach HTC sites were reported, along with 655 (static) ART sites, 580 PMTCT sites (Option B+), 602 Pre‐ART sites, and 590 sites offering HIV‐ exposed child follow‐up services.

This rapid expansion in quantity and coverage has compromised quality of testing. Task shifting has taken root in Malawi, with much of the rapid testing performed by non‐health worker HTC providers and health surveillance assistants (HSAs). Research conducted in many countries has documented that non‐health worker testers can maintain a high level of accuracy when they are well trained and supervised.